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Multi-study randomised controlled trial to develop, implement and evaluate bra prescription to reduce breast pain and improve quality of life. Complement Ther Clin Pract 2021; 43:101346. [PMID: 33691268 DOI: 10.1016/j.ctcp.2021.101346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 02/25/2021] [Accepted: 02/27/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND and Purpose: Breast pain is a common condition presented at breast care clinics and bras are often recommended to reduce symptoms, although criteria and pathways for obtaining appropriate bras are limited. This multi-study, randomised controlled trial (RCT) aimed to establish criteria and performance variables to prescribe bras for breast pain patients, to implement this bra prescription, and evaluate whether, compared to standard care alone, the bra prescription improves breast pain and quality of life (QoL). MATERIALS AND METHODS Eighteen breast pain patients from a UK hospital were assigned to standard care or bra prescription groups and completed the study. Bra prescription patients were prescribed a bra to wear every day for eight weeks. Patient Global Impression of Change (PGIC), breast pain intensity, QoL, and adherence were assessed. RESULTS Between-groups there were no differences in baseline breast pain or QoL and no differences in PGIC or breast pain following the intervention. Within-groups, improvements in QoL within bra prescription patients were identified. CONCLUSION This study developed a framework for bra prescription for breast pain patients and the intervention demonstrated improvements in QoL.
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Collins SE, Goldstein SC, Suprasert B, Doerr SAM, Gliane J, Song C, Orfaly VE, Moodliar R, Taylor EM, Hoffmann G. Jail and Emergency Department Utilization in the Context of Harm Reduction Treatment for People Experiencing Homelessness and Alcohol Use Disorder. J Urban Health 2021; 98:83-90. [PMID: 33185824 PMCID: PMC7873130 DOI: 10.1007/s11524-020-00452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
People experiencing homelessness are disproportionately affected by alcohol use disorder (AUD). Abstinence-based treatment, however, does not optimally engage or treat this population. Thus, Harm Reduction Treatment for Alcohol (HaRT-A) was developed together with people with the lived experience of homelessness and AUD and community-based agencies that serve them. HaRT-A is a compassionate and pragmatic approach that aims to help people reduce alcohol-related harm and improve quality of life (QoL) without requiring abstinence or use reduction. The parent RCT showed that HaRT-A precipitated statistically significant reductions in alcohol use, alcohol-related harm, AUD symptoms, and positive urine toxicology tests. This secondary study tested HaRT-A effects on more distal, 6-month pre-to-posttreatment changes on jail and emergency department (ED) utilization. People experiencing homelessness and AUD (N = 168; 24% women) were recruited in community-based clinical and social services settings. Participants were randomized to receive HaRT-A or services as usual. Over four sessions, HaRT-A interventionists delivered three components: (a) collaborative tracking of participant-preferred alcohol metrics, (b) elicitation of harm-reduction and QoL goals, and (c) discussion of safer-drinking strategies. Administrative data on jail and ED utilization were extracted for 6 months pre- and posttreatment. Findings indicated no statistically significant treatment group differences on 6-month changes in jail or ED utilization (ps > .23). Exploratory analyses showed that 2-week frequency of alcohol use was positively correlated with number of jail bookings in the 12 months surrounding their study participation. Additionally, self-reported alcohol-related harm, importance of reducing alcohol-related harm, and perceived physical functioning predicted more ED visits. Future studies are needed to further assess how harm-reduction treatment may be enhanced to move the needle in criminal justice and healthcare utilization in the context of larger samples, longer follow-up timeframes, and more intensive interventions.
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Affiliation(s)
- Susan E Collins
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA.
| | - Silvi C Goldstein
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Bow Suprasert
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Samantha A M Doerr
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Joanne Gliane
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Clarissa Song
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Victoria E Orfaly
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Rddhi Moodliar
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Emily M Taylor
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Gail Hoffmann
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
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Zhou J, Wang L, Wang F, Xu P, Li Y, Bai B, Dang L, Sun D. 4q27 as a psoriasis susceptibility locus in the Northeastern Chinese Han population. ACTA ACUST UNITED AC 2014; 85:15-9. [PMID: 25495849 DOI: 10.1111/tan.12471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 09/23/2014] [Accepted: 10/13/2014] [Indexed: 01/19/2023]
Abstract
Psoriasis is an autoimmune inflammatory skin disease with genetic components. Chromosome 4q27 is related to many autoimmune diseases, however, the relationship between psoriasis and 4q27 has not been fully established yet. The objective of this study is to investigate the association between chromosome 4q27 and psoriasis in the Northeastern Chinese Han population. Four common single nucleotide polymorphisms (rs2069762, rs4833837, rs6840978, and rs7684187) from chromosome 4q27 were genotyped in 400 psoriasis cases and 398 controls from the Northeastern Chinese Han population using the Multiplex SNaPSHOT method. Single nucleotide polymorphism and haplotype frequencies were analyzed using spss 13.0. Our data indicated that rs2069762 GG, TG genotypes [GG: odds ratio (OR) = 2.6875, 95% confidence interval (CI) = 1.5948-4.5290, P < 0.0001; TG: OR = 1.6159, 95% CI = 1.2044-2.1681, P = 0.0013], and H3 haplotype (OR = 1.717, 95% CI = 1.050-2.808, P = 0.030) increased the risk of psoriasis. Furthermore, rs4833837 GG, GA genotypes (GG: OR = 0.2071, 95% CI = 0.0685-0.6266, P = 0.0022; GA: OR = 0.4711, 95% CI = 0.3289-0.6746, P < 0.0001), and H5 haplotype (OR = 0.482, 95% CI = 0.238-0.978, P = 0.039) were identified as protective factors for psoriasis. 4q27 polymorphisms are associated with psoriasis in the Northeastern Chinese Han population.
