7 results on '"Frayne SM"'
Search Results
2. Anticoagulation in atrial fibrillation: impact of mental illness.
- Author
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Schmitt SK, Turakhia MP, Phibbs CS, Moos RH, Berlowitz D, Heidenreich P, Chiu VY, Go AS, Friedman SA, Than CT, and Frayne SM
- Subjects
- Aged, Alcoholism complications, Anxiety Disorders complications, Depressive Disorder complications, Female, Humans, Male, Middle Aged, Psychotic Disorders complications, Retrospective Studies, Stress Disorders, Post-Traumatic complications, Anticoagulants therapeutic use, Atrial Fibrillation complications, Mental Disorders complications, Warfarin therapeutic use
- Abstract
Objectives: To characterize warfarin eligibility and receipt among Veterans Health Administration (VHA) patients with and without mental health conditions (MHCs)., Study Design: Retrospective cohort study., Methods: This observational study identified VHA atrial fibrillation (AF) patients with and without MHCs in 2004. We examined unadjusted MHC-related differences in warfarin eligibility and warfarin receipt among warfarin-eligible patients, using logistic regression for any MHC and for specific MHCs (adjusting for sociodemographic and clinical characteristics)., Results: Of 125,670 patients with AF, most (96.8%) were warfarin-eligible based on a CHADS2 stroke risk score. High stroke risk and contraindications to anticoagulation were both more common in patients with MHC. Warfarin-eligible patients with MHC were less likely to receive warfarin than those without MHC (adjusted odds ratio [AOR], 0.90; 95% CI, 0.87-0.94). The association between MHC and warfarin receipt among warfarin-eligible patients varied by specific MHC. Patients with anxiety disorders (AOR, 0.86; 95% CI, 0.80-0.93), psychotic disorders (AOR, 0.77; 95% CI, 0.65-0.90), and alcohol use disorders (AOR 0.62, 95% CI 0.54-0.72) were less likely to receive warfarin than patients without these conditions, whereas patients with depressive disorders and posttraumatic stress disorder were no less likely to receive warfarin than patients without these conditions., Conclusions: Compared with patients with AF without MHCs, those with MHCs are less likely to be eligible for warfarin receipt and, among those eligible, are less likely to receive such treatment. Although patients with AF with MHC need careful assessment of bleeding risk, this finding suggests potential missed opportunities for more intensive therapy among some individuals with MHCs.
- Published
- 2015
3. Mental illness and intensification of diabetes medications: an observational cohort study.
- Author
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Frayne SM, Holmes TH, Berg E, Goldstein MK, Berlowitz DR, Miller DR, Pogach LM, Laungani KJ, Lee TT, and Moos R
- Subjects
- Aged, Female, Glycated Hemoglobin analysis, Humans, Male, Middle Aged, United States, Veterans, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 drug therapy, Hypoglycemic Agents administration & dosage, Mental Disorders complications
- Abstract
Background: Mental health condition (MHC) comorbidity is associated with lower intensity care in multiple clinical scenarios. However, little is known about the effect of MHC upon clinicians' decisions about intensifying antiglycemic medications in diabetic patients with poor glycemic control. We examined whether delay in intensification of antiglycemic medications in response to an elevated Hemoglobin A1c (HbA1c) value is longer for patients with MHC than for those without MHC, and whether any such effect varies by specific MHC type., Methods: In this observational study of diabetic Veterans Health Administration (VA) patients on oral antiglycemics with poor glycemic control (HbA1c ≥8) (N =52,526) identified from national VA databases, we applied Cox regression analysis to examine time to intensification of antiglycemics after an elevated HbA1c value in 2003-2004, by MHC status., Results: Those with MHC were no less likely to receive intensification: adjusted Hazard Ratio [95% CI] 0.99 [0.96-1.03], 1.13 [1.04-1.23], and 1.12 [1.07-1.18] at 0-14, 15-30 and 31-180 days, respectively. However, patients with substance use disorders were less likely than those without substance use disorders to receive intensification in the first two weeks following a high HbA1c, adjusted Hazard Ratio 0.89 [0.81-0.97], controlling for sex, age, medical comorbidity, other specific MHCs, and index HbA1c value., Conclusions: For most MHCs, diabetic patients with MHC in the VA health care system do not appear to receive less aggressive antiglycemic management. However, the subgroup with substance use disorders does appear to have excess likelihood of non-intensification; interventions targeting this high risk subgroup merit attention.
