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Ben-Zacharia AB, Smrtka J, Kalina JT, Vignos M, Smith S. Shared decision-making in underserved populations with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2024; 90:105792. [PMID: 39121597 DOI: 10.1016/j.msard.2024.105792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/23/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND The concept of shared decision-making (SDM) is valuable to ensure patients receive individualized care. SDM occurs when healthcare providers engage patients in making personal healthcare decisions that could contribute to better long-term outcomes. With the ever-increasing landscape of treatment options available, SDM can be challenging but valuable for patients. Patients from underserved populations are potentially less likely to engage in SDM, impacting their long-term care. This systematic literature review aimed to explore SDM in these patient populations. METHODS Relevant articles were retrieved from PubMed using key search terms, without any restriction on publication date. All searches and data retrieval were conducted between May 25, 2022, and August 17, 2022, and abstracts were reviewed by two independent reviewers. A thematic analysis was used to present the data. RESULTS All search terms yielded 418 articles; 89 were included (33 involving patients with multiple sclerosis [MS]). Reported mean percentage of patients with MS (including from underserved populations) who preferred SDM was 52 % (range: 37.5-71.5; n = 4). Differences in racial/ethnic assimilation of information communicated by clinicians were reported, impacted by the lower literacy level and certain cultural health beliefs in groups of underserved populations. Primary care clinicians play a key role in providing information to patients in underserved populations. CONCLUSIONS There is a clear benefit for SDM for patients with MS, and without it, patients report dissatisfaction, decisional regret, and lack of confidence in the medical system. However, there are several challenges, including the need for further examination of social determinants of health, for underserved patient populations which still need to be addressed.
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Affiliation(s)
- Aliza Bitton Ben-Zacharia
- Hunter Bellevue School of Nursing and Mount Sinai Hospital; Hunter Bellevue School of Nursing, 425 E 25th St, New York, NY 10010, USA; Mount Sinai, 146 East 126 Street, New York, NY 10035, USA.
| | - Jen Smrtka
- Biogen, 225 Binney St, Cambridge, MA 02142, USA
| | | | | | - Stacyann Smith
- Judith Jaffe Multiple Sclerosis Center, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, USA
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Hearld LR, Tafili A, Kelly RJ. Patterns and trends in local health departments' efforts to promote access to care in local communities throughout the United States: The contributions of governance structures. Int J Health Plann Manage 2023; 38:1284-1299. [PMID: 37160718 DOI: 10.1002/hpm.3653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 04/03/2023] [Accepted: 04/26/2023] [Indexed: 05/11/2023] Open
Abstract
Public health agencies like local health departments (LHDs) play an important role in addressing healthcare access disparities and service delivery gaps in local communities throughout the United States. Previous research has provided important snapshots into specific access issues confronted by LHDs; however, the literature lacks a more comprehensive view of LHDs' efforts to ensure broad access to care, how these have evolved over time more recently, and whether certain types of LHDs governance structures are more likely to engage in activities to ensure access to care. The purpose of this study was to address these gaps in the literature by exploring the prevalence of different activities to ensure access to care, describing how the prevalence of these activities have evolved over time, and examining whether the prevalence of these activities varied as a function of different governance structures. Using pooled, cross-sectional survey data from four waves of a survey (2009, 2013, 2016, 2019) of LHDs in the United States, the univariate and bivariate analysis revealed that, over time, LHDs have generally increased their efforts to assess gaps in access to healthcare services and across all healthcare categories (i.e., medical, dental, behavioural health) but especially for behavioural health. Poisson regression models showed that LHDs with a more decentralised decision-making structure were associated with more activities to ensure access to care, as compared to more centralised structures. Collectively, our findings indicate that despite growth in the number and percentage of LHDs assessing and addressing gaps in services, opportunities still exist to enhance access to healthcare services in local communities, particularly in the areas of dental and behavioural health. Our findings also suggest that stakeholders interested in improving LHDs' efforts to ensure access to care in local communities may want to pay close attention to governance features of LHDs.