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Affiliation(s)
- J Zhou
- Department of Dermatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, PR China
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Collins SE, Saxon AJ, Duncan MH, Smart BF, Merrill JO, Malone DK, Jackson TR, Clifasefi SL, Joesch J, Ries RK. Harm reduction with pharmacotherapy for homeless people with alcohol dependence: protocol for a randomized controlled trial. Contemp Clin Trials 2014; 38:221-34. [PMID: 24846619 PMCID: PMC4104260 DOI: 10.1016/j.cct.2014.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/05/2014] [Accepted: 05/10/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Interventions requiring abstinence from alcohol are neither preferred by nor shown to be highly effective with many homeless individuals with alcohol dependence. It is therefore important to develop lower-threshold, patient-centered interventions for this multimorbid and high-utilizing population. Harm-reduction counseling requires neither abstinence nor use reduction and pairs a compassionate style with patient-driven goal-setting. Extended-release naltrexone (XR-NTX), a monthly injectable formulation of an opioid receptor antagonist, reduces craving and may support achievement of harm-reduction goals. Together, harm-reduction counseling and XR-NTX may support alcohol harm reduction and quality-of-life improvement. AIMS Study aims include testing: a) the relative efficacy of XR-NTX and harm-reduction counseling compared to a community-based, supportive-services-as-usual control, b) theory-based mediators of treatment effects, and c) treatment effects on publicly funded service costs. METHODS This RCT involves four arms: a) XR-NTX+harm-reduction counseling, b) placebo+harm-reduction counseling, c) harm-reduction counseling only, and d) community-based, supportive-services-as-usual control conditions. Participants are currently/formerly homeless, alcohol dependent individuals (N=300). Outcomes include alcohol variables (i.e., craving, quantity/frequency, problems and biomarkers), health-related quality of life, and publicly funded service utilization and associated costs. Mediators include 10-point motivation rulers and the Penn Alcohol Craving Scale. XR-NTX and harm-reduction counseling are administered every 4weeks over the 12-week treatment course. Follow-up assessments are conducted at weeks 24 and 36. DISCUSSION If found efficacious, XR-NTX and harm-reduction counseling will be well-positioned to support reductions in alcohol-related harm, decreases in costs associated with publicly funded service utilization, and increases in quality of life among homeless, alcohol-dependent individuals.
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Affiliation(s)
- Susan E Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave Box 359911, Seattle, WA 98195, USA.
| | - Andrew J Saxon
- VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 45th St. Box 354944, Seattle, WA 98195, USA.
| | - Mark H Duncan
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave Box 359911, Seattle, WA 98195, USA.
| | - Brian F Smart
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave Box 359911, Seattle, WA 98195, USA.
| | - Joseph O Merrill
- Department of Medicine, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359780, Seattle, WA 98195, USA.
| | - Daniel K Malone
- Downtown Emergency Service Center (DESC), 515 Third Ave, Seattle, WA 98104, USA.
| | - T Ron Jackson
- Evergreen Treatment Services - REACH, 1700 Airport Way S, Seattle, WA 98134, USA.
| | - Seema L Clifasefi
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 45th St. Box 354944, Seattle, WA 98195, USA.
| | - Jutta Joesch
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave Box 359911, Seattle, WA 98195, USA.
| | - Richard K Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave Box 359911, Seattle, WA 98195, USA.
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Joesch JM, Sherbourne CD, Sullivan G, Stein MB, Craske MG, Roy-Byrne P. Incremental benefits and cost of coordinated anxiety learning and management for anxiety treatment in primary care. Psychol Med 2012; 42:1937-48. [PMID: 22152230 PMCID: PMC3340455 DOI: 10.1017/s0033291711002893] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Improving the quality of mental health care requires integrating successful research interventions into 'real-world' practice settings. Coordinated Anxiety Learning and Management (CALM) is a treatment-delivery model for anxiety disorders encountered in primary care. CALM offers cognitive behavioral therapy (CBT), medication, or both; non-expert care managers assisting primary care clinicians with adherence promotion and medication optimization; computer-assisted CBT delivery; and outcome monitoring. This study describes incremental benefits, costs and net benefits of CALM versus usual care (UC). METHOD The CALM randomized, controlled effectiveness trial was conducted in 17 primary care clinics in four US cities from 2006 to 2009. Of 1062 eligible patients, 1004 English- or Spanish-speaking patients aged 18-75 years with panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD) and/or post-traumatic stress disorder (PTSD) with or without major depression were randomized. Anxiety-free days (AFDs), quality-adjusted life years (QALYs) and expenditures for out-patient visits, emergency room (ER) visits, in-patient stays and psychiatric medications were estimated based on blinded telephone assessments at baseline, 6, 12 and 18 months. RESULTS Over 18 months, CALM participants, on average, experienced 57.1 more AFDs [95% confidence interval (CI) 31-83] and $245 additional medical expenses (95% CI $-733 to $1223). The mean incremental net benefit (INB) of CALM versus UC was positive when an AFD was valued ≥$4. For QALYs based on the Short-Form Health Survey-12 (SF-12) and the EuroQol EQ-5D, the mean INB was positive at ≥$5000. CONCLUSIONS Compared with UC, CALM provides significant benefits with modest increases in health-care expenditures.
