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Goodwin L, Leightley D, Chui ZE, Landau S, McCrone P, Hayes RD, Jones M, Wessely S, Fear NT. Hospital admissions for non-communicable disease in the UK military and associations with alcohol use and mental health: a data linkage study. BMC Public Health 2020; 20:1236. [PMID: 32912179 PMCID: PMC7488237 DOI: 10.1186/s12889-020-09300-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/26/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Since the recent conflicts in Iraq and Afghanistan, the short-term focus of military healthcare research has been on the consequences of deployment for mental health and on those wounded or injured in combat. Now that these conflicts have ended for the UK Armed Forces, it is important to consider the longer term physical and mental health consequences, and just as importantly, the links between these. The aims of this study were to determine the most common physical conditions requiring a hospital admission in UK military personnel and whether they were more common in personnel with a mental health condition, smokers, and/or those misusing alcohol compared to those without. METHODS Data linkage of a prospective UK military cohort study to electronic admitted patient care records for England, Wales and Scotland. Nine thousand nine hundred ninety military personnel completed phase 2 of a military cohort study (56% response rate, data collected from 2007 to 2009), with analyses restricted to 86% of whom provided consent for linkage to healthcare records (n = 8602). Ninety percent were male and the mean age at phase 2 was 36 years. The outcome was physical non communicable diseases (NCDs) requiring a hospital admission which occurred after phase 2 of the cohort when the mental health, smoking and alcohol use exposure variables had been assessed until the end of March 2014. RESULTS The most common NCDs requiring a hospital admission were gastrointestinal disorders 5.62% (95% Confidence Intervals (CI) 5.04, 6.19) and joint disorders 5.60% (95% CI 5.02, 6.18). Number of NCDs requiring a hospital admission was significantly higher in those with a common mental disorder (Hazard ratio (HR) 1.40 (95% CI 1.16-1.68), post-traumatic stress disorder (HR 1.78 (95% CI 1.32-2.40)) and in current smokers (HR 1.35 (95% CI 1.12-1.64) compared to those without the disorder, and non-smokers, respectively. CONCLUSIONS Military personnel with a mental health problem are more likely to have an inpatient hospital admission for NCDs compared to those without, evidencing the clear links between physical and mental health in this population.
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Affiliation(s)
- L Goodwin
- Department of Psychology, University of Liverpool, Room 2.31 Eleanor Rathbone Building, Liverpool, L69 7ZA, UK.
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Liverpool Centre for Alcohol Research, Liverpool Health Partners, Liverpool, UK.
| | - D Leightley
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Z E Chui
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - S Landau
- Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - P McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - R D Hayes
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - M Jones
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - S Wessely
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - N T Fear
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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2
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Schure MB, Lindow JC, Greist JH, Nakonezny PA, Bailey SJ, Bryan WL, Byerly MJ. Use of a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention in a Community Population of Adults With Depression Symptoms: Randomized Controlled Trial. J Med Internet Res 2019; 21:e14754. [PMID: 31738173 PMCID: PMC6887812 DOI: 10.2196/14754] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 09/23/2019] [Accepted: 10/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background Although internet-based cognitive behavior therapy (iCBT) interventions can reduce depression symptoms, large differences in their effectiveness exist. Objective The aim of this study was to evaluate the effectiveness of an iCBT intervention called Thrive, which was designed to enhance engagement when delivered as a fully automated, stand-alone intervention to a rural community population of adults with depression symptoms. Methods Using no diagnostic or treatment exclusions, 343 adults with depression symptoms were recruited from communities using an open-access website and randomized 1:1 to the Thrive intervention group or the control group. Using self-reports, participants were evaluated at baseline and 4 and 8 weeks for the primary outcome of depression symptom severity and secondary outcome measures of anxiety symptoms, work and social adjustment, psychological resilience, and suicidal ideation. Results Over the 8-week follow-up