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Affiliation(s)
- Larry R Hearld
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Aurora Tafili
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Reena Joseph Kelly
- Health Administration and Policy Department, School of Health Sciences, University of New Haven, New Haven, Connecticut, USA
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Ater AD, Kurella S, Shah GH, Waterfield KC. Local Health Department Engagement in Access to Mental Health Services and Mental Health Policy or Advocacy Activities. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:377-386. [PMID: 36729800 DOI: 10.1097/phh.0000000000001650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
CONTEXT Mental health is a public health concern that requires national attention at the local level. Major issues facing local health departments (LHDs) to actively engage in mental health activities include inadequate surveillance data and limited resources. OBJECTIVE To examine the levels of engagement in access to mental health services, as well as policy or advocacy activities, by LHDs characteristics. DESIGN The study design is cross-sectional based on the national survey of LHDs. We analyzed the survey data from the National Association of County and City Health Officials' 2019 Profile study. Logistic regression was performed with 6 levels of engagement in mental health activities as the outcome measures. RESULTS LHDs reported that a majority had assessed the gaps in access to mental health (57.69%), followed by other activities-had implemented strategies to increase access to mental health (48.77%), implemented strategies to target underserved populations (40.66%), evaluated strategies to target underserved populations (38.84%), engaged in policy/advocacy to address mental health (32.27%), and finally addressed gaps through provision of mental health (22.31%). LHDs' governance structure was strongly associated with engagement in all 6 mental health activities. LHDs that had performed improvement processes, had behavioral health staff, and had cross-jurisdictional sharing were more likely to be engaged in all 6 of the mental health activities. LHDs were also more likely to be engaged in 5 of the 6 mental health activities if they had some relationships with faith communities and in 4 of the 6 mental health activities if they had some relationships with community health centers. CONCLUSIONS Levels of engagement in mental health policy or advocacy activities among LHDs were low and varied by LHD characteristics. Intervention strategies may include encouraging LHDs to actively engage in mental health activities, participating in Public Health Accreditation Board accreditation program, and incentivizing mental health workforce retention.
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Affiliation(s)
- Abraham Deng Ater
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia
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Nguyen TH, Shah G, Muzamil M, Ikhile O, Ayangunna E, Kaur R. Association of In-School and Electronic Bullying with Suicidality and Feelings of Hopelessness among Adolescents in the United States. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040755. [PMID: 37190004 DOI: 10.3390/children10040755] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Suicide-related behaviors increasingly contribute to behavioral health crises in the United States (U.S.) and worldwide. The problem was worsened during the COVID-19 pandemic, especially for youth and young adults. Existing research suggests suicide-related behaviors are a consequence of bullying, while hopelessness is a more distal consequence. This study examines the association of in-school and electronic bullying with suicide-related behavior and feelings of despair among adolescents, adjusted for sociodemographic characteristics, abuse experience, risk-taking behaviors, and physical appearance/lifestyles. METHOD Using Chi-square, logistic regression, and multinomial logistic regression, we analyzed the US 2019 Youth Risk Behavior Surveillance System (YRBSS) national component. The YRBSS includes federal, state, territorial, and freely associated state, tribal government, and local school-based surveys of representative sample middle and high school students in the US. The 2019 YRBSS participants comprised 13,605 students aged 12 to 18 years and roughly equal proportions of males and females (50.63% and 49.37%, respectively). RESULTS We observed a significant association (p < 0.05) between being bullied and depressive symptoms, and the association was more vital for youth bullied at school and electronically. Being bullied either at school or electronically was associated with suicidality, with a stronger association for youth who experienced being bullied in both settings. CONCLUSION Our findings shed light on assessing early signs of depression to prevent the formation of suicidality among bullied youth.