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Affiliation(s)
- J M Joesch
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations (CHAMMP), Seattle, WA 98104-2499, USA.
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Von Korff M, Katon WJ, Lin EHB, Ciechanowski P, Peterson D, Ludman EJ, Young B, Rutter CM. Functional outcomes of multi-condition collaborative care and successful ageing: results of randomised trial. BMJ 2011; 343:d6612. [PMID: 22074851 PMCID: PMC3213240 DOI: 10.1136/bmj.d6612] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of integrated care for chronic physical diseases and depression in reducing disability and improving quality of life. DESIGN A randomised controlled trial of multi-condition collaborative care for depression and poorly controlled diabetes and/or risk factors for coronary heart disease compared with usual care among middle aged and elderly people SETTING Fourteen primary care clinics in Seattle, Washington. PARTICIPANTS Patients with diabetes or coronary heart disease, or both, and blood pressure above 140/90 mm Hg, low density lipoprotein concentration >3.37 mmol/L, or glycated haemoglobin 8.5% or higher, and PHQ-9 depression scores of ≥ 10. INTERVENTION A 12 month intervention to improve depression, glycaemic control, blood pressure, and lipid control by integrating a "treat to target" programme for diabetes and risk factors for coronary heart disease with collaborative care for depression. The intervention combined self management support, monitoring of disease control, and pharmacotherapy to control depression, hyperglycaemia, hypertension, and hyperlipidaemia. MAIN OUTCOME MEASURES Social role disability (Sheehan disability scale), global quality of life rating, and World Health Organization disability assessment schedule (WHODAS-2) scales to measure disabilities in activities of daily living (mobility, self care, household maintenance). RESULTS Of 214 patients enrolled (106 intervention and 108 usual care), disability and quality of life measures were obtained for 97 intervention patients at six months (92%) and 92 at 12 months (87%), and for 96 usual care patients at six months (89%) and 92 at 12 months (85%). Improvements from baseline on the Sheehan disability scale (-0.9, 95% confidence interval -1.5 to -0.2; P = 0.006) and global quality of life rating (0.7, 0.2 to 1.2; P = 0.005) were significantly greater at six and 12 months in patients in the intervention group. There was a trend toward greater improvement in disabilities in activities of daily living (-1.5, -3.3 to 0.4; P = 0.10). CONCLUSIONS Integrated care that covers chronic physical disease and comorbid depression can reduce social role disability and enhance global quality of life. Trial registration Clinical Trials NCT00468676.
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Affiliation(s)
- Michael Von Korff
- Group Health Research Institute, 1730 Minor Avenue, Seattle, WA 98101, USA.
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Edoka IP, Petrou S, Ramchandani PG. Healthcare costs of paternal depression in the postnatal period. J Affect Disord 2011; 133:356-60. [PMID: 21561664 PMCID: PMC3161179 DOI: 10.1016/j.jad.2011.04.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 04/06/2011] [Accepted: 04/06/2011] [Indexed: 10/27/2022]
Abstract
BACKGROUND There is growing evidence that fathers experience depressive symptoms following the birth of a child. The aim of this study was to estimate the healthcare costs of paternal postnatal depression, thereby informing research into cost-effective preventative and treatment interventions for the condition. METHODS Data on healthcare resource-use over the first 12 months postpartum was collected from 192 fathers recruited from two postnatal wards in southern England. Three groups of fathers were identified: fathers with depression (n=31), fathers at high risk of developing depression (n=67) and fathers without depression (n=94). RESULTS Mean father-child dyad costs were estimated at £ 1103.51, £ 1075.06 and £ 945.03 (£ sterling, 2008 prices) in these three groups, respectively (P=0.796). After controlling for potentially confounding factors, paternal depression was associated with significantly higher community care costs. CONCLUSION This study provides useful preliminary insights into the healthcare costs associated with paternal depression during the postnatal period. LIMITATION The small sample size may, in part, account for the failure to detect statistically significant differences in mean costs between study groups for most cost categories.
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Affiliation(s)
- Ijeoma P. Edoka
- Centre for Health Economics, Alcuin block A, University of York, York YO10 5DD, United Kingdom,Corresponding author.
| | - Stavros Petrou
- Warwick Clinical Trials unit, University of Warwick, Conventry, CV4 7AL, United Kingdom
| | - Paul G. Ramchandani
- University of Oxford, Department of Psychiatry, Warneford Hospital, Headington, Oxford OX3 7JX, United Kingdom
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Patel A, Knapp M, Romeo R, Reeder C, Matthiasson P, Everitt B, Wykes T. Cognitive remediation therapy in schizophrenia: cost-effectiveness analysis. Schizophr Res 2010; 120:217-24. [PMID: 20056391 DOI: 10.1016/j.schres.2009.12.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 10/26/2009] [Accepted: 12/03/2009] [Indexed: 12/26/2022]
Abstract
PURPOSE There is a lack of evidence on the cost-effectiveness of cognitive remediation therapy (CRT). METHODS Randomised controlled trial comparing usual care plus CRT with usual care alone. Participants had a diagnosis of schizophrenia and cognitive and social functioning difficulties. Health/social care and societal costs were estimated at 14 weeks (time 2) and 40 weeks (time 3) after randomisation. The outcome, proportion of participants improving their working memory since baseline, was combined with costs to explore cost-effectiveness. RESULTS 85 participants were recruited. There were no differences in total health/social care or societal costs between the two groups at either time 2 or time 3. An additional 21% of participants in the CRT group improved their working memory at both follow-ups. When placing these cost and outcomes in hypothetical scenarios concerning how much policy-makers would pay for another 1% of participants improving their working memory, there was more than an 80% chance that CRT would be cost-effective compared to usual care; at time 3, the likelihood of cost-effectiveness peaked at 30% even for investments up to pound 5000. CONCLUSIONS CRT can improve memory among people with schizophrenia and cognitive deficits at no additional cost. Although cost-effective in the short term, CRT may have limited potential to save costs in the medium term because it could increase take up of services. This could confer important longer term benefits for the patient group examined here, in terms of improved social functioning and less reliance on services. This can only be ascertained through longer follow-up.