period, the intervention group (n=181) had significantly lower depression symptom severity than the control group (n=162; P<.001), with a moderate treatment effect size (d=0.63). Moderate to near-moderate effect sizes favoring the intervention group were observed for anxiety symptoms (P<.001; d=0.47), work/social functioning (P<.001; d=0.39), and resilience (P<.001; d=0.55). Although not significant, the intervention group was 45% less likely than the control group to experience increased suicidal ideation (odds ratio 0.55). Conclusions These findings suggest that the Thrive intervention was effective in reducing depression and anxiety symptom severity and improving functioning and resilience among a mostly rural community population of US adults. The effect sizes associated with Thrive were generally larger than those of other iCBT interventions delivered as a fully automated, stand-alone intervention. Trial Registration ClinicalTrials.gov NCT03244878; https://clinicaltrials.gov/ct2/show/NCT03244878
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Affiliation(s)
- Mark B Schure
- Department of Health & Human Development, Montana State University, Bozeman, MT, United States.,Center for Mental Health Research and Recovery, Montana State University, Bozeman, MT, United States
| | - Janet C Lindow
- Center for Mental Health Research and Recovery, Montana State University, Bozeman, MT, United States.,Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States.,Biomedical Research and Education Foundation of Southern Arizona, Tucson, AZ, United States.,Southern Arizona VA Health Care System, Tucson, AZ, United States
| | - John H Greist
- Center for Mental Health Research and Recovery, Montana State University, Bozeman, MT, United States.,Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States.,School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States.,Healthcare Technology Systems, Madison, WI, United States.,Department of Cell Biology and Neuroscience, Montana State University, Bozeman, MT, United States
| | - Paul A Nakonezny
- Department of Population and Data Science, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sandra J Bailey
- Department of Health & Human Development, Montana State University, Bozeman, MT, United States.,Center for Mental Health Research and Recovery, Montana State University, Bozeman, MT, United States.,Montana State University Extension, Bozeman, MT, United States
| | - William L Bryan
- Center for Mental Health Research and Recovery, Montana State University, Bozeman, MT, United States.,One Montana, Bozeman, MT, United States
| | - Matthew J Byerly
- Center for Mental Health Research and Recovery, Montana State University, Bozeman, MT, United States.,Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States.,Southern Arizona VA Health Care System, Tucson, AZ, United States.,Department of Cell Biology and Neuroscience, Montana State University, Bozeman, MT, United States
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3
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Schaad KA, Bukhari AS, Brooks DI, Kocher JD, Barringer ND. The relationship between vitamin D status and depression in a tactical athlete population. J Int Soc Sports Nutr 2019; 16:40. [PMID: 31500652 PMCID: PMC6734287 DOI: 10.1186/s12970-019-0308-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/27/2019] [Indexed: 01/24/2023] Open
Abstract
Background Stressors inherent to the military, such as combat exposure, separation from family, and strenuous training, collectively contribute to compromised psychological resilience and greatly impact military performance. Methods This retrospective review of records was conducted to determine whether vitamin D status was associated with diagnoses of depression and if diagnoses differed by geographic location. Results Depression (defined using diagnostic codes) was more prevalent in individuals who were diagnosed with vitamin D deficiency (20.4%) than in individuals who were not (4.2%). After adjustment, vitamin D deficient diagnoses remained significantly associated with depression diagnoses (OR = 1.22; 95% CI, 1.11–1.33, p < 0.001). Furthermore, vitamin D deficient diagnoses were strongly associated with geographic latitude (r2 = 0.92, p = 0.002). Conclusion These results suggest that service members stationed at installations located at northerly latitudes may be at increased risk for vitamin D deficiency. Furthermore, vitamin D deficient service members may be at higher risk for diagnosis of depression. As a number of military service members avoid reporting symptoms or seeking treatment, vitamin D status may be a useful screening tool to identify service members at risk for depression.
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Affiliation(s)
- Kelly A Schaad
- U.S. Baylor Military Graduate Program in Nutrition, 3630 Stanley Road, San Antonio, TX, 78234, USA. .,Nutrition Services Department, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD, 20889, USA.
