Search

The purpose of this study was to examine mental health treatment use among Vietnam Veterans with posttraumatic stress disorder and determine whether undergoing major surgery interrupted mental health treatment or increased the risk of psychiatric hospitalization. Using retrospective data from Veterans Health Administration’s electronic medical record system, a total of 3320 Vietnam-era surgery patients with preoperative posttraumatic stress disorder were identified and matched 1:4 with non-surgical patients with posttraumatic stress disorder. The receipt of surgery was associated with a decline in overall mental health treatment and posttraumatic stress disorder–specific treatment 1 month following surgery but not during any subsequent month thereafter. Additionally, surgery was not associated with psychiatric admission. [ABSTRACT FROM AUTHOR]

Background Positive associations between medication adherence and beneficial outcomes primarily come from studying filling/consumption behaviors after therapy initiation. Few studies have focused on what happens before initiation, the point from prescribing to dispensing of an initial prescription. Objective Our objective was to provide guidance and encourage high-quality research on the relationship between beneficial outcomes and initial medication adherence (IMA), the rate initially prescribed medication is dispensed. Methods Using generic adherence terms, an international research panel identified IMA publications from 1966 to 2014. Their data sources were classified as to whether the primary source reflected the perspective of a prescriber, patient, or pharmacist or a combined perspective. Terminology and methodological differences were documented among core (essential elements of presented and unpresented prescribing events and claimed and unclaimed dispensing events regardless of setting), supplemental (refined for accuracy), and contextual (setting-specific) design parameters. Recommendations were made to encourage and guide future research. Results The 45 IMA studies identified used multiple terms for IMA and operationalized measurements differently. Primary data sources reflecting a prescriber’s and pharmacist’s perspective potentially misclassified core parameters more often with shorter/nonexistent pre- and postperiods (1–14 days) than did a combined perspective. Only a few studies addressed supplemental issues, and minimal contextual information was provided. Conclusions General recommendations are to use IMA as the standard nomenclature, rigorously identify all data sources, and delineate all design parameters. Specific methodological recommendations include providing convincing evidence that initial prescribing and dispensing events are identified, supplemental parameters incorporating perspective and substitution biases are addressed, and contextual parameters are included. [ABSTRACT FROM AUTHOR]

The article focuses on a study of racial/ethnic disparities in monitoring metabolic parameters of patients with Schizophrenia receiving antipsychotic medications. Results in terms of demographic characteristics, the Repeated-Measures Model and logistic regression of laboratory monitoring at 7 years postbaseline are discussed. Limitations of the study are also mentioned.

Recent reports of antipsychotic medication use in pediatric populations describe large increases in rates of use. Much interest in the increasing use has focused on potentially inappropriate prescribing for non-Food and Drug Administration-approved uses and use amongst youth with no mental health diagnosis. Different studies of antipsychotic use have used different time periods, geographic and insurance populations of youth, and aggregations of diagnoses. We review recent estimates of use and comment on the similarities and dissimilarities in rates of use. We also report new data obtained on 11 health maintenance organizations that are members of the Mental Health Research Network in order to update and extend the knowledge base on use by diagnostic indication. Results indicate that most use in pediatric populations is for disruptive behaviors and not psychotic disorders. Differences in estimates are likely a function of differences in methodology; however, there is remarkable consistency in estimates of use by diagnosis. [ABSTRACT FROM AUTHOR]

ABSTRACT: Objectives: Numerous factors influencing medication adherence in chronically ill patients are well documented, but the paucity of studies concerning initial treatment course experiences represents a significant knowledge gap. As interventions targeting this crucial first phase can affect long-term adherence and outcomes, an international panel conducted a systematic literature review targeting behavioral or psychosocial risk factors. Methods: Eligible published articles presenting primary data from 1966 to 2011 were abstracted by independent reviewers through a validated quality instrument, documenting terminology, methodological approaches, and factors associated with initial adherence problems. Results: We identified 865 potentially relevant publications; on full review, 24 met eligibility criteria. The mean Nichol quality score was 47.2 (range 19–74), with excellent reviewer concordance (0.966, P < 0.01). The most prevalent pharmacotherapy terminology was initial, primary, or first-fill adherence. Articles described the following factors commonly associated with initial nonadherence: patient characteristics (n = 16), medication class (n = 12), physical comorbidities (n = 12), pharmacy co-payments or medication costs (n = 12), health beliefs and provider communication (n = 5), and other issues. Few studies reported health system factors, such as pharmacy information, prescribing provider licensure, or nonpatient dynamics. Conclusions: Several methodological challenges synthesizing the findings were observed. Despite implications for continued medication adherence and clinical outcomes, relatively few articles directly examined issues associated with initial adherence. Notwithstanding this lack of information, many observed factors associated with nonadherence are amenable to potential interventions, establishing a solid foundation for appropriate ongoing behaviors. Besides clarifying definitions and methodology, future research should continue investigating initial prescriptions, treatment barriers, and organizational efforts to promote better long-term adherence. [Copyright &y& Elsevier]

The article discusses practice facilitation cost. A research was done to find the variable cost associated with practice facilitation activities. It states that it was found that depending on the facilitator wages, and on the intervention, the cost of practice facilitation ranged between 9,670 dollars and 15,098 per practice per year and states that it has the potential to be cost neutral from a societal prospective.

