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Vaitsiakhovich N, Landes SD. The association between the Patient Protection and Affordable Care Act and healthcare affordability among US adults with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1270-1290. [PMID: 37129079 DOI: 10.1111/jir.13037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 02/28/2023] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Historically, US adults with intellectual disability (ID) experience worse healthcare access than the general population. However, the implementation of the Patient Protection and Affordable Care Act (ACA) may have reduced disparities in healthcare access. METHODS Using a pre-ACA 2011-2013 sample and a post-ACA implementation 2014-2016 sample from the National Health Interview Survey data, we examined the association between the ACA's introduction and healthcare access among adults with ID (N = 623). Negative binomial regression models were used to test the association between the ACA and the total number of foregone healthcare services. Binary logistic regression was used to explore whether the ACA's implementation was associated with the increased likelihood of possessing health insurance as well as the decreased likelihood of any and particular measures of foregone healthcare services due to cost. RESULTS The study provides evidence that the ACA's implementation was associated with the decreased likelihood of the total number and any foregone care services owing to cost. Findings also revealed that the ACA's implementation was associated with expansion of health insurance coverage and decreasing instances of foregone care services for medical care, dental care, specialist visit and mental care among adults with ID. However, persons with ID were still at a higher risk of foregone prescription medicines, follow-up medical care and eyeglasses due to cost in the post-ACA years. CONCLUSIONS The study provides evidence that healthcare access among Americans with ID improved after the ACA's implementation. However, challenges in access to follow-up care, eyeglasses and prescription medicines persist and require policy solutions, which extend beyond the ACA's provisions.
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Affiliation(s)
- N Vaitsiakhovich
- Department of Sociology and Lerner Center for Public Health Promotion and Population Health, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, USA
| | - S D Landes
- Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, USA
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2
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Chandrashekhar A, Thakur HP. Efficacy of Government-Sponsored Community Health Programs for Older Adults: A Systematic Review of Published Evaluation Studies. Public Health Rev 2022; 43:1604473. [PMID: 36211228 PMCID: PMC9537370 DOI: 10.3389/phrs.2022.1604473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 09/02/2022] [Indexed: 11/22/2022] Open
Abstract
Objective: Population aging is an ongoing challenge for global health policy and is expected to have an increasing impact on developing economies in years to come. A variety of community health programs have been developed to deliver health services to older adults, and evaluating these programs is crucial to improving service delivery and avoiding barriers to implementation. This systematic review examines published evaluation research relating to public and community health programs aimed at older adults throughout the world. Methods: A literature search using standardized criteria yielded 58 published articles evaluating 46 specific programs in 14 countries. Results: Service models involving sponsorship of comprehensive facilities providing centralized access to multiple types of health services were generally evaluated the most positively, with care coordination programs appearing to have generally more modest success, and educational programs having limited effectiveness. Lack of sufficient funding was a commonly-cited barrier to successful program implementations. Conclusion: It is important to include program evaluation as a component of future community and public health interventions aimed at aging populations to better understand how to improve these programs.
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3
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Sfetcu R, Toma D, Tudose C, Vladescu C. Romanian GPs Involvement in Caring for the Mental Health Problems of the Elderly Population: A Cross-Sectional Study. Front Neurol 2021; 12:641217. [PMID: 34248814 PMCID: PMC8263930 DOI: 10.3389/fneur.2021.641217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/31/2021] [Indexed: 11/02/2022] Open
Abstract
The mental health of the elderly is a matter of increased concern in the context of an aging population since currently only a small fraction of this population is receiving adequate care. The provision of treatment in primary care by the General Practitioners (GPs) has been proposed for over a decade as a potential solution, as services offered by GPs are more accessible, less susceptible to stigma, and have a more comprehensive view of the other health care problems that the elderly might suffer from. In this study, we explored the perception of Romanian GPs regarding their practice and roles in caring for the mental health of the elderly as well as the willingness to increase their future involvement in the management of dementia and other mental health problems. Data was collected via an online questionnaire structured on four dimensions: (1) GPs' sociodemographic profile and practice characteristics, (2) GPs assessment of the services available for elderly with mental health problems, (3) GPs current involvement in mental health care for different categories of problems, and (4) factors that might influence the future involvement of GPs in providing care for elderly with mental health problems. The survey was sent via the member mailing lists of the National Society for Family Medicine. Results show that GPs are currently limited by prescribing possibilities, available resources and knowledge in the area, but they are willing to expand their role in the areas of early recognition and prevention of mental health problems as well as providing disease management and collaborative care. An improved communication with mental health care professionals, a better access to resources and having more financial incentives are the three most important categories for GPs to increase their involvement. In conclusion, increasing the access to personal and professional resources and setting up functional communication channels with specialized mental health care could motivate GPs to provide timely mental health support to elderly patients.