| | - Asma S Bukhari
- U.S. Baylor Military Graduate Program in Nutrition, 3630 Stanley Road, San Antonio, TX, 78234, USA.,Nutrition Services Department, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD, 20889, USA
| | - Daniel I Brooks
- Department of Research Programs, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD, 20889, USA
| | - Justin D Kocher
- U.S. Baylor Military Graduate Program in Nutrition, 3630 Stanley Road, San Antonio, TX, 78234, USA.,Health Readiness Center of Excellence, Capability Development Integration Directorate, 3630 Stanley Road, San Antonio, TX, 78234, USA
| | - Nicholas D Barringer
- U.S. Baylor Military Graduate Program in Nutrition, 3630 Stanley Road, San Antonio, TX, 78234, USA.,Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
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Mars NJ, Kerola AM, Kauppi MJ, Pirinen M, Elonheimo O, Sokka-Isler T. Patients with rheumatic diseases share similar patterns of healthcare resource utilization. Scand J Rheumatol 2019; 48:300-307. [PMID: 30836033 DOI: 10.1080/03009742.2018.1559878] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Healthcare service needs have changed with the use of effective treatment strategies. Using data from the modern era, we aimed to explore and compare health service-related direct costs in juvenile idiopathic arthritis (JIA), psoriatic arthritis (PsA), rheumatoid arthritis (RA), and axial spondyloarthritis (AxSpA). Methods: We linked a longitudinal, population-based clinical data set from Finland's largest non-university hospital's rheumatology clinic with an administrative database on health service-related direct costs in 2014. We compared all-cause costs and costs of comorbidities between adult patients with JIA, PsA, RA, and AxSpA (including ankylosing spondylitis). We also characterized patients with high healthcare resource utilization. Results: Cost distributions were similar between rheumatic diseases (p = 0.88). In adulthood, patients with JIA displayed a similar economic burden to much older patients with other inflammatory rheumatic diseases. A minority were high utilizers: among 119 patients with JIA, 15% utilized as much as the remaining 85%. For PsA (213 patients), RA (1086), and AxSpA (277), the high-utilization proportion was 10%. Both low and high utilizers showed rather low disease activity, but in high utilizers, the patient-reported outcomes were slightly worse, with the most distinct differences in pain levels. Of health service-related direct costs, index rheumatic diseases comprised only one-third (43.6% in JIA) and the majority were comorbidity costs. Conclusions: Patients with JIA, PsA, RA, and AxSpA share similar patterns of healthcare resource utilization, with substantial comorbidity costs and a minority being high utilizers. Innovations in meeting these patients' needs are warranted.
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Affiliation(s)
- N J Mars
- a Faculty of Medicine , University of Helsinki , Helsinki , Finland.,b Institute for Molecular Medicine Finland (FIMM) , University of Helsinki , Helsinki , Finland
| | - A M Kerola
- a Faculty of Medicine , University of Helsinki , Helsinki , Finland.,c Department of Internal Medicine , Päijät-Häme Central Hospital , Lahti , Finland
| | - M J Kauppi
- c Department of Internal Medicine , Päijät-Häme Central Hospital , Lahti , Finland.,d School of Medicine , University of Tampere , Tampere , Finland
| | - M Pirinen
- b Institute for Molecular Medicine Finland (FIMM) , University of Helsinki , Helsinki , Finland.,e Helsinki Institute for Information Technology HIIT and Department of Mathematics and Statistics , University of Helsinki , Helsinki , Finland.,f Department of Public Health , University of Helsinki , Helsinki , Finland
| | - O Elonheimo
- a Faculty of Medicine , University of Helsinki , Helsinki , Finland
| | - T Sokka-Isler
- g Department of Medicine , Jyväskylä Central Hospital , Jyväskylä , Finland
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Conway SJ, Himmelrich S, Feeser SA, Flynn JA, Kravet SJ, Bailey J, Hebert LC, Donovan SH, Kachur SG, Brown PM, Baumgartner WA, Berkowitz SA. Strategic Review Process for an Accountable Care Organization and Emerging Accountable Care Best Practices. Popul Health Manag 2018; 21:357-365. [DOI: 10.1089/pop.2017.0149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - John A. Flynn
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | | | - Susan H. Donovan
- Primary Care Coalition of Montgomery County Maryland, Silver Spring, Maryland
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Ongeri L, McCulloch C, Neylan T, Bukusi E, Macfarlane S, Othieno C, Ngugi A, Meffert S. Suicidality and associated risk factors in outpatients attending a general medical facility in rural Kenya. J Affect Disord 2018; 225:413-421. [PMID: 28850856 PMCID: PMC5663198 DOI: 10.1016/j.jad.2017.08.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/10/2017] [Accepted: 08/20/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Low-and-Middle-Income-Countries (LMICs) account for 75% of global suicides. While primary care populations in high-income countries (HIC) typically have higher prevalence of suicidal behavior relative to general populations, few studies have explored suicidal behavior among general medical outpatients in LMICs. This study addresses the research gap by characterizing potential risk factors for suicidal ideation in a large general medical outpatient setting in rural Kenya. METHODS A cross-sectional study of adult general medical outpatients attending a rural sub-county hospital in Kaloleni, Kenya. Primary outcomes included major depressive disorder (MDD), posttraumatic stress disorder (PTSD) and suicidal behavior measured by the Mini International Neuropsychiatric Interview (MINI 5.0). We use binary logistic regression to model suicidality, mental disorders, intimate partner violence, and lifetime abuse. RESULTS 394 outpatients completed the assessment. The prevalence of SI over the past month was 20%. 18% of those with suicidal ideation over the past month also attempted suicide in the past month. Participants who met criteria for MDD (suicidality item removed) were 19 times [CI: 4.56, 79.05] more likely to report suicidal ideation compared to those without MDD (adjusted odds ratio 12.15 [CI: 2.66, 55.49]). LIMITATIONS This was a cross sectional study design with convenience sampling and hence vulnerable to selection and recall bias. CONCLUSION The prevalence of SI and its strong association with actual suicide attempt in this population, make an urgent public health case for intervention. These data identify MDD as a highly significant correlate of SI.