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Affiliation(s)
- Tran H Nguyen
- Department of Interdisciplinary Health Sciences, College of Allied Health, Augusta University, Augusta, GA 30912, USA
| | - Gulzar Shah
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA
| | - Maham Muzamil
- Department of Education, Kinnaird College for Women's University, Lahore 54000, Pakistan
| | - Osaremhen Ikhile
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA
| | - Elizabeth Ayangunna
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA
| | - Ravneet Kaur
- Department of Family and Community Medicine, College of Medicine, University of Illinois, Chicago, IL 60612, USA
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Bommersbach TJ, Rosenheck RA, Everett AS. Suicide Hot Spots: Leveraging County-Level Data and Local Agencies to Target Prevention in High-Risk Areas. Public Health Rep 2021; 137:408-413. [PMID: 34011219 PMCID: PMC9109527 DOI: 10.1177/00333549211016606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
| | - Robert A. Rosenheck
- Department of Psychiatry, Yale University School of Medicine,
New Haven, CT, USA,US Department of Veterans Affairs, New England Mental Illness
Research, Education, and Clinical Center, West Haven, CT, USA
| | - Anita S. Everett
- Center for Mental Health Services, Substance Abuse and Mental
Health Services Administration, US Department of Health and Human Services,
Rockville, MD, USA,Anita S. Everett, MD, US Department of
Health and Human Services, Substance Abuse and Mental Health Services
Administration, Center for Mental Health Services, 5600 Fishers Ln, Rockville,
MD 20857, USA;
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Purtle J, Nelson KL, Counts NZ, Yudell M. Population-Based Approaches to Mental Health: History, Strategies, and Evidence. Annu Rev Public Health 2020; 41:201-221. [PMID: 31905323 PMCID: PMC8896325 DOI: 10.1146/annurev-publhealth-040119-094247] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
There is growing recognition in the fields of public health and mental health services research that the provision of clinical services to individuals is not a viable approach to meeting the mental health needs of a population. Despite enthusiasm for the notion of population-based approaches to mental health, concrete guidance about what such approaches entail is lacking, and evidence of their effectiveness has not been integrated. Drawing from research and scholarship across multiple disciplines, this review provides a concrete definition of population-based approaches to mental health, situates these approaches within their historical context in the United States, and summarizes the nature of these approaches and their evidence. These approaches span three domains: (a) social, economic, and environmental policy interventions that can be implemented by legislators and public agency directors, (b) public health practice interventions that can be implemented by public health department officials, and (c) health care system interventions that can be implemented by hospital and health care system leaders.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania 19104, USA;
| | - Katherine L Nelson
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania 19104, USA;
| | | | - Michael Yudell
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania 19104, USA
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Barath D, Chen J. Integrating local health departments to reduce suicide-related emergency department visits among people with substance use disorders - Evidence from the state of Maryland. Prev Med 2019; 129:105825. [PMID: 31473219 PMCID: PMC6864273 DOI: 10.1016/j.ypmed.2019.105825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022]
Abstract
Individuals with a substance use disorder (SUD) are six times as likely than those without a SUD to attempt suicide, however just 18% of the SUD population has received treatment. One of the barriers to treatment is appropriate and timely mental health services. This resulted in a substantial increase in emergency department (ED) visits related to SUD and suicide. This study sought to determine if the number of suicide-related ED visits for patients with SUD is associated with the types of mental health activities provided by their local health department (LHD). Specifically, we examined whether patients with a SUD aged 18-64 experienced reductions in suicide-related ED visits when their LHD directly engaged in mental health activities, such as (1) primary prevention for mental illness or (2) mental health services. Using linked datasets for 2012 from the National Profile of Local Health Departments, U.S. Census data, Area Health Resource File, and Maryland's State Emergency Department Databases (SEDD), we employed multivariable logistic regressions and instrumental variable models to examine this association. After adjusting for the endogeneity of LHDs' activity measures and controlling for individual-, hospital-, LHD-, and county-level characteristics, results demonstrated patients with a SUD experienced a 6% and 5% reduction in suicide-related ED visits when their LHD directly provided primary prevention for mental illness and mental health services, respectively. The results are small but significant, with robust standard errors. This study suggests LHDs may be key players in preventing suicide-related ED visits among the SUD population.
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Affiliation(s)
- Deanna Barath
- University of Maryland, 4200 Valley Drive, Suite 3310, College Park, MD 20742, United States of America.
| | - Jie Chen
- University of Maryland, 4200 Valley Drive, Suite 3310, College Park, MD 20742, United States of America.
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Local Health Departments' Promotion of Mental Health Care and Reductions in 30-Day All-Cause Readmission Rates in Maryland. Med Care 2018; 56:153-161. [PMID: 29271821 DOI: 10.1097/mlr.0000000000000850] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Individuals affected with mental health conditions, including mood disorders and substance abuse, are at an increased risk of hospital readmission. OBJECTIVES The objective of this study is to examine whether local health departments' (LHDs) active roles of promoting mental health are associated with reductions in 30-day all-cause readmission rates, a common quality metric. METHODS Using datasets linked from multiple sources, including 2012-2013 State Inpatient Databases for the State of Maryland, the National Association of County and City Health Officials Profiles Survey, the Area Health Resource File, and US Census data, we employed multivariate logistic models to examine whether LHDs' active provision of mental health preventive care, mental health services, and health promotion were associated with the likelihood of having any 30-day all-cause readmission. RESULTS Multivariate logistic regressions showed that LHDs' provision of mental health preventive care, mental health services, and health promotion were negatively associated with the likelihoods of having any 30-day readmission for adults 18-64 years old (odds ratios=0.71-0.82, P<0.001), and adults 65 and above (odds ratios=0.61-0.63, P<0.001, preventive care and services, respectively). These estimated associations were more prominent among individuals with mental illness and/or substance use disorders, African Americans, Medicare, and Medicaid enrollees. CONCLUSIONS Our results suggest that LHDs in Maryland that engage in mental health prevention, promotion, and coordination activities are associated with benefits for residents and for the health care system at large. Additional research is needed to evaluate LHD activities in other states to determine if these results are generalizable.