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Affiliation(s)
- Anita Patel
- Centre for the Economics of Mental Health, Health Service and Population Research Department, Box 24, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom.
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Economic costs of social phobia: a population-based study. J Affect Disord 2009; 115:421-9. [PMID: 19012968 DOI: 10.1016/j.jad.2008.10.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 10/06/2008] [Accepted: 10/06/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND Information about the economic costs of social phobia is scant. In this study, we examine the economic costs of social phobia and subthreshold social phobia. METHODS Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS) which is a population-based prospective study (n=4,789). Costs related to health service uptake, patients' out-of-pocket expenses, and costs arising from production losses were calculated for the reference year 2003. The costs for people with social phobia were compared with the costs for people with no mental disorder. RESULTS The annual per capita total costs of social phobia were euro 11,952 (95% CI=7,891-16,013) which is significantly higher than the total costs for people with no mental disorder, euro 2957 (95% CI=2690-3224). When adjusting for mental and somatic co-morbidity, the costs decreased to euro 6,100 (95% CI=2681-9519), or 136 million euro per year per 1 million inhabitants, which was still significantly higher than the costs for people with no mental disorder. The costs of subthreshold social phobia were also significantly higher than the costs for people without any mental disorder, at euro 4,687 (95% CI=2557-6816). LIMITATIONS The costs presented here are conservative lower estimates because we only included costs related to mental health services. CONCLUSIONS The economic costs associated with social phobia are substantial, and those of subthreshold social phobia approach those of the full-blown disorder.
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Cost-effectiveness of transcranial magnetic stimulation vs. electroconvulsive therapy for severe depression: a multi-centre randomised controlled trial. J Affect Disord 2008; 109:273-85. [PMID: 18262655 DOI: 10.1016/j.jad.2008.01.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Revised: 01/01/2008] [Accepted: 01/01/2008] [Indexed: 11/21/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) has a long history of use in treating depression. Repetitive transcranial magnetic stimulation (rTMS) has been introduced more recently to the treatment spectrum. Its cost-effectiveness has not been explored. METHOD Forty-six right-handed people with severe depressive episodes referred for ECT were randomised to receive either ECT twice weekly or rTMS on consecutive weekdays. Health and other service use were recorded for retrospective periods of 3 months prior to initiation of treatment and during the 6 months following the end of allocated treatment. Costs were calculated for the treatment period and the subsequent 6 months, and comparisons made between groups after adjustment for any baseline differences. Cost-effectiveness analysis was conducted with incremental change on the 17-item Hamilton Rating Scale for Depression (HRSD) as the primary outcome measure, and quality-adjusted life years (based on SF6D-generated utility scores with societal weights) as secondary outcome, cost-effectiveness acceptability curves plotted. RESULTS Based on the HRSD scores and other outcome measures, rTMS was not as effective as ECT. The cost of a single session of rTMS was lower than the cost of a session of ECT, but overall there were no treatment cost differences. In the treatment and 6-month follow-up periods combined, health and other service costs were not significantly different between the two groups. Informal care costs were higher for the rTMS group. Total treatment, service and informal care costs were also higher for the rTMS group. The cost-effectiveness acceptability curves indicated a very small probability that decision-makers would view rTMS as more cost-effective than ECT. LIMITATIONS Small sample size, some sample attrition and a relatively short follow-up period of 6 months for a chronic illness. Productivity losses could not be calculated. CONCLUSIONS ECT is more cost-effective than rTMS in the treatment of severe depression.
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Batelaan N, Smit F, de Graaf R, van Balkom A, Vollebergh W, Beekman A. Economic costs of full-blown and subthreshold panic disorder. J Affect Disord 2007; 104:127-36. [PMID: 17466380 DOI: 10.1016/j.jad.2007.03.013] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 03/26/2007] [Accepted: 03/26/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND Data on the societal costs of mental disorders are necessary to inform health policies. METHODS This study assessed the costs of panic disorder and subthreshold panic disorder, compared these with costs of other mental disorders, and assessed the effects of (psychiatric and somatic) comorbidity and agoraphobia on the costs of panic. Using a large, population-based study in The Netherlands (n=5504), both medical and production costs were estimated from a societal perspective within a one-year timeframe. RESULTS Annual per capita costs of panic disorder were 10,269 euros, while subthreshold panic disorder generated 6384 euros. These costs were higher than those of the other mental disorders studied. About one quarter of the costs could be attributed to comorbidity. Agoraphobia was associated with higher costs. LIMITATIONS Methodological choices influence cost estimates. In the present study most of these will result in conservative cost estimates. CONCLUSIONS Panic thus causes substantial societal costs. Given the availability of effective treatment, treatment may not only benefit individual patients, but also have economic returns for society.