- Published
- 2014
- Full Text
- View/download PDF
4. Mental illness and warfarin use in atrial fibrillation.
- Author
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Walker GA, Heidenreich PA, Phibbs CS, Go AS, Chiu VY, Schmitt SK, Ananth L, and Frayne SM
- Subjects
- Anticoagulants adverse effects, Chi-Square Distribution, Drug Interactions, Drug Monitoring, Health Status Indicators, Humans, International Normalized Ratio, United States, United States Department of Veterans Affairs, Warfarin adverse effects, Anticoagulants therapeutic use, Atrial Fibrillation drug therapy, Mental Disorders, Practice Patterns, Physicians' statistics & numerical data, Warfarin therapeutic use
- Abstract
Objectives: To determine whether atrial fibrillation (AF) patients with mental health conditions (MHCs) were less likely than AF patients without MHCs to be prescribed warfarin and, if receiving warfarin, to maintain an International Normalized Ratio (INR) within the therapeutic range., Study Design: Detailed chart review of AF patients using a Veterans Health Administration (VHA) facility in 2003., Methods: For a random sample of 296 AF patients, records identified clinician-diagnosed MHCs (independent variable) and AF-related care in 2003 (dependent variables), receipt of warfarin, INR values below/above key thresholds, and time spent within the therapeutic range (2.0-3.0) or highly out of range. Differences between the MHC and comparison groups were examined using X2 tests and logistic regression controlling for age and comorbidity., Results: Among warfarin-eligible AF patients (n = 246), 48.5% of those with MHCs versus 28.9% of those without MHCs were not treated with warfarin (P = .004). Among those receiving warfarin and monitored in VHA, highly supratherapeutic INRs were more common in the MHC group; for example, 27.3% versus 1.6% had any INR >5.0 (P <.001). Differences persisted after adjusting for age and comorbidity., Conclusions: MHC patients with AF were less likely than those without MHC to have adequate management of their AF care. Interventions directed at AF patients with MHC may help to optimize their outcomes.
- Published
- 2011
5. Using administrative data to identify mental illness: what approach is best?
- Author
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Frayne SM, Miller DR, Sharkansky EJ, Jackson VW, Wang F, Halanych JH, Berlowitz DR, Kader B, Rosen CS, and Keane TM
- Subjects
- Aged, Databases as Topic, Female, Health Services Research methods, Humans, International Classification of Diseases, Male, Middle Aged, Quality of Health Care, Statistics as Topic, United States, United States Department of Veterans Affairs, Algorithms, Mental Disorders diagnosis
- Abstract
The authors estimated the validity of algorithms for identification of mental health conditions (MHCs) in administrative data for the 133 068 diabetic patients who used Veterans Health Administration (VHA) nationally in 1998 and responded to the 1999 Large Health Survey of Veteran Enrollees. They compared various algorithms for identification of MHCs from International Classification of Diseases, 9th Revision (ICD-9) codes with self-reported depression, posttraumatic stress disorder, or schizophrenia from the survey. Positive predictive value (PPV) and negative predictive value (NPV) for identification of MHC varied by algorithm (0.65-0.86, 0.68-0.77, respectively). PPV was optimized by requiring > or =2 instances of MHC ICD-9 codes or by only accepting codes from mental health visits. NPV was optimized by supplementing VHA data with Medicare data. Findings inform efforts to identify MHC in quality improvement programs that assess health care disparities. When using administrative data in mental health studies, researchers should consider the nature of their research question in choosing algorithms for MHC identification.