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Affiliation(s)
- L. Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya,Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya,Corresponding author at: Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya. (L. Ongeri)
| | - C.E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA,Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - T.C. Neylan
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya,Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, USA
| | - E. Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya,Global Health Sciences, University of California San Francisco, California, USA
| | - S.B. Macfarlane
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya,Department of Psychiatry, University of Nairobi, Kenya
| | - C. Othieno
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya,Centre for Population Health Sciences, Faculty of Health Sciences-East Africa, Aga Khan University, Nairobi, Kenya
| | - A.K. Ngugi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya,Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, USA
| | - S.M. Meffert
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya,Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, USA
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7
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Schuttner L, Zhang Z, Kuo A. REDUCING ER USE THROUGH A TRAINEE-DESIGNED, INTERPROFESSIONAL CARE GROUP FOR HIGH-UTILIZING CHRONICALLY ILL PATIENTS: A PILOT PROGRAM. JOURNAL OF INTERPROFESSIONAL EDUCATION & PRACTICE 2017; 9:86-90. [PMID: 28966984 PMCID: PMC5619876 DOI: 10.1016/j.xjep.2017.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Healthcare utilization is skewed to a subset of high-need, high-use patients, but optimal models of care are not known. PURPOSE To reduce emergency room (ER) use and hospital readmissions, trainees designed an innovative model of care delivery for chronically ill, high-utilizing adult patients. METHODS Enrolled patients (N = 65) joined an interprofessional care program (nutrition, behavioral health, pharmacy, and care coordination), located in a single ambulatory clinic with extended hours. RESULTS Evaluated by generalized linear mixed-effects models, the primary outcome of all-cause ER visits showed a significant decreasing trend after enrollment, from an increasing odds of ER visits (OR 1.07) in the 12-months prior to the program, compared to a decreasing trend post-enrollment (OR 0.88). Implementation and completion of the program was cost neutral. DISCUSSION AND CONCLUSIONS This pilot supports team-based ambulatory care models that address the diverse needs of chronically ill patients, with a focus on improving select health services utilization.
