Literature Collection

341

Costs and Utilization for Low Income Minority Patients with Depression in a Collaborative Care Model Implemented in a Community‐Based Academic Health System

Type: Journal Article

Authors: U. Patel, M. Blackmore, D. Stein, K. Carleton, H. Chung

Year: 2020

Publication Place: Chicago

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342

Costs of an intervention for primary care patients with medically unexplained symptoms: a randomized controlled trial

Type: Journal Article

Authors: Z. Luo, J. Goddeeris, J. C. Gardiner, R. C. Smith

Year: 2007

Publication Place: United States

Abstract: OBJECTIVE: This study sought to determine whether an intervention for patients with medically unexplained symptoms in primary care reduced total costs, components of cost, and longer-term costs and whether it led to decreased service use outside the health maintenance organization (HMO). METHODS: A randomized controlled trial involving 206 patients with medically unexplained symptoms was conducted in a staff-model HMO. The protocol emphasized the provider-patient relationship and included cognitive-behavioral therapy and pharmacological management. Cost data for medical treatments were derived from the HMO's electronic database. Patients were interviewed about work days lost and out-of-pocket expenses for medical care outside the HMO. RESULTS: The difference in total costs ($1,071) for the 12-month intervention was not significant. The treatment group had significantly higher costs for antidepressants than the usual-care group ($192 higher) during the intervention, and a larger proportion received antidepressants. The intervention group used less medical care outside the HMO and missed one less work day per month on average (1.23 days), indicating a slight improvement in productivity, but the difference was not significant. The between-group difference in estimated total cost was smaller in the year after the intervention (difference of $341) but were not significant. CONCLUSIONS: The total costs for the intervention group were not significantly different, but the group had greater use of antidepressants. Coupled with findings of improved mental health outcomes for this group in a previous study, the results indicate that the intervention may be cost-effective. The longer-term impact needs to be further studied.

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343

Costs of care for persons with opioid dependence in commercial integrated health systems

Type: Journal Article

Authors: F. L. Lynch, D. McCarty, J. Mertens, N. A. Perrin, C. A. Green, S. Parthasarathy, J. F. Dickerson, B. M. Anderson, D. Pating

Year: 2014

Publication Place: England

Abstract: BACKGROUND: When used in general medical practices, buprenorphine is an effective treatment for opioid dependence, yet little is known about how use of buprenorphine affects the utilization and cost of health care in commercial health systems. METHODS: The objective of this retrospective cohort study was to examine how buprenorphine affects patterns of medical care, addiction medicine services, and costs from the health system perspective. Individuals with two or more opioid-dependence diagnoses per year, in two large health systems (System A: n = 1836; System B: n = 4204) over the time span 2007-2008 were included. Propensity scores were used to help adjust for group differences. RESULTS: Patients receiving buprenorphine plus addiction counseling had significantly lower total health care costs than patients with little or no addiction treatment (mean health care costs with buprenorphine treatment = $13,578; vs. mean health care costs with no addiction treatment = $31,055; p < .0001), while those receiving buprenorphine plus addiction counseling and those with addiction counseling only did not differ significantly in total health care costs (mean costs with counseling only: $17,017; p = .5897). In comparison to patients receiving buprenorphine plus counseling, those with little or no addiction treatment had significantly greater use of primary care (p < .001), other medical visits (p = .001), and emergency services (p = .020). Patients with counseling only (compared to patients with buprenorphine plus counseling) used less inpatient detoxification (p < .001), and had significantly more PC visits (p = .001), other medical visits (p = .005), and mental health visits (p = .002). CONCLUSIONS: Buprenorphine is a viable alternative to other treatment approaches for opioid dependence in commercial integrated health systems, with total costs of health care similar to abstinence-based counseling. Patients with buprenorphine plus counseling had reduced use of general medical services compared to the alternatives.