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Affiliation(s)
- Raluca Sfetcu
- Psychology Department, “Spiru Haret” University, Bucharest, Romania
- The Center for Health Services Assessment and Research, National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Daciana Toma
- National Society for Family Medicine, Bucharest, Romania
| | - Catalina Tudose
- Psychiatry Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| | - Cristian Vladescu
- The Center for Health Services Assessment and Research, National School of Public Health, Management and Professional Development, Bucharest, Romania
- Public Health Department, Faculty of Medicine, “Titu Maiorescu” University, Bucharest, Romania
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4
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Fink-Samnick E. The Social Determinants of Mental Health: Definitions, Distinctions, and Dimensions for Professional Case Management: Part 1. Prof Case Manag 2021; 26:121-137. [PMID: 33784719 DOI: 10.1097/ncm.0000000000000497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ellen Fink-Samnick
- Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CCTP, CMHIMP, CRP, DBH(c), is an award-winning industry thought leader who empowers health care's interprofessional workforce. She is a sought out professional speaker, author, and educator for her innovative content and vibrant presence. Ellen is an international national expert on the Social Determinants of Health, Workplace Bullying, Professional Ethics, Professional Case Management Practice, and Wholistic Case Management. Her recent books include, The Essential Guide to Interprofessional Ethics in Healthcare Case Management, The Social Determinants of Health: Case Management's Next Frontier , and End of Life for Case Management, all through HCPro. Along with several academic teaching appointments, Ellen is a doctoral in behavioral health (DBH) student at Cummings Graduate Institute for Behavioral Health Studies. View more on her LinkedIn profile
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5
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Kim Y, Kim K, Chartier KG, Wike TL, McDonald SE. Adverse childhood experience patterns, major depressive disorder, and substance use disorder in older adults. Aging Ment Health 2021; 25:484-491. [PMID: 31769297 DOI: 10.1080/13607863.2019.1693974] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This article investigates distinct patterns of adverse childhood experiences (ACEs) in a representative sample of US older adults, and how the ACEs patterns relate to major depression and substance use disorder (SUD). METHODS Data came from the National Epidemiologic Survey on Alcohol and Related Conditions III. The study sample consisted of older adults aged 55 or older (N = 11,386). The dependent variable was past-year SUD measuring any DSM-5 diagnosis for alcohol, tobacco, cannabis, and other illicit drugs. The independent variables were the classes of ACEs identified using 11 types of early adversities. The mediating variable was past-year major depressive disorder. We conducted a latent class analysis (LCA) to identify latent classes of ACEs, estimated the relationships between the ACEs classes, major depressive disorder, and SUD, and tested mediation by major depression. RESULTS Results of the LCA identified four classes of ACEs: High Adversity (6%), Low Adversity (69%), Child Abuse (16%), and Parental Substance Use (8%). The three classes of High Adversity, Child Abuse, and Parental Substance Use showed significantly higher rates of SUD than the Low Adversity class. The High Adversity and Child Abuse classes were more likely to have major depression compared to the Low Adversity class. In addition, major depression mediated the association between ACEs and SUD for those two classes. CONCLUSION The findings provide evidence for a long-term impact of ACEs on mental health and SUD later in life and emphasize trauma-informed care principles in interventions for older adults with SUD.