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Affiliation(s)
- Neeltje Batelaan
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
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Katon W, Lin EHB, Kroenke K. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry 2007; 29:147-55. [PMID: 17336664 DOI: 10.1016/j.genhosppsych.2006.11.005] [Citation(s) in RCA: 606] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Accepted: 11/27/2006] [Indexed: 12/12/2022]
Abstract
BACKGROUND Primary care patients with anxiety and depression often describe multiple physical symptoms, but no systematic review has studied the effect of anxiety and depressive comorbidity in patients with chronic medical illnesses. METHODS MEDLINE databases were searched from 1966 through 2006 using the combined search terms diabetes, coronary artery disease (CAD), congestive heart failure (CHF), asthma, COPD, osteoarthritis (OA), rheumatoid arthritis (RA), with depression, anxiety and symptoms. Cross-sectional and longitudinal studies with >100 patients were included as were all randomized controlled trials that measure the impact of improving anxiety and depressive symptoms on medical symptom outcomes. RESULTS Thirty-one studies involving 16,922 patients met our inclusion criteria. Patients with chronic medical illness and comorbid depression or anxiety compared to those with chronic medical illness alone reported significantly higher numbers of medical symptoms when controlling for severity of medical disorder. Across the four categories of common medical disorders examined (diabetes, pulmonary disease, heart disease, arthritis), somatic symptoms were at least as strongly associated with depression and anxiety as were objective physiologic measures. Two treatment studies also showed that improvement in depression outcome was associated with decreased somatic symptoms without improvement in physiologic measures. CONCLUSIONS Accurate diagnosis of comorbid depressive and anxiety disorders in patients with chronic medical illness is essential in understanding the cause and in optimizing the management of somatic symptom burden.
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Affiliation(s)
- Wayne Katon
- Department of Psychiatry, University of Washington School of Medicine, Seattle, WA 98195-6560, USA.
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Cuijpers P, Smit F, Oostenbrink J, de Graaf R, Ten Have M, Beekman A. Economic costs of minor depression: a population-based study. Acta Psychiatr Scand 2007; 115:229-36. [PMID: 17302623 DOI: 10.1111/j.1600-0447.2006.00851.x] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Although the clinical relevance of minor depression has been demonstrated in many studies, the economic costs are not well explored. In this study, we examine the economic costs of minor depression. METHOD In a large-scale, population-based study in the Netherlands (n = 5504) the costs of minor depression were compared with the costs of major depression and dysthymia. Excess costs, i.e. the costs of a disorder over and above the costs attributable to other illnesses, were estimated with help of regression analysis. The direct medical costs, the direct non-medical costs and the indirect non-medical costs were calculated. The year 2003 was used as the reference year. RESULTS The annual per capita excess costs of minor depression were US$ 2141 (95% CI = 753-3529) higher than the base rate costs of US$ 1023, while the costs of major depression were US$ 3313 (95% CI = 1234-5390) higher than the base rate. The costs of minor depression per 1 million inhabitants were 160 million dollars per year, which is somewhat less than the costs of major depression (192 million dollars per year). CONCLUSION The economic costs associated with minor depression are considerable and approach those of major depression.
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Affiliation(s)
- P Cuijpers
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands.
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Knapp M, Thorgrimsen L, Patel A, Spector A, Hallam A, Woods B, Orrell M. Cognitive stimulation therapy for people with dementia: cost-effectiveness analysis. Br J Psychiatry 2006; 188:574-80. [PMID: 16738349 DOI: 10.1192/bjp.bp.105.010561] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Psychological therapy groups for people with dementia are widely used, but their cost-effectiveness has not been explored. AIMS To investigate the cost-effectiveness of an evidence-based cognitive stimulation therapy (CST) programme for people with dementia as part of a randomised controlled trial. METHOD A total of 91 people with dementia, living in care homes or the community, received a CST group intervention twice weekly for 8 weeks; 70 participants with dementia received treatment as usual. Service use was recorded 8 weeks before and during the 8-week intervention and costs were calculated. A cost-effectiveness analysis was conducted with cognition as the primary outcome, and quality of life as the secondary outcome. Cost-effectiveness acceptability curves were plotted. RESULTS Cognitive stimulation therapy has benefits for cognition and quality of life in dementia, and costs were not different between the groups. Under reasonable assumptions, there is a high probability that CST is more cost-effective than treatment as usual, with regard to both outcome measures. CONCLUSIONS Cognitive stimulation therapy for people with dementia has effectiveness advantages over, and may be more cost-effective than, treatment as usual.
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Affiliation(s)
- Martin Knapp
- Personal Social Services Research Unit, London School of Economics, Houghton Street, London WC2A 2AE.
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Perini SJ, Slade T, Andrews G. Generic effectiveness measures: sensitivity to symptom change in anxiety disorders. J Affect Disord 2006; 90:123-30. [PMID: 16337690 DOI: 10.1016/j.jad.2005.10.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Revised: 10/18/2005] [Accepted: 10/19/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to compare a newly developed screening measure of disability, the WHODAS II, to three established generic effectiveness measures in terms of its sensitivity to symptom change in people with anxiety disorders. METHOD Patients who had undergone treatment for social phobia or panic disorder/agoraphobia at an anxiety disorders clinic were administered generic effectiveness measures and symptom measures before and after treatment. The design was naturalistic and observational. Data analysis included correlations between generic effectiveness and symptom measures; and effect size calculations regarding the ability of each generic effectiveness measure to discriminate between patients whose symptoms improved and patients whose symptoms did not improve over the course of treatment. RESULTS The WHODAS II was consistently the most sensitive generic effectiveness measure in its capacity to detect symptom changes in patients with social phobia. The SF-12 and K-10 also showed moderate sensitivity to symptom change. In the sample of patients with panic disorder/agoraphobia, the SF-12 was the most sensitive measure overall, closely followed by the K-10 and WHODAS II. The NCS Disability Days were the least sensitive to symptom change in both samples. CONCLUSION The WHODAS II is at least as sensitive as other generic effectiveness measures to anxiety symptom changes, and is particularly sensitive to changes in social anxiety symptoms. It may prove to be a valuable measurement tool for informing public health policy in relation to anxiety disorders.