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Affiliation(s)
- Linnaea Schuttner
- Department of Internal Medicine-Pediatrics, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095
| | - Zhenyu Zhang
- Department of Biostatistics, University of California Los Angeles, 650 Charles E. Young Dr. South, 51-254 CHS, Los Angeles, CA 90095
| | - Alice Kuo
- Department of Internal Medicine-Pediatrics, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095
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8
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Chen KH, Hsieh HM, Chen CM, Chiu HC, Lee IC. The Long-Term Trends of the Association Between Falls Among the Elderly in Taiwan and their Utilization of Medical Facilities. INT J GERONTOL 2017. [DOI: 10.1016/j.ijge.2016.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cholera R, Pence BW, Gaynes BN, Bassett J, Qangule N, Pettifor A, Macphail C, Miller WC. Depression and Engagement in Care Among Newly Diagnosed HIV-Infected Adults in Johannesburg, South Africa. AIDS Behav 2017; 21:1632-1640. [PMID: 27251436 DOI: 10.1007/s10461-016-1442-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Delayed engagement in HIV care threatens the success of HIV treatment programs in sub-Saharan Africa and may be influenced by depression. We examined the relationship between depression prior to HIV diagnosis and engagement in HIV care at a primary care clinic in Johannesburg, South Africa. We screened 1683 patients for depression prior to HIV testing using the Patient Health Questionnaire-9. Among patients who tested positive for HIV we assessed linkage to HIV care, defined as obtaining a CD4 count within 3 months. Among those who linked to care and were eligible for ART, we assessed ART initiation within 3 months. Multivariable Poisson regression with a robust variance estimator was used to assess the association between depression and linkage to care or ART initiation. The prevalence of HIV was 26 % (n = 340). Among HIV-infected participants, the prevalence of depression was 30 %. The proportion of linkage to care was 80 % among depressed patients and 73 % among patients who were not depressed (risk ratio 1.08; 95 % confidence interval 0.96, 1.23). Of the participants who linked to care, 81 % initiated ART within 3 months in both depressed and not depressed groups (risk ratio 0.99; 95 % confidence interval 0.86, 1.15). Depression was not associated with engagement in HIV care in this South African primary care setting. Our unexpected findings suggest that some depressed HIV-infected patients might be more likely to engage in care than their counterparts without depression, and highlight the complex relationship between depression and HIV infection. These findings have led us to propose a new framework relating HIV infection, depression, and the population under study.
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Affiliation(s)
- R Cholera
- UNC School of Medicine, Pediatric Education Office, 230 MacNider Hall, Campus Box 7593, Chapel Hill, NC, 27599, USA.
| | - B W Pence
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - B N Gaynes
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, USA
| | - J Bassett
- Witkoppen Health and Welfare Center, Johannesburg, South Africa
| | - N Qangule
- Witkoppen Health and Welfare Center, Johannesburg, South Africa
| | - A Pettifor
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - C Macphail
- Collaborative Research Network for Mental Health and Well-being in Rural Communities, University of New England, Armidale, Australia
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - W C Miller
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
- Department of Medicine, UNC School of Medicine, Chapel Hill, NC, USA
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10
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Gloster AT, Meyer AH, Lieb R. Psychological flexibility as a malleable public health target: Evidence from a representative sample. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2017. [DOI: 10.1016/j.jcbs.2017.02.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dinkel A, Schneider A, Schmutzer G, Brähler E, Häuser W. Family physician-patient relationship and frequent attendance of primary and specialist health care: Results from a German population-based cohort study. PATIENT EDUCATION AND COUNSELING 2016; 99:1213-1219. [PMID: 26924610 DOI: 10.1016/j.pec.2016.02.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 02/09/2016] [Accepted: 02/12/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the association between the quality of the family physician-patient relationship and frequent attendance of primary and specialist health care. METHODS Cross-sectional survey of a representative German population sample (N=2.266). Family physician-patient relationship was assessed with the Patient Doctor Relationship Questionnaire (PDRQ-9). Determinants of frequent attendance were analyzed using logistic regression. RESULTS Frequent attendance of family physicians was associated with lower income (OR 1.43, 95% CI 1.02-2.00), not being in paid work (OR 1.58, CI 1.08-2.30), psychological distress (OR 1.14, CI 1.07-1.22), somatic symptoms (OR 1.07, CI 1.04-1.11), and physical comorbidity (OR 1.54, CI 1.36-1.74) in the multivariate analysis. Frequent attendance of specialists was related to psychological distress (OR 1.12, CI 1.04-1.20), somatic symptoms (OR 1.08, CI 1.04-1.11), and physical comorbidity (OR 1.69, CI 1.48-1.93) in the multivariate analysis. Quality of the relationship was associated with frequent attendance only in the univariate analyses. A stronger relationship with the family physician was not associated with reduced contact with specialists. CONCLUSIONS The quality of the family physician-patient relationship is not independently associated with frequent attendance. PRACTICE IMPLICATIONS Family physicians should be aware that need factors, i.e. symptom burden and physical comorbidities, are main drivers of frequent attendance.
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Affiliation(s)
- Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Antonius Schneider
- Institute of General Practice, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Gabriele Schmutzer
- Department of Medical Psychology and Medical Sociology, Universität Leipzig, Leipzig, Germany.
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, Universität Leipzig, Leipzig, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg Universität Mainz, Mainz, Germany.
| | - Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department of Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany.