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Affiliation(s)
- Youngmi Kim
- Virginia Commonwealth University School of Social Work, Richmond, VA, USA
| | - Kyeongmo Kim
- Virginia Commonwealth University School of Social Work, Richmond, VA, USA
| | - Karen G Chartier
- Virginia Commonwealth University School of Social Work, Richmond, VA, USA
| | - Traci L Wike
- Virginia Commonwealth University School of Social Work, Richmond, VA, USA
| | - Shelby E McDonald
- Virginia Commonwealth University School of Social Work, Richmond, VA, USA
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6
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The Geriatric Workforce Enhancement Program: Review of the Coordinating Center and Examples of the GWEP in Practice. Am J Geriatr Psychiatry 2019; 27:675-686. [PMID: 31130415 DOI: 10.1016/j.jagp.2019.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/05/2019] [Accepted: 04/19/2019] [Indexed: 11/22/2022]
Abstract
The Health Resources and Services Administration created the Geriatric Workforce Enhancement Program (GWEP) in 2015 to address future geriatric workforce challenges and redefine the delivery of care to older adults. The John A. Hartford Foundation subsequently funded the GWEP Coordinating Center (GWEP-CC) to offer centralized, strategic support to these 44 diverse GWEP sites. This article outlines the last 3 years of GWEP work done at the national and local levels to transform geriatric care. Dissemination of the innovative Geriatric Interprofessional Team Transformation in Primary Care program, created by the Dartmouth GWEP, demonstrates how the GWEP-CC can benefit local initiatives and inform national perspectives. The GWEP-CC is a change agent in this way, scaling and distributing information and implementation support across the country. The GWEP-CC also serves as an essential repository of data, continuously determining what is working and what could be improved. This informs activity of the GWEP-CC, funders and other stakeholders, and provides the most up-to-date resources to GWEP sites and their partners. The GWEP-CC achieves its objectives through several key pillars: networking opportunities, education and training, advocacy, and evaluation. Although many advances have been made, opportunities to continue paving the way are plenty, especially with regards to mental health. This article discusses the work accomplished to date and presents some future considerations for mental health and overall healthcare transformation.
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7
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Schmidt EM, Behar S, Barrera A, Cordova M, Beckum L. Potentially Preventable Medical Hospitalizations and Emergency Department Visits by the Behavioral Health Population. J Behav Health Serv Res 2019; 45:370-388. [PMID: 28905296 DOI: 10.1007/s11414-017-9570-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study investigated geographic variation in potentially preventable medical outcomes that might be used to monitor access to high-quality medical care in the behavioral health population. Analyzing public and non-public data sources from California on adults admitted between 2009 and 2011 to all non-federal licensed medical inpatient (N = 6,603,146) or emergency department units (N = 21,011,958) revealed that 33.6% of nearly 1 million potentially preventable hospitalizations and 9.8% of 1.5 million potentially preventable emergency department visits were made by people with mental or substance use disorder diagnoses. Across California counties or county groups (N = 36), a higher preventable hospitalization rate in the behavioral health population was associated with higher poverty, higher primary care safety net utilization, and fewer mental health providers. Although further validation is required, rates of potentially preventable encounters, particularly hospitalizations, may be useful measures of access to high-quality care in the behavioral health population.
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Affiliation(s)
- Eric M Schmidt
- Center for Innovation to Implementation (Ci2i), HSR&D, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA. .,Center for Primary Care and Outcomes Research/Center for Health Policy, Stanford University, 117 Encina Commons, Stanford, CA, 94305, USA.