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Affiliation(s)
- Sarah J Perini
- Clinical Research Unit for Anxiety and Depression, University of New South Wales at St Vincent's Hospital, Sydney, Australia.
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Rost K, Dickinson LM, Fortney J, Westfall J, Hermann RC. Clinical Improvement Associated with Conformance to HEDIS-Based Depression Care. ACTA ACUST UNITED AC 2005; 7:103-12. [PMID: 15974156 PMCID: PMC1350978 DOI: 10.1007/s11020-005-3781-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Employers recently requested a valid metric of depression treatment quality. Such an indicator needs to measure the proportion of the population in need who receive high-quality care, and to predict clinical improvement. METHODS We constructed an administrative database indicator derived from HEDIS criteria for antidepressant medication management, and tested it in 230 employed patients in five health plans. RESULTS Indicator rates were 7.0% in the population in need. Conformance to indicator criteria in this population was associated with 23.0% improvement in depression severity over 1 year (p = .02). CONCLUSIONS Administrative database indicators that predict clinical improvement are a very rare accomplishment. Existing depression indicators may need to be calculated for the population in need to provide a valid metric for employer purchasers.
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Affiliation(s)
- Kathryn Rost
- Center for Studies in Family Medicine, Department of Family Medicine, University of Colorado Health Sciences Center, UCHSC at Fitzsimons, P.O. Box 6508 Mail Stop F496, Aurora, CO 80045-0508, USA.
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Phillips KA, Rasmussen SA. Change in psychosocial functioning and quality of life of patients with body dysmorphic disorder treated with fluoxetine: a placebo-controlled study. PSYCHOSOMATICS 2004; 45:438-44. [PMID: 15345790 PMCID: PMC1613753 DOI: 10.1176/appi.psy.45.5.438] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In a 12-week placebo-controlled study of fluoxetine in the treatment of body dysmorphic disorder, the authors investigated change in psychosocial functioning and mental health-related quality of life in 60 subjects. The subjects were assessed with the LIFE-RIFT (a measure of impaired functioning), Social and Occupational Functioning Scale (SOFAS), and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) before and after receiving fluoxetine or placebo. At baseline, the patients had impaired psychosocial functioning and markedly poor mental health-related quality of life. Compared to placebo, fluoxetine was associated with significantly greater improvement in LIFE-RIFT and SOFAS scores and with improvement on the mental health subscale of the SF-36 that approached significance. Decrease in the severity of body dysmorphic disorder, as measured by the Yale-Brown Obsessive Compulsive Scale Modified for Body Dysmorphic Disorder, was significantly correlated with improvement in functioning and quality of life.
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Erwin BA, Sullivan PA, ten Have TR. Trial of Antidepressants for Mildly Depressed Cancer Patients Should Have Been Reported in a Manner Allowing Independent Evaluation of Investigators' Claims. J Clin Oncol 2004; 22:753-4; author reply 754-6. [PMID: 14966107 DOI: 10.1200/jco.2004.99.253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chisholm D, Diehr P, Knapp M, Patrick D, Treglia M, Simon G. Depression status, medical comorbidity and resource costs. Evidence from an international study of major depression in primary care (LIDO). Br J Psychiatry 2003; 183:121-31. [PMID: 12893665 DOI: 10.1192/bjp.183.2.121] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite the burden of depression, there remain few data on its economic consequences in an international context. AIMS To explore the relationship between depression status (with and without medical comorbidity), work loss and health care costs, using cross-sectional data from a multi-national study of depression in primary care. METHOD Primary care attendees were screened for depression. Those meeting eligibility criteria were categorised according to DSM-IV criteria for major depressive disorder and comorbid status. Unit costs were attached to self-reported days absent from work and uptake of health care services. RESULTS Medical comorbidity was associated with a 17-46% increase in health care costs in five of the six sites, but a clear positive association between costs and clinical depression status was identified in only one site. CONCLUSIONS The economic consequences of depression are influenced to a greater (and considerable) extent by the presence of medical comorbidity than by symptom severity alone.
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Affiliation(s)
- Daniel Chisholm
- Health Services Research Department, King's College of Medicine and Institute of Psychiatry, London, UK.
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Abstract
The Institute of Medicine report "Crossing the Quality Chasm: A New Health Care System for the 21st Century" describes the barriers in the American health care system to improving quality of care and outcomes of chronic illness. This article describes how depression collaborative care models as well as newer research aimed at organizational and economic issues have addressed these barriers in order to improve outcomes for patients with depression in primary care systems.
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Affiliation(s)
- Wayne J Katon
- University of Washington School of Medicine, Seattle, WA, USA.