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Bommersbach T, Borger K, Steverman S, Manderscheid RW, Sharfstein J, Everett A. Behavioral Health, Local Health Department Accreditation, and Public Health 3.0: Leveraging Opportunities for Collaboration. Am J Public Health 2018; 108:1334-1340. [PMID: 30138073 PMCID: PMC6137774 DOI: 10.2105/ajph.2018.304533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2018] [Indexed: 11/04/2022]
Abstract
The rise of the opioid epidemic and the increasing rate of suicides have drawn attention to mental health and addiction and have highlighted the need for collaboration between public health and behavioral health. However, these 2 fields have had limited engagement with one another. The introduction of Public Health 3.0 and population-based financing models that promote prevention and value in health care have created opportunities and incentives for local health departments and behavioral health agencies and providers to work together. New undertakings include the creation of accountable care organizations, community health needs assessment requirements for all non-profit hospitals, local health department requirements to conduct community Health Assessments (CHA), and increasing numbers of public health departments that are pursing accreditation. We argue that by taking advantage of these opportunities and others, local health departments can play a vital role in addressing critical challenges in mental health and addiction facing their communities.
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Affiliation(s)
- Tanner Bommersbach
- Tanner Bommersbach is with the Yale School of Medicine, New Haven, CT. Kylee Borger is with the Rollins School of Public Health, Emory University, Atlanta, GA. Sarah Steverman is with Abt Associates, Bethesda, MD. Anita Everett is with the US Health and Human Services, Substance Abuse and Mental Health Services Administration, Rockville, MD. Ron W. Manderscheid is with the National Association of County Behavioral Health and Developmental Disability Directors, Washington, DC. Joshua Sharfstein is with Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kylee Borger
- Tanner Bommersbach is with the Yale School of Medicine, New Haven, CT. Kylee Borger is with the Rollins School of Public Health, Emory University, Atlanta, GA. Sarah Steverman is with Abt Associates, Bethesda, MD. Anita Everett is with the US Health and Human Services, Substance Abuse and Mental Health Services Administration, Rockville, MD. Ron W. Manderscheid is with the National Association of County Behavioral Health and Developmental Disability Directors, Washington, DC. Joshua Sharfstein is with Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sarah Steverman
- Tanner Bommersbach is with the Yale School of Medicine, New Haven, CT. Kylee Borger is with the Rollins School of Public Health, Emory University, Atlanta, GA. Sarah Steverman is with Abt Associates, Bethesda, MD. Anita Everett is with the US Health and Human Services, Substance Abuse and Mental Health Services Administration, Rockville, MD. Ron W. Manderscheid is with the National Association of County Behavioral Health and Developmental Disability Directors, Washington, DC. Joshua Sharfstein is with Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ron W Manderscheid
- Tanner Bommersbach is with the Yale School of Medicine, New Haven, CT. Kylee Borger is with the Rollins School of Public Health, Emory University, Atlanta, GA. Sarah Steverman is with Abt Associates, Bethesda, MD. Anita Everett is with the US Health and Human Services, Substance Abuse and Mental Health Services Administration, Rockville, MD. Ron W. Manderscheid is with the National Association of County Behavioral Health and Developmental Disability Directors, Washington, DC. Joshua Sharfstein is with Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Joshua Sharfstein
- Tanner Bommersbach is with the Yale School of Medicine, New Haven, CT. Kylee Borger is with the Rollins School of Public Health, Emory University, Atlanta, GA. Sarah Steverman is with Abt Associates, Bethesda, MD. Anita Everett is with the US Health and Human Services, Substance Abuse and Mental Health Services Administration, Rockville, MD. Ron W. Manderscheid is with the National Association of County Behavioral Health and Developmental Disability Directors, Washington, DC. Joshua Sharfstein is with Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anita Everett