Abstract: Aims: Cost burdens represent a significant barrier to medication adherence among chronically ill patients, yet financial pressures may be mitigated by clinical or organizational factors, such as treatment aligned with the Chronic Care Model (CCM). This study examines how perceptions of chronic illness care attenuate the relationship between adherence and cost burden. Methods: Surveys were administered to patients at 40 small community-based primary care practices. Medication adherence was assessed using the 4-item Morisky scale, while five cost-related items documented recent pharmacy restrictions. CCM experiences were assessed via the 20-item Patient Assessment of Chronic Illness Care (PACIC). Nested random effects models determined if chronic care perceptions modified the association between medication adherence and cost-related burden. Results: Of 1823 respondents reporting diabetes and other chronic diseases, one-quarter endorsed intrapersonal adherence barriers, while 23% restricted medication due of cost. Controlling for age and health status, the relationship between medication cost and CCM with adherence was significant; including PACIC scores attenuated cost-related problems patients with adequate or problematic adherence behavior. Conclusions: Patients experiencing treatment more consistent with the CCM reported better adherence and lower cost-related burden. Fostering highly activated patients and shared clinical decision making may help alleviate medication cost pressures and improve adherence. [Copyright &y& Elsevier]

Abstract: Objective: Veterans from the wars in Afghanistan and Iraq (OEF/OIF) report high rates of mental distress especially affective disorders. Ensuring continuity of care across institutions is a priority for both the Department of Defense (DoD) and the Veterans Health Administration (VHA), yet this process is not monitored nor are medical records integrated. This study assessed transition from DoD to VHA and subsequent psychiatric care of service members traumatically injured in OEF/OIF. Methods: Inpatients at a DoD trauma treatment facility discharged in FY02–FY06 (n=994) were tracked into the VHA via archival data (n=216 OEF/OIF veterans). Mental health utilization in both systems was analyzed. Results: VHA users were 9% female, 15% Hispanic; mean age 32 (SD=10; range 19–59). No DoD inpatients received diagnoses of post-traumatic stress disorder (PTSD); 21% had other mental health diagnoses, primarily drug abuse. In the VHA, 38% sought care within 6months of DoD discharge; 75% within 1year. VHA utilization increased over time, with 88–89% of the transition cohort seeking care in FY07–FY09. Most accessed VHA mental health services (81%) and had VHA psychiatric diagnoses (71%); half met criteria for depression (27%) or PTSD (38%). Treatment retention through FY09 was significantly greater for those receiving psychiatric care: 98% vs 62% of those not receiving psychiatric care (x2 =53.3; p<.001). Limitations: DoD outpatient data were not available. The study relied on administrative data. Conclusions: Although physical trauma led to hospitalization in the DoD, high rates of psychiatric disorders were identified in subsequent VHA care, suggesting delay in development or recognition of psychiatric problems. [Copyright &y& Elsevier]

Objectives: Assess glycemic monitoring and follow-up. Design: Retrospective study using administrative data (October 2001-September 2005). Setting: Veterans Health Administration. Participants: A nationwide sample of 39,226 outpatients aged 50 years or older with schizophrenia. Patients had no diagnosis or medications for diabetes at baseline. Measurements: Hemoglobin A1c tests; blood glucose tests with same-day low-density lipoprotein to approximate fasting glucose. Glycemic tests were combined to indicate a) prediabetic dysglycemia (100-125 mg/dl. proxy fasting glucose or 5-8%-6.4% hemoglobin Ale) and b) diabetic dysglycemia (≥126 proxy lasting glucose or ≥6.5% Ale). Results: Approximately one-third of patients (32%; 12.587) bad proxy fasting blood glucose or Ale tests in 2002: multiple tests were rare. The proportion tested increased to 40% by 2005. Test results suggested prediabetic dysglycemia for 5,345 tested patients (42% of those tested) and diabetic dysglycemia for 1,287 tested patients (10%) at baseline. In multivariate regression models, glycemic testing was associated with dyslycemia, hypertension, and younger age. Dysglycemia was associated with hypertension, dysglycemia.and older age. Follow-up treatment/diagnosis of diabetes occurred for 8%, of patients (11% of those tested) and was associated with baseline dysglycemia, hypertension, and younger age. Mortality (15% during the 4-year study) was higher among untested and untreated patients. Conclusions: Dysglycemia was prevalent among older patients with schizophrenia, although monitoring and follow-up were uncommon. Follow-up treatment correlated with survival. Despite evident utility of testing, few at-risk patients with schizophrenia were adequately monitored, diagnosed, or treated for dysglycemia. [ABSTRACT FROM AUTHOR]

The article focuses on a causal model that linked Participatory Decision Making (PDM) to improved clinical outcomes that included patient activation and medication adherence. It states that observational study was conducted in five family physician offices and diabetic patients. It reports that study of patients with type 2 diabetes resulted in improvements in hemoglobin levels and LDL cholesterol values by improving patient activation.