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Hudson TJ, Sullivan G, Feng W, Owen RR, Thrush CR. Economic evaluations of novel antipsychotic medications: a literature review. Schizophr Res 2003; 60:199-218. [PMID: 12591584 DOI: 10.1016/s0920-9964(02)00228-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the evidence that novel antipsychotic medications offer a cost advantage compared to traditional antipsychotic medications. METHODS Literature for this review was identified through a computerized search of Medline, Healthstar and Psyc-INFO databases inclusive from January 1989 to January 2002. Articles included in the review were required to include cost evaluation and to be published in peer-reviewed journals. RESULTS Twenty-two studies met inclusion criteria. All five studies that used experimental designs found that second-generation antipsychotic medications were associated with a cost advantage or were cost-neutral, and, in some cases, improved quality of life. Of the ten studies using a pre-post design, four found an increase in total costs, six reported a decrease in total costs, and four reported increased effectiveness with use of a second-generation antipsychotic. All seven of the simulation studies reported a cost advantage for novel antipsychotics for specific patient populations under certain conditions. CONCLUSIONS The majority of studies found that novel antipsychotics are at least cost-neutral and may offer cost advantages compared to traditional agents. Some studies also reported greater improvement in effectiveness and quality of life when novel antipsychotics were compared to traditional antipsychotic medications. However, it is difficult to draw firm conclusions given the small sample sizes and limited study designs available in this literature.
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Affiliation(s)
- Teresa J Hudson
- South Central VA Mental Illness Research Education and Clinical Center, Little Rock, AR, USA.
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Parthasarathy S, Mertens J, Moore C, Weisner C. Utilization and cost impact of integrating substance abuse treatment and primary care. Med Care 2003; 41:357-67. [PMID: 12618639 DOI: 10.1097/01.mlr.0000053018.20700.56] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the impact of integrating medical and substance abuse treatment on health care utilization and cost. RESEARCH DESIGN Randomized clinical trial assigning patients to one of two treatment modalities: an Integrated Care model where primary health care is provided along with substance abuse treatment within the unit and an Independent Care model where medical care is provided in the HMO's primary care clinics independently from substance abuse treatment. SUBJECTS Adult patients entering treatment at the outpatient Chemical Dependency Recovery Program in Kaiser Sacramento. MEASURES Medical utilization and cost for 12 months pretreatment and 12 months after treatment entry. RESULTS For the full, randomized cohort, there were no statistically significant differences between the two treatment groups over time. However, among the subset of patients with substance abuse related medical conditions (SAMC), Integrated Care patients had significant decreases in hospitalization rates (P = 0.04), inpatient days (P = 0.05) and ER use (P = 0.02). Total medical costs per member-month declined from 431.12 US dollars to 200.03 US dollars (P = 0.02). Among SAMC Independent Care patients, there was a downward trend in inpatient days (P = 0.08) and ER costs (P = 0.05) but no statistically significant decrease in total medical cost. CONCLUSIONS (Non)findings for the full sample suggest that integrating substance abuse treatment with primary care, may not be necessary or appropriate for all patients. However, it may be beneficial to refer patients with substance abuse related medical conditions to a provider also trained in addiction medicine. There appear to be large cost impacts of providing integrated care for such patients.
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Affiliation(s)
- Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, California 94612, USA
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Pyne JM, Sullivan G, Kaplan R, Williams DK. Comparing the sensitivity of generic effectiveness measures with symptom improvement in persons with schizophrenia. Med Care 2003; 41:208-17. [PMID: 12555049 DOI: 10.1097/01.mlr.0000044900.72470.d4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the sensitivity of four generic effectiveness measures with clinically meaningful symptom improvement in persons with schizophrenia. METHOD Baseline and 6-month interviews were conducted with 134 subjects diagnosed with schizophrenia or schizoaffective disorder. The design was observational. The four generic effectiveness measures included the Quality of Well-Being scale (QWB), a quality-adjusted index score based on the SF-36 VAS, Veterans SF-36 mental health component summary score (MCS), and the World Health Organization Disablement Assessment Schedule (WHO-DAS). Symptom measures included the Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale (CDS). The side effect measure was the Extrapyramidal Symptom Rating Scale (ESRS). Data analysis included correlations between symptom, side effect, and generic effectiveness change scores; and an effect size calculation to detect a clinically significant improvement in the total PANSS. RESULTS All four effectiveness measures were correlated with changes in side effects. All but the SG-36 VAS were correlated with changes in depression. Only the QWB was correlated with changes in PANSS scores. The QWB required at least three times fewer subjects (n = 61) to detect a clinically significant improvement in total PANSS compared with the other effectiveness measures (n = 201-324). CONCLUSIONS It is recommended that clinicians and researchers use the QWB to demonstrate the effectiveness and cost-effectiveness of schizophrenia interventions. The QWB allows for direct comparison of the effectiveness and cost-effectiveness of schizophrenia interventions with other mental and physical health interventions and may contribute to a greater recognition of the value of mental health interventions.
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Affiliation(s)
- Jeffrey M Pyne
- South Central VA Healthcare Network, and the Department of Psychiatry, Central Arkansas Veterans Healthcare System, the University of Arkansas for Medical Sciences, Little Rock, Arkansas 72114, USA.