| | - Simone Behar
- Pacific Graduate School of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94305, USA
| | - Alinne Barrera
- Pacific Graduate School of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94305, USA
| | - Matthew Cordova
- Pacific Graduate School of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94305, USA.,VA Northern California Health Care System, 150 Muir Road, Martinez, CA, 94553, USA
| | - Leonard Beckum
- Pacific Graduate School of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94305, USA
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Giannouchos TV, Kum HC, Foster MJ, Ohsfeldt RL. Characteristics and predictors of adult frequent emergency department users in the United States: A systematic literature review. J Eval Clin Pract 2019; 25:420-433. [PMID: 31044484 DOI: 10.1111/jep.13137] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE We conducted a systematic literature review to identify and to update patient characteristics and contextual factors for adult frequent emergency department users (FEDUs) compared with non-FEDU in an era where the US health care system underwent substantial changes. METHODS We searched MEDLINE, CINAHL, and EMBASE to identify all relevant articles after 2010 through July 2018 that describe FEDU. We included US studies on adult FEDU only and excluded studies on specific subgroups of FEDU. We included demographic, clinical, and health care utilization information, and two reviewers independently evaluated the studies using the Joanna Briggs Institute Critical Appraisal tool. RESULTS The 11 studies included in the review indicated that FEDU were 4% to 16% of total ED users but accounted for 14% to 47% of ED visits, with six to nine visits per year on average. The majority of FEDU were young or middle-aged adults, females, of low socioeconomic status and high school or less education, with public insurance, multiple primary care provider visits, and chronic conditions. Fair or poor self-perceived health status, unemployment, unmet needs from primary care providers (PCPs), mental health, and substance abuse were predictors of FEDU. CONCLUSION FEDUs are disproportionally sicker and are also heavy users of non-ED health care service providers. The limited data for non-ED health services use in facility-specific studies of FEDU may contribute to findings in such studies that complex and unmet needs from PCPs contributed to ED visits. This suggests the need for more comprehensive data analysis beyond a few sites that can inform systemic management approaches.
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Affiliation(s)
- Theodoros V Giannouchos
- Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, TX, USA.,Population Informatics Lab, Texas A&M University, College Station, TX, USA
| | - Hye-Chung Kum
- Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, TX, USA.,Population Informatics Lab, Texas A&M University, College Station, TX, USA.,Department of Computer Science & Engineering, Texas A&M University, College Station, TX, USA.,Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX, USA
| | - Margaret J Foster
- Medical Sciences Library, Texas A&M University, College Station, TX, USA
| | - Robert L Ohsfeldt
- Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, TX, USA.,Population Informatics Lab, Texas A&M University, College Station, TX, USA
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9
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Devine M, DeCaporale-Ryan L, Lim M, Berenyi J. Psychological Issues in Medically Underserved Patients. PHYSICIAN ASSISTANT CLINICS 2019. [DOI: 10.1016/j.cpha.2018.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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10
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Smeeding J, Malone DC, Ramchandani M, Stolshek B, Green L, Schneider P. Biosimilars: Considerations for Payers. P & T : A PEER-REVIEWED JOURNAL FOR FORMULARY MANAGEMENT 2019; 44:54-63. [PMID: 30766011 PMCID: PMC6355057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Evaluating biosimilars requires payers to go beyond cost considerations: safety and efficacy, reliability of supply and logistics, and the impact of state laws on substitution and interchangeability must all be deliberated.
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11
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Perelman J, Chaves P, de Almeida JMC, Matias MA. Reforming the Portuguese mental health system: an incentive-based approach. Int J Ment Health Syst 2018; 12:25. [PMID: 29853991 PMCID: PMC5975562 DOI: 10.1186/s13033-018-0204-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 05/11/2018] [Indexed: 11/25/2022] Open
Abstract
Background To promote an effective mental health system, the World Health Organization recommends the involvement of primary care in prevention and treatment of mild diseases and community-based care for serious mental illnesses. Despite a prevalence of lifetime mental health disorders above 30%, Portugal is failing to achieve such recommendations. It was argued that this failure is partly due to inadequate financing mechanisms of mental health care providers. This study proposes an innovative payment model for mental health providers oriented toward incentivising best practices. Methods We performed a comprehensive review of healthcare providers’ payment schemes and their related incentives, and a narrative review of best practices in mental health prevention and care. We designed an alternative payment model, on the basis of the literature, and then we presented it individually, through face-to-face interviews, to a panel of 22 experts with different backgrounds and experience, and from southern and northern Portuguese regions, asking them to comment on the model and provide suggestions. Then, after a first round of interviews, we revised our model, which we presented to experts again for their approval, and provide new suggestions and comments, if deemed necessary. This approach is close to what is generally known as the Delphi technique, although it was not applied in a rigid way. Results We designed a four-dimension model that focused on (i) the prevention of mental disorders early in life; (ii) the detection of mental disorders in childhood and adolescence; (iii) the implementation of a collaborative stepped care model for depression; and (iv) the integrated community-based care for patients with serious mental illnesses. First, we recommend a bundled payment to primary care practices for the follow-up of children with special needs or at risk under 2 years of age. Second, we propose a pay-for-performance scheme for all primary care practices, based on the number of users under 18 years old who are provided with check-up consultations. Third, we propose a pay-for-performance scheme for all primary care practices, based on the implementation of collaborative stepped care for depression. Finally, we propose a value-based risk-adjusted bundled payment for patients with serious mental illness. Conclusions The implementation of evidence-based best practices in mental health needs to be supported by adequate payment mechanisms. Our study shows that mental health experts, including decision makers, agree with using economic tools to support best practices, which were also consensual.