- Published
- 2010
- Full Text
- View/download PDF
6. Mental illness-related disparities in length of stay: algorithm choice influences results.
- Author
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Frayne SM, Berg E, Holmes TH, Laungani K, Berlowitz DR, Miller DR, Pogach L, Jackson VW, and Moos R
- Subjects
- Adult, Aged, Choice Behavior, Cohort Studies, Comorbidity, Databases as Topic, Female, Health Services Research methods, Hospitals, Veterans, Humans, Male, Mental Disorders epidemiology, Middle Aged, United States epidemiology, United States Department of Veterans Affairs, Veterans, Algorithms, Diabetes Mellitus epidemiology, Healthcare Disparities statistics & numerical data, Length of Stay statistics & numerical data, Mental Disorders diagnosis
- Abstract
Methodological challenges arise when one uses various Veterans Health Administration (VHA) data sources, each created for distinct purposes, to characterize length of stay (LOS). To illustrate this issue, we examined how algorithm choice affects conclusions about mental health condition (MHC)-related differences in LOS for VHA patients with diabetes nationally (n = 784,321). We assembled a record-level database of all fiscal year (FY) 2003 inpatient care. In 10 steps, we sequentially added instances of inpatient care from various VHA sources. We processed databases in three stages, truncating stays at the beginning and end of FY03 and consolidating overlapping stays. For patients with MHCs versus those without MHCs, mean LOS was 17.7 versus 13.6 days, respectively (p < 0.001), for the crudest algorithm and 37.2 versus 21.7 days, respectively (p < 0.001), for the most refined algorithm. Researchers can improve the quality of data applied to VHA systems redesign by applying methodological considerations raised by this study to inform LOS algorithm choice.
- Published
- 2010
- Full Text
- View/download PDF
7. Disparities in diabetes care: impact of mental illness.
- Author
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Frayne SM, Halanych JH, Miller DR, Wang F, Lin H, Pogach L, Sharkansky EJ, Keane TM, Skinner KM, Rosen CS, and Berlowitz DR
- Subjects
- Age Factors, Aged, Cohort Studies, Cross-Sectional Studies, Databases as Topic, Diabetes Mellitus blood, Female, Glycated Hemoglobin analysis, Health Care Surveys, Humans, Male, Middle Aged, Racial Groups, Sex Factors, United States epidemiology, Veterans, Diabetes Complications prevention & control, Diabetes Mellitus epidemiology, Mental Disorders epidemiology, Quality Indicators, Health Care
- Abstract
Background: Emerging evidence indicates that patients with mental health conditions (MHCs) may receive less intensive medical care. Diabetes serves as a useful condition in which to test for MHC-related disparities in care. We examined whether quality measures for diabetes care are worse for patients with or without MHCs., Methods: This national, cross-sectional study included 313 586 noninstitutionalized Veterans Health Administration patients with diabetes (identified from diagnostic codes and prescriptions) whose Veterans Health Administration facility transmitted laboratory data to a central database; 76 799 (25%) had MHCs (based on diagnostic codes for depressed mood, anxiety, psychosis, manic symptoms, substance use disorders, personality disorders, and other categories). National data from Veterans Health Administration records, Medicare claims, and a national survey were linked to characterize 1999 diabetes care., Results: Failure to meet diabetes performance measures was more common in patients with MHCs: unadjusted odds ratio (95% confidence interval) was 1.24 (1.22-1.27) for no hemoglobin A(1c) testing, 1.25 (1.23-1.28) for no low-density lipoprotein cholesterol testing, 1.05 (1.03-1.07) for no eye examination, 1.32 (1.30-1.35) for poor glycemic control, and 1.17 (1.15-1.20) for poor lipemic control. Disparities persisted after case mix adjustment and were more pronounced with specific MHCs (psychotic, manic, substance use, and personality disorders). The percentage not meeting diabetes care standards increased with increasing number of MHCs., Conclusion: Patients with mental illness merit special attention in national diabetes quality improvement efforts.
- Published
- 2005
- Full Text
- View/download PDF
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