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Katon W, Russo J, Von Korff M, Lin E, Simon G, Bush T, Ludman E, Walker E. Long-term effects of a collaborative care intervention in persistently depressed primary care patients. J Gen Intern Med 2002; 17:741-8. [PMID: 12390549 PMCID: PMC1495114 DOI: 10.1046/j.1525-1497.2002.11051.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE A previous study described the effect of a collaborative care intervention on improving adherence to antidepressant medications and depressive and functional outcomes of patients with persistent depressive symptoms 8 weeks after the primary care physician initiated treatment. This paper examined the 28-month effect of this intervention on adherence, depressive symptoms, functioning, and health care costs. DESIGN Randomized trial of stepped collaborative care intervention versus usual care. SETTING HMO in Seattle, Wash. PATIENTS Patients with major depression were stratified into severe and moderate depression groups prior to randomization. INTERVENTIONS A multifaceted intervention targeting patient, physician, and process of care, using collaborative management by a psychiatrist and a primary care physician. MEASURES AND MAIN RESULTS The collaborative care intervention was associated with continued improvement in depressive symptoms at 28 months in patients in the moderate-severity group (F1,87 = 8.65; P =.004), but not in patients in the high-severity group (F1,51 = 0.02; P =.88) Improvements in the intervention group in antidepressant adherence were found to occur for the first 6 months (chi2(1) = 8.23; P <.01) and second 6-month period (chi2(1) = 5.98; P <.05) after randomization in the high-severity group and for 6 months after randomization in the moderate-severity group(chi2(1) = 6.10; P <.05). There were no significant differences in total ambulatory costs between intervention and control patients over the 28-month period (F1,180 = 0.77; P =.40). CONCLUSIONS A collaborative care intervention was associated with sustained improvement in depressive outcomes without additional health care costs in approximately two thirds of primary care patients with persistent depressive symptoms.
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Affiliation(s)
- Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, Wash 98195, USA.
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Abstract
In this article we discuss the strengths and weaknesses of using different types of data sources for alcohol and drug abuse services research. To do this, we describe four types of data sources used in substance abuse services research: surveys of organizations, medical records, claim and encounter data and program-level administrative data. For each, we outline where to obtain data, how each type has been used, and the advantages and challenges. This overview should allow investigators to think more critically about the datasets they now use; providers to understand the types of data sources most appropriate for specific research questions so as to participate more fully in research; and policy makers to interpret correctly results based on different types of data. Moreover, it should foster better communication among these stakeholders in collaborative projects to improve the effectiveness of services for people with addictions.
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Affiliation(s)
- Deborah W Garnick
- Schneider Institute for Health Policy, Heller Graduate School, Brandeis University, 415 South Street, Waltham, MA 02454-9110, USA.
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Unützer J, Katon W, Williams JW, Callahan CM, Harpole L, Hunkeler EM, Hoffing M, Arean P, Hegel MT, Schoenbaum M, Oishi SM, Langston CA. Improving primary care for depression in late life: the design of a multicenter randomized trial. Med Care 2001; 39:785-99. [PMID: 11468498 DOI: 10.1097/00005650-200108000-00005] [Citation(s) in RCA: 184] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Late life depression can be successfully treated with antidepressant medications or psychotherapy, but few depressed older adults receive effective treatment. RESEARCH DESIGN A randomized controlled trial of a disease management program for late life depression. SUBJECTS Approximately 1,750 older adults with major depression or dysthymia are recruited from seven national study sites. INTERVENTION Half of the subjects are randomly assigned to a collaborative care program where a depression clinical specialist supervised by a psychiatrist and a primary care expert supports the patient's regular primary care provider to treat depression. Intervention services are provided for 12 months using antidepressant medications and Problem Solving Treatment in Primary Care according to a stepped care protocol that varies intervention intensity according to clinical needs. The other half of the subjects are assigned to care as usual. EVALUATION Subjects are independently assessed at baseline, 3 months, 6 months, 12 months, 18 months, and 24 months. The evaluation assesses the incremental cost-effectiveness of the intervention compared with care as usual. Specific outcomes examined include care for depression, depressive symptoms, health-related quality of life, satisfaction with depression care, health care costs, patient time costs, market and nonmarket productivity, and household income. CONCLUSIONS The study blends methods from health services and clinical research in an effort to protect internal validity while maximizing the generalizability of results to diverse health care systems. We hope that this study will show the cost-effectiveness of a new model of care for late life depression that can be applied in a range of primary care settings.
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Affiliation(s)
- J Unützer
- Center for Health Services Research, UCLA Neuropsychiatric Institute, Los Angeles, CA, USA.
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Meyer GJ, Finn SE, Eyde LD, Kay GG, Moreland KL, Dies RR, Eisman EJ, Kubiszyn TW, Reed GM. Psychological testing and psychological assessment: A review of evidence and issues. AMERICAN PSYCHOLOGIST 2001. [DOI: 10.1037/0003-066x.56.2.128] [Citation(s) in RCA: 731] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sturm R. What type of information is needed to inform mental health policy? THE JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS 1999; 2:141-144. [PMID: 11967424 DOI: 10.1002/(sici)1099-176x(199909)2:3<141::aid-mhp56>3.0.co;2-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The most valuable research integrates from thre levels of investigation: clinical efficacy, "real life" effectiveness (including cost-effectiveness) and policy research. Successful applications of systematic reviews have largely been limited to clinical efficacy questions. The contribution of systematic reviews/meta-analyses to effectiveness and economic questions in mental health has been very minor and their contribution to inform policy is negligible. The latter is unlikely to change due to the different type of information that policy makers need.
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Affiliation(s)
- Roland Sturm
- Ph.D. Senior Economist RAND, 1700 Main Street, Santa Monica, CA 90401, USA
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Katon W. Treatment trials in real world settings. Methodological issues and measurement of disability and costs. Gen Hosp Psychiatry 1999; 21:237-8. [PMID: 10514946 DOI: 10.1016/s0163-8343(99)00031-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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