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Affiliation(s)
- Julian Perelman
- 1Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisbon, Portugal.,2Centro de Investigação em Saúde Publica, Escola Nacional de Saúde Pública, Avenida Padre Cruz, 1600-560 Lisbon, Portugal
| | - Pedro Chaves
- 1Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisbon, Portugal.,4Nova School of Business and Economics, Universidade NOVA de Lisboa, Campus de Campolide, 1099-032 Lisbon, Portugal
| | - José Miguel Caldas de Almeida
- 3NOVA Medical School, Campus Sant'Ana, Pólo de Investigação, NMS, UNL, Rua do Instituto, Bacteriológico, no 5, 1150-082 Lisbon, Portugal
| | - Maria Ana Matias
- 1Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisbon, Portugal.,4Nova School of Business and Economics, Universidade NOVA de Lisboa, Campus de Campolide, 1099-032 Lisbon, Portugal
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12
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Xiang X, Danilovich MK, Tomasino KN, Jordan N. Depression prevalence and treatment among older home health services users in the United States. Arch Gerontol Geriatr 2018; 75:151-157. [DOI: 10.1016/j.archger.2017.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/19/2017] [Accepted: 12/10/2017] [Indexed: 01/20/2023]
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13
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Baker J, Travers JL, Buschman P, Merrill JA. An Efficient Nurse Practitioner-Led Community-Based Service Model for Delivering Coordinated Care to Persons With Serious Mental Illness at Risk for Homelessness [Formula: see text]. J Am Psychiatr Nurses Assoc 2018; 24:101-108. [PMID: 28402750 DOI: 10.1177/1078390317704044] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Access to mental health care is a struggle for those with serious mental illness (SMI). About 25% of homeless suffer from SMI, compared with 4.2% of the general population. OBJECTIVE From 2003 to 2012, St. Paul's Center (SPC) operated a unique model to provide quality care to the homeless and those at risk for homelessness, incarceration, and unnecessary hospitalization because of SMI. Data were available for analysis for the years 2008 to 2010. DESIGN The SPC was developed, managed, and staffed by board-certified psychiatric/mental health nurse practitioners, offering comprehensive mental health services and coordinated interventions. RESULTS All clients were housed and none incarcerated. From 2008 to 2010, only 3% of clients were hospitalized, compared with 7.5% of adults with SMI. Clinical, academic, and community partnerships increased value, but Medicaid reimbursement was not available. CONCLUSION Mental health provisions in the recently passed 21st Century Cures Act support community mental health specialty treatment. The SPC provides a template for similar nurse practitioner-led models.