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12
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Robinson RL, Grabner M, Palli SR, Faries D, Stephenson JJ. Covariates of depression and high utilizers of healthcare: Impact on resource use and costs. J Psychosom Res 2016; 85:35-43. [PMID: 27212668 DOI: 10.1016/j.jpsychores.2016.04.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To characterize healthcare costs, resource use, and treatment patterns of survey respondents with a history of depression who are high utilizers (HUds) of healthcare and to identify factors associated with high utilization. METHODS Adults with two or more depression diagnoses identified from the HealthCore Integrated Research Database were invited to participate in the CODE study, which links survey data with 12-month retrospective claims data. Patient surveys provided data on demographics, general health, and symptoms and/or comorbidities associated with depression. Similar clinical conditions also were identified from the medical claims. Factors associated with high utilization were identified using logistic regression models. RESULTS Of 3132 survey respondents, 1921 were included, 193 of whom were HUds (defined as those who incurred the top 10% of total all-cause costs in the preceding 12months). Mean total annual healthcare costs were eightfold greater for HUds than for non-HUds ($US56,145 vs. $US6,954; p<.0001). HUds incurred more inpatient encounters (p<.0001) and emergency department (p=.01) and physician office visits (p<.0001). Similar findings were observed for mental healthcare costs/resource use. HUds were prescribed twice as many medications (total mean: 16.86 vs. 8.32; psychotropic mean: 4.11 vs. 2.61; both p<.0001). HUds reported higher levels of depression severity, fatigue, sleep difficulties, pain, high alcohol consumption, and anxiety. Predictors of becoming a HUd included substance use, obesity, cardiovascular disease, comorbidity severity, psychiatric conditions other than depression, and pain. CONCLUSION Focusing on pain, substance use, and psychiatric conditions beyond depression may be effective approaches to reducing high costs in patients with depression.
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Affiliation(s)
| | | | - Swetha Rao Palli
- CTI Clinical Trial and Consulting Services, Cincinnati, OH, United States
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Broder MS, Chang E, Romanus D, Cherepanov D, Neary MP. Healthcare and economic impact of diarrhea in patients with carcinoid syndrome. World J Gastroenterol 2016; 22:2118-2125. [PMID: 26877616 PMCID: PMC4726684 DOI: 10.3748/wjg.v22.i6.2118] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/26/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To examine healthcare resource utilization patterns and costs accrued by carcinoid syndrome (CS) patients with and without diarrhea.
METHODS: We conducted a retrospective cohort study using MarketScan® data from 1/1/2002-12/31/2012. Newly diagnosed CS patients had 1 medical claim for CS (ICD-9-CM code 259.2) plus either ≥ 1 additional claim for CS or for carcinoid tumors (ICD-9-CM 209.x), and had no evidence of CS for 1 year prior to index CS diagnosis, in commercially-insured patients < 65 years old. Patients were required to have continuous enrollment one year prior and after index date (first claim with CS diagnosis in the ID period). We identified patients with evidence of non-infectious diarrhea (ICD-9-CM codes 564.5 and 787.91) within one year from the index date. Overall and CS-related healthcare resource utilization and costs were compared between patients with and without non-infectious diarrhea during the one year period after the index date.
RESULTS: There were 2822 newly diagnosed CS patients; 534 (18.9%) had evidence of non-infectious diarrhea. Compared to patients without non-infectious diarrhea, non-infectious diarrhea patients more commonly had at ≥ 1 CS-related hospitalization (13.7% vs 7.2%), ≥ 1 CS-related ED visit (11.0% vs 4.4%), and CS-related office visits in one year (6.9 vs 4.1; all P < 0.001). After adjusting for demographics, region, number of chronic conditions and the Charlson Comorbidity Index, the proportions of patients with any and with CS-related hospitalizations were 9.7% and 6.8% higher, respectively, among non-infectious diarrhea patients compared to those with without non-infectious diarrhea (P < 0.001). Unadjusted costs were significantly higher among non-infectious diarrhea patients vs those without non-infectious diarrhea. The non-infectious diarrhea group was also more costly, with adjusted mean annual costs of $81610, compared to $51719 in the group without non-infectious diarrhea (P < 0.001).
CONCLUSION: Diarrhea is burdensome and costly in CS patients. Reduction of CS-related healthcare expenditures may be achievable through preventive treatment and appropriate management of diarrhea in CS.