- Tanner Bommersbach is with the Yale School of Medicine, New Haven, CT. Kylee Borger is with the Rollins School of Public Health, Emory University, Atlanta, GA. Sarah Steverman is with Abt Associates, Bethesda, MD. Anita Everett is with the US Health and Human Services, Substance Abuse and Mental Health Services Administration, Rockville, MD. Ron W. Manderscheid is with the National Association of County Behavioral Health and Developmental Disability Directors, Washington, DC. Joshua Sharfstein is with Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Chen J, Novak P, Goldman H. Public Health System-Delivered Mental Health Preventive Care Links to Significant Reduction of Health Care Costs. Popul Health Manag 2018; 21:462-468. [PMID: 29683382 DOI: 10.1089/pop.2018.0010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The objective was to estimate the association between health care expenditures and implementation of preventive mental health programs by local health departments (LHDs). Multilevel nationally representative data sets were linked to test the hypothesis that LHDs' provision of preventive mental health programs was associated with cost savings. A generalized linear model with log link and gamma distribution and state-fixed effects was used to estimate the association between LHDs' mental illness prevention services and total health care expenditures per person per year for adults aged 18 years and older. The main outcome measure was the annual total health care expenditure per person. The findings indicated that LHD provision of population-based prevention of mental illness was associated with an $824 reduction (95% confidence interval: -$1,562.94 to -$85.42, P < 0.05) in annual health care costs per person, after controlling for individual, LHD, community, and state characteristics. LHDs can play a critical role in establishing an integrated health care model. Their impact, however, has often been underestimated or neglected. Results showed that a small investment in LHDs may yield substantial cost savings at the societal level. The findings of this research are critical to inform policy decisions for the expansion of the Public Health 3.0 infrastructure.
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Affiliation(s)
- Jie Chen
- 1 Department of Health Services Administration, School of Public Health, University of Maryland , College Park, Maryland
| | - Priscilla Novak
- 1 Department of Health Services Administration, School of Public Health, University of Maryland , College Park, Maryland
| | - Howard Goldman
- 2 School of Medicine, University of Maryland , Baltimore, Maryland
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11
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Chen J, Bloodworth R, Novak P, Cook BL, Goldman HH, Rendall MS, Thomas SB, Reynolds CF. Reducing Preventable Hospitalization and Disparity: Association With Local Health Department Mental Health Promotion Activities. Am J Prev Med 2018; 54:103-112. [PMID: 29254550 PMCID: PMC5807070 DOI: 10.1016/j.amepre.2017.10.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 09/19/2017] [Accepted: 10/12/2017] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Serving as the center of community-engaged health programs, local health departments can play a critical role in promoting community mental health. The objectives of this study were to explore the association between local health department activities and (1) preventable hospitalizations for individuals with mental disorders, and (2) associated racial disparities in preventable hospitalizations. METHOD Employing the linked data sets of the 2012-2013 Healthcare Cost and Utilization Project state inpatient discharge file of the State of Maryland, the National Association of County and City Health Officials Profiles Survey, the Area Resource File, and U.S. Census data, the authors estimated the association between local health department activities (i.e., provision of mental health preventive care and community mental health promotion) and the reduction of the preventable hospitalizations for ambulatory care-sensitive conditions and coexisting mental disorders. All the data analyses were conducted during September 2016-August 2017. RESULTS Multilevel regression showed that local health departments' provision of mental health preventive care (OR=0.76, 95% CI=0.63, 0.92) and mental health promotion activities (OR=0.77, 95% CI=0.62, 0.94) were significantly associated with lower rates of preventable hospitalizations for individuals with ambulatory care-sensitive conditions and coexisting mental disorders. Decomposition results suggested that local health departments' direct provision of mental health preventive care could reduce 9% of the racial disparities. CONCLUSIONS Improving care coordination and integration are essential to meeting the growing demands for healthcare access, while controlling costs and improving quality of service delivery. These results suggest that it will be effective to engage local health departments in the integrated behavioral health system.
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Affiliation(s)
- Jie Chen
- Department of Health Services and Administration, School of Public Health, University of Maryland, College Park, Maryland.