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Affiliation(s)
- Jeannemarie Baker
- 1 Jeannemarie Baker, PMH, NP, Columbia University, New York, NY, USA
| | - Jasmine L Travers
- 2 Jasmine L. Travers, PhD, AGNP-C, RN, University of Pennsylvania, Philadelphia, PA, USA
| | - Penelope Buschman
- 3 Penelope Buschman, MS, RN, PMHCNS-BC, FAAN, Columbia University, New York, NY, USA
| | - Jacqueline A Merrill
- 4 Jacqueline A. Merrill, PhD, MPH, RN, FACMI, FAAN, Columbia University, New York, NY, USA
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Abstract
Objective: To examine factors and reasons associated with medical care avoidance among older adults in the United States. Method: Analysis of data on 2,155 adults aged 65 and older, who completed the 2008 Health Information National Trends Survey. Results: Nearly one fourth of older adults reported medical care avoidance ( n = 449; weighted % = 22.5%). Of these, more than one third reported doing so because of feeling uncomfortable when their body is examined (34.5%) or fearing a serious illness (35.9%) and with fewer reporting avoiding care because it made them think of dying (14.3%). Likelihood of avoidance was higher among those with worse self-reported health status, severe psychological distress, lower health self-efficacy, lower confidence in obtaining health information, lower trust in doctors, less patient-centered communication, lower perceived health care quality, and those who were current smokers. Qualitative reasons for avoidance corroborated quantitative results. Conclusion: Avoidance by older adults appears to be largely associated with evaluations of the quality of care and provider communication.
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Affiliation(s)
| | | | - Amal N. Trivedi
- Brown University, Providence, RI, USA
- Providence VA Medical Center, RI, USA
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15
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Chavez LJ, Liu CF, Tefft N, Hebert PL, Devine B, Bradley KA. The Association Between Unhealthy Alcohol Use and Acute Care Expenditures in the 30 Days Following Hospital Discharge Among Older Veterans Affairs Patients with a Medical Condition. J Behav Health Serv Res 2017; 44:602-624. [PMID: 27585803 PMCID: PMC5332352 DOI: 10.1007/s11414-016-9529-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hospital readmissions and emergency department (ED) visits within 30 days of discharge are costly. Heavy alcohol use could predict increased risk for post-discharge acute care. This study assessed 30-day acute care utilization and expenditures for different categories of alcohol use. Veterans Affairs (VA) patients age ≥65 years with past-year alcohol screening, hospitalized for a medical condition, were included. VA and Medicare health care utilization data were used. Two-part models adjusted for patient demographics. Among 416,050 hospitalized patients, 25% had 30-day acute care use. Nondrinking patients (n = 267,746) had increased probability of acute care use, mean utilization days, and expenditures (difference of $345; 95% CI $268-$423), relative to low-risk drinkers (n = 105,023). High-risk drinking patients (n = 5,300) had increased probability of acute care use and mean utilization days, but not expenditures. Although these patients did not have greater acute care expenditures than low-risk drinking patients, they may nevertheless be vulnerable to poor post-discharge outcomes.
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Affiliation(s)
- Laura J Chavez
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA.
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH, 43210, USA.
| | - Chuan-Fen Liu
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
- Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Nathan Tefft
- Bates College, 2 Andrews Rd, Lewiston, ME, 04240, USA
| | - Paul L Hebert
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
- Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Beth Devine
- Department of Pharmacy, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Katharine A Bradley
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
- Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
- Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
- Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
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16
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Kunik ME, Mills WL, Amspoker AB, Cully JA, Kraus-Schuman C, Stanley M, Wilson NL. Expanding the geriatric mental health workforce through utilization of non-licensed providers. Aging Ment Health 2017; 21:954-960. [PMID: 27243369 PMCID: PMC5568805 DOI: 10.1080/13607863.2016.1186150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We evaluate policy and practice strategies for bolstering the geriatric mental healthcare workforce and describe costs and considerations of implementing one approach. METHOD Narrative overview of the literature and policy retrieved from searches of databases, hand searches, and authoritative texts. We identified three proposed strategies to increase the geriatric mental healthcare workforce: (1) production of more geriatric mental health providers; (2) team-based care; and (3) non-licensed providers. We evaluate each in terms of challenges and potential and provide estimates of costs, policy, and practice considerations for training, employing, and supervising non-licensed mental health providers. RESULTS Use of non-licensed providers is key to reforms needed to allow a more older adults to access necessary mental healthcare. Licensed and non-licensed providers have achieved similar improvements for generalized anxiety disorder among patients, although non-licensed providers did so at a lower cost. CONCLUSION Supervised non-licensed providers can extend the reach of licensed providers for specific mental health conditions, resulting in lower costs and increased number of patients treated. Although several barriers to implementation exist, policy and infrastructure changes that may support this type of care delivery model are emerging from reforms in financing and associated delivery initiatives created by the Affordable Care Act.