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Using Patient Health Questionnaire-9 item parameters of a common metric resulted in similar depression scores compared to independent item response theory model reestimation. J Clin Epidemiol 2015; 71:25-34. [PMID: 26475569 DOI: 10.1016/j.jclinepi.2015.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 09/29/2015] [Accepted: 10/06/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To investigate the validity of a common depression metric in independent samples. STUDY DESIGN AND SETTING We applied a common metrics approach based on item-response theory for measuring depression to four German-speaking samples that completed the Patient Health Questionnaire (PHQ-9). We compared the PHQ item parameters reported for this common metric to reestimated item parameters that derived from fitting a generalized partial credit model solely to the PHQ-9 items. We calibrated the new model on the same scale as the common metric using two approaches (estimation with shifted prior and Stocking-Lord linking). By fitting a mixed-effects model and using Bland-Altman plots, we investigated the agreement between latent depression scores resulting from the different estimation models. RESULTS We found different item parameters across samples and estimation methods. Although differences in latent depression scores between different estimation methods were statistically significant, these were clinically irrelevant. CONCLUSION Our findings provide evidence that it is possible to estimate latent depression scores by using the item parameters from a common metric instead of reestimating and linking a model. The use of common metric parameters is simple, for example, using a Web application (http://www.common-metrics.org) and offers a long-term perspective to improve the comparability of patient-reported outcome measures.
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Everett AS, Reese J, Coughlin J, Finan P, Smith M, Fingerhood M, Berkowitz S, Young JH, Johnston D, Dunbar L, Zollinger R, Ju J, Reuland M, Strain EC, Lyketsos C. Behavioural health interventions in the Johns Hopkins Community Health Partnership: integrated care as a component of health systems transformation. Int Rev Psychiatry 2014; 26:648-56. [PMID: 25553782 PMCID: PMC6588403 DOI: 10.3109/09540261.2014.979777] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Health systems in the USA have received a mandate to improve quality while reining in costs. Several opportunities have been created to stimulate this transformation. This paper describes the design, early implementation and lessons learned for the behavioural components of the John Hopkins Community Health Partnership (J-CHiP) programme. J-CHiP is designed to improve health outcomes and reduce the total healthcare costs of a group of high healthcare use patients who are insured by the government-funded health insurance programmes, Medicaid and Medicare. These patients have a disproportionately high prevalence of depression, other psychiatric conditions, and unhealthy behaviours that could be addressed with behavioural interventions. The J-CHiP behavioural intervention is based on integrated care models, which include embedding mental health professionals into primary sites. A four-session behaviour-based protocol was developed to motivate self-efficacy through illness management skills. In addition to staff embedded in primary care, the programme design includes expedited access to specialist psychiatric services as well as a community outreach component that addresses stigma. The progress and challenges involved with developing this programme over a relatively short period of time are discussed.
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Affiliation(s)
- Anita S Everett
- Department of Psychiatry, Johns Hopkins University , Baltimore, Maryland , USA
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Zanone Poma S, Vicentini S, Siviero F, Grossi A, Toniolo E, Cocchio S, Baldo V, De Leo D. Life span history of non-fatal suicidal behaviours in a large sample of general practitioners' patients: data from Rovigo, Northern Italy. Community Ment Health J 2014; 50:981-6. [PMID: 24563137 DOI: 10.1007/s10597-014-9715-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 02/16/2014] [Indexed: 10/25/2022]
Abstract
A survey about history of non-fatal suicidal behaviour was performed on 1,171 subjects in the waiting room of general practitioners' practices in the territory of Rovigo (Northern Italy). The mean age of interviewed subjects was 52.9 ± 17.0, with a majority of female individuals. Two and two percent admitted previous experience of non-suicidal self-injury, 4.7 % admitted having had serious suicidal thoughts/plans, and 1.8 % reported at least one suicide attempt. Compared to the rest of the sample, people with history of suicidal behaviours resulted to be of younger age (p < .05), whilst their level of well-being was poorer (p < .001). When compared to the results of the Italian arm of the European Study of the Epidemiology of Mental Disorders, carried out on general population samples, the present study produces higher rates of suicidality, despite the much higher mean age of the interviewed subjects compared to the general population.
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Affiliation(s)
- S Zanone Poma
- Department of Mental Health, Local Health Authority (ULSS 18) of Rovigo, Rovigo, Italy,
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