| | - Robin Bloodworth
- Department of Health Services and Administration, School of Public Health, University of Maryland, College Park, Maryland
| | - Priscilla Novak
- Department of Health Services and Administration, School of Public Health, University of Maryland, College Park, Maryland
| | - Benjamin Le Cook
- Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Howard H Goldman
- Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Michael S Rendall
- Department of Sociology, University of Maryland, College Park, Maryland; Maryland Population Research Center, University of Maryland, College Park, Maryland
| | - Stephen B Thomas
- Department of Health Services and Administration, School of Public Health, University of Maryland, College Park, Maryland; Maryland Population Research Center, University of Maryland, College Park, Maryland; Maryland Center for Health Equity, University of Maryland, College Park, Maryland
| | - Charles F Reynolds
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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12
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Assessment of self-care and medication adherence in individuals with mental health conditions. J Am Pharm Assoc (2003) 2017; 57:S203-S210.e3. [DOI: 10.1016/j.japh.2017.02.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/06/2017] [Accepted: 02/16/2017] [Indexed: 11/22/2022]
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13
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Factors Perceived as Influencing Local Health Department Involvement in Mental Health. Am J Prev Med 2017; 52:64-73. [PMID: 27816382 DOI: 10.1016/j.amepre.2016.09.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 08/26/2016] [Accepted: 09/15/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Local health departments (LHDs) are potentially well positioned to implement population-based approaches to mental health promotion, but research indicates that most LHDs are not substantively engaged in activities to address mental health. Little is known about factors that influence if and how LHDs address population mental health. The objectives of this qualitative study were to (1) understand how LHD officials perceive population mental health; (2) identify factors that influence these perceptions and LHD activities to address population mental health; and (3) develop an empirically derived conceptual framework of LHD engagement in population mental health. METHODS Twenty-one semi-structured interviews were conducted with a purposive sample of LHD officials and analyzed using thematic content analysis in 2014-2015. Transcripts were double coded, inter-rater reliability statistics were calculated, and categories with κ ≥0.60 were retained. RESULTS Respondents perceived mental health as a public health issue and expressed that it has emerged as a priority through community health needs assessment processes, such as those conducted for health department accreditation. However, most LHDs were not substantively engaged in population mental health activities because of limited resources, knowledge, data, and hesitancy to infringe upon the territory of local behavioral health agencies. LHDs and local behavioral health agencies had difficulty communicating and collaborating because of divergent perspectives and financing arrangements. CONCLUSIONS LHD officials are eager to embrace population mental health, but resources, training and education, and systems-level changes are needed. Contemporary reforms to the structure and financing of the U.S. health system offer opportunities to address these challenges.
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Shah GH, Sotnikov S, Leep CJ, Ye J, Van Wave TW. Creating a Taxonomy of Local Boards of Health Based on Local Health Departments' Perspectives. Am J Public Health 2016; 107:72-80. [PMID: 27854524 DOI: 10.2105/ajph.2016.303516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To develop a local board of health (LBoH) classification scheme and empirical definitions to provide a coherent framework for describing variation in the LBoHs. METHODS This study is based on data from the 2015 Local Board of Health Survey, conducted among a nationally representative sample of local health department administrators, with 394 responses. The classification development consisted of the following steps: (1) theoretically guided initial domain development, (2) mapping of the survey variables to the proposed domains, (3) data reduction using principal component analysis and group consensus, and (4) scale development and testing for internal consistency. RESULTS The final classification scheme included 60 items across 6 governance function domains and an additional domain-LBoH characteristics and strengths, such as meeting frequency, composition, and diversity of information sources. Application of this classification strongly supports the premise that LBoHs differ in their performance of governance functions and in other characteristics. CONCLUSIONS The LBoH taxonomy provides an empirically tested standardized tool for classifying LBoHs from the viewpoint of local health department administrators. Future studies can use this taxonomy to better characterize the impact of LBoHs.
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Affiliation(s)
- Gulzar H Shah
- Gulzar H. Shah is with Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Sergey Sotnikov and Timothy W. Van Wave are with the Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA. Carolyn J. Leep and Jiali Ye are with National Association of County and City Health Officials, Washington, DC
| | - Sergey Sotnikov
- Gulzar H. Shah is with Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Sergey Sotnikov and Timothy W. Van Wave are with the Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA. Carolyn J. Leep and Jiali Ye are with National Association of County and City Health Officials, Washington, DC
| | - Carolyn J Leep
- Gulzar H. Shah is with Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Sergey Sotnikov and Timothy W. Van Wave are with the Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA. Carolyn J. Leep and Jiali Ye are with National Association of County and City Health Officials, Washington, DC
| | - Jiali Ye
- Gulzar H. Shah is with Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Sergey Sotnikov and Timothy W. Van Wave are with the Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA. Carolyn J. Leep and Jiali Ye are with National Association of County and City Health Officials, Washington, DC
| | - Timothy W Van Wave
- Gulzar H. Shah is with Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Sergey Sotnikov and Timothy W. Van Wave are with the Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA. Carolyn J. Leep and Jiali Ye are with National Association of County and City Health Officials, Washington, DC
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