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Affiliation(s)
- Mark E. Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414,Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, 713-798-4951,South Central Mental Illness Research, Education and Clinical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414
| | - Whitney L. Mills
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414,Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, 713-798-4951
| | - Amber B. Amspoker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414,Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, 713-798-4951
| | - Jeffrey A. Cully
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414,Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, 713-798-4951,South Central Mental Illness Research, Education and Clinical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414
| | - Cynthia Kraus-Schuman
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, 713-798-4951,Michael E. DeBakey VA Medical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414
| | - Melinda Stanley
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414,Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, 713-798-4951,South Central Mental Illness Research, Education and Clinical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414
| | - Nancy L. Wilson
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe, Houston, TX 77030, 713-791-1414,Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, 713-798-4951
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Calmer Life: A Hybrid Effectiveness-implementation Trial for Late-life Anxiety Conducted in Low-income, Mental Health-Underserved Communities. J Psychiatr Pract 2017; 23:180-190. [PMID: 28492456 PMCID: PMC5448556 DOI: 10.1097/pra.0000000000000234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Anxiety is common among older adults and is associated with multiple negative outcomes. Late-life anxiety is usually unrecognized by providers and undertreated, although evidence supports the effectiveness of psychosocial treatment. Access to mental health care is especially poor among African American seniors. New treatment models are needed to expand the reach of mental health care to minority elders. METHODS Our article outlines a study designed to test the effectiveness and implementation potential of Calmer Life (CL), a community-based, person-centered, flexible and culturally tailored intervention for late-life anxiety and worry, offered in low-income, mental health-underserved and predominantly African American communities. CL is skills-based, but also includes resource counseling and an option to integrate religion/spirituality. The study population includes individuals 50 years of age and older who are experiencing high levels of worry. The program was developed in the context of a community-academic partnership with organizations that provide services for seniors in underserved communities, and it trains nontraditional community providers to deliver the intervention. RESULTS Study progress to date, challenges, and lessons learned are discussed. Data collection is ongoing, and study findings will be available in late 2017. CONCLUSIONS CL will offer valuable information to help expand the reach of anxiety treatment among minority seniors living in underserved neighborhoods.
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Renn BN, Areán PA. Psychosocial Treatment Options for Major Depressive Disorder in Older Adults. ACTA ACUST UNITED AC 2017; 4:1-12. [PMID: 28932652 DOI: 10.1007/s40501-017-0100-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Late-life depression (LLD) is a public health concern with deleterious effects on overall health, cognition, quality of life, and mortality. Although LLD is relatively common, it is not a normal part of aging and is often under-recognized in older adults. However, psychotherapy is an effective treatment for LLD that aligns with many patients' preferences and can improve health and functioning. This review synthesized the current literature on evidence-based psychotherapies for the treatment of depression in older adults. Findings suggest that active, skills-based psychotherapies (cognitive behavioral therapy [CBT] and problem-solving therapy [PST]) may be more effective for LLD than non-directive, supportive counseling. PST may be particularly relevant for offsetting skill deficit associated with LLD, such as in instances of cognitive impairment (especially executive dysfunction) and disability. Emerging treatments also consider contextual factors to improve treatment delivery, such as personalized care, access, and poverty. Tele-mental health represents one such exciting new way of improving access and uptake of treatment by older adults. Although these strategies hold promise, further investigation via randomized controlled trials and comparative effectiveness are necessary to advance our treatment of LLD. Priority should be given to recruiting and training the geriatric mental health workforce to deliver evidence-based psychosocial interventions for LLD.
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Affiliation(s)
- Brenna N Renn
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
| | - Patricia A Areán
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
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19
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Devine M, DeCaporale-Ryan L, Lim M, Berenyi J. Psychological Issues in Medically Underserved Patients. Prim Care 2017; 44:99-112. [PMID: 28164823 DOI: 10.1016/j.pop.2016.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The US population has a subset of those that are underserved who are in need of primary care and also suffer from mental health disorders. In this article, categories of underserved populations are described. Each section defines the population being presented, identifies the mental health problems each is likely to encounter, explores the barriers that prevent access to care, and identifies potential methods to minimize such barriers. The ways in which psychiatric issues vary in underserved settings compared with the general population are differentiated. Recommendations are offered for primary care physicians to support improved recognition and management of psychosocial stressors and psychiatric illness among the underserved.
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Affiliation(s)
- Mathew Devine
- Department of Family Medicine, University of Rochester, 777 South Clinton Avenue, Rochester, NY 14620, USA; Accountable Health Partners, 135 Corporate Woods Suite 320, Rochester, NY 14623, USA.
| | - Lauren DeCaporale-Ryan
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Box Psych, Rochester, NY 14642, USA; Department of Medicine, University of Rochester Medical Center, 300 Crittenden Boulevard, Box Psych, Rochester, NY 14642, USA; Department of Surgery, University of Rochester Medical Center, 300 Crittenden Boulevard, Box Psych, Rochester, NY 14642, USA
| | - Magdalene Lim
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, USA; Department of Medicine, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, USA
| | - Juliana Berenyi
- Department of Family Medicine, University of Rochester Family Medicine Resident, 777 South Clinton Avenue, Rochester, NY 14620, USA
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Clarke JL, Skoufalos A, Medalia A, Fendrick AM. Improving Health Outcomes for Patients with Depression: A Population Health Imperative. Report on an Expert Panel Meeting. Popul Health Manag 2016; 19 Suppl 2:S1-S12. [PMID: 27636743 PMCID: PMC5076486 DOI: 10.1089/pop.2016.0114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Improving Health Outcomes for Patients with Depression: A Population Health Imperative. Report on an Expert Panel Meeting Janice L. Clarke, RN, Alexis Skoufalos, EdD, Alice Medalia, PhD, and A. Mark Fendrick, MD Editorial: A Call to Action : David B. Nash, MD, MBA S-2 OVERVIEW: Depression and the Population Health Imperative S-3 Promoting Awareness of the Issues and Opportunities for Improvement S-5 Cognitive Dysfunction in Affective Disorders S-5 Critical Role of Employers in Improving Health Outcomes for Employees with Depression S-6 Closing the Behavioral Health Professional and Process Gaps S-6 Achieving the Triple Aim for Patients with Depressive Disorders S-6 Improving the Experience of Care for Patients with Depression S-6 Improving Quality of Care and Health Outcomes for Patients with Depression S-7 Changing the Cost of Care Discussion from How Much to How Well S-8 Panel Insights and Recommendations S-9 Conclusion S-10.
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Affiliation(s)
| | | | | | - A Mark Fendrick
- 3 University of Michigan , Center for Value-Based Design, Ann Arbor, MI
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Bartels SJ, Pepin R, Gill LE. The Paradox of Scarcity in a Land of Plenty: Meeting the Needs of Older Adults with Mental Health and Substance Use Disorders. GENERATIONS (SAN FRANCISCO, CALIF.) 2014; 38:6-13. [PMID: 25663741 PMCID: PMC4316367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Between the ACA, innovative strategies to create a new type of workforce, and technology, we have a chance to redesign healthcare to adequately address physical and mental health.
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Affiliation(s)
- Stephen J Bartels
- Professor of psychiatry and Community and Family Medicine at the Dartmouth Institute, and serves as director of the Dartmouth Centers for Health and Aging in Lebanon, New Hampshire
| | - Renee Pepin
- Postdoctoral fellow at the Centers for Health and Aging at the Geisel School of Medicine at Dartmouth
| | - Lydia E Gill
- Research assistant at the Dartmouth Centers for Health and Aging at the Geisel School of Medicine
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