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344

Costs of screening and brief intervention for illicit drug use in primary care settings

Type: Journal Article

Authors: G. Zarkin, J. Bray, J. Hinde, R. Saitz

Year: 2015

Publication Place: United States

Abstract: OBJECTIVE: In this article, the authors estimate implementation costs for illicit drug screening and brief intervention (SBI) and identify a key source of variation in cost estimates noted in the alcohol SBI literature. This is the first study of the cost of SBI for drug use only. METHOD: Using primary data collected from a clinical trial of illicit drug SBI (n = 528) and a hybrid costing approach, we estimated a per-service implementation cost for screening and two models of brief intervention. A taxonomy of activities was first compiled, and then resources and prices were attached to estimate the per-activity cost. Two components of the implementation cost, direct service delivery and service support costs, were estimated separately. RESULTS: Per-person cost estimates were $15.61 for screening, $38.94 for a brief negotiated interview, and $252.26 for an adaptation of motivational interviewing. (Amounts are in 2011 U.S. dollars.) Service support costs per patient are 5 to 7.5 times greater than direct service delivery costs per patient. Ongoing clinical supervision costs are the largest component of service support costs. CONCLUSIONS: Implementation cost estimates for illicit drug brief intervention vary greatly depending on the brief intervention method, and service support is the largest component of SBI costs. Screening and brief intervention cost estimates for drug use are similar to those published for alcohol SBI. Direct service delivery cost estimates are similar to costs at the low end of the distribution identified in the alcohol literature. The magnitude of service support costs may explain the larger cost estimates at the high end of the alcohol SBI cost distribution.

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345

Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system

Type: Journal Article

Authors: K. Yeung, J. Richards, E. Goemer, P. Lozano, G. Lapham, E. Williams, J. Glass, A. Lee, C. Achtmeyer, R. Caldeiro, R. Parrish, K. Bradley

Year: 2020

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346

Counseling versus antidepressant therapy for the treatment of mild to moderate depression in primary care: Economic analysis

Type: Journal Article

Authors: P. Miller, C. Chilvers, M. Dewey, K. Fielding, V. Gretton, B. Palmer, D. Weller, R. Churchill, I. Williams, N. Bedi, C. Duggan, A. Lee, G. Harrison

Year: 2003

Publication Place: England

Abstract: OBJECTIVE: To compare the cost-effectiveness of generic psychological therapy (counseling) with routinely prescribed antidepressant drugs in a naturalistic general practice setting for a follow-up period of 12 months. METHODs: Economic analysis alongside a randomized clinical trial with patient preference arm. Comparison of depression-related health service costs at 12 months. Cost-effectiveness analysis of bootstrapped trial data using net monetary benefits and acceptability curves. RESULTS: No significant difference between the mean observed costs of patients randomized to antidepressants or to counseling (342 pounds sterling vs 302 pounds sterling , p = .56 [t test]). If decision makers are not willing to pay more for additional benefits (value placed on extra patient with good outcome, denoted by K, is zero), then we find little difference between the treatment modalities in terms of cost-effectiveness. If decision makers do place value on additional benefit (K > 0 pounds sterling), then the antidepressant group becomes more likely to be cost-effective. This likelihood is in excess of 90% where decision makers are prepared to pay an additional 2,000 pounds sterling or more per additional patient with a good global outcome. The mean values for incremental net monetary benefits (INMB) from antidepressants are substantial for higher values of K (INMB = 406 pounds sterling when K = 2,500 pounds sterling). CONCLUSION: For a small proportion of patients, the counseling intervention (as specified in this trial) is a dominant cost-effective strategy. For a larger proportion of patients, the antidepressant intervention (as specified in this trial) is the dominant cost-effective strategy. For the remaining group of patients, cost-effectiveness depends on the value of K. Since we cannot observe K, acceptability curves are a useful way to inform decision makers.

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347

Counselling for mental health and psychosocial problems in primary care

Type: Journal Article

Authors: P. Bower, S. Knowles, P. A. Coventry, N. Rowland

Year: 2011

Publication Place: England

Abstract: BACKGROUND: The prevalence of mental health and psychosocial problems in primary care is high. Counselling is a potential treatment for these patients, but there is a lack of consensus over the effectiveness of this treatment in primary care. OBJECTIVES: To assess the effectiveness and cost effectiveness of counselling for patients with mental health and psychosocial problems in primary care. SEARCH STRATEGY: To update the review, the following electronic databases were searched: the Cochrane Collaboration Depression, Anxiety and Neurosis (CCDAN) trials registers (to December 2010), MEDLINE, EMBASE, PsycINFO and the Cochrane Central Register of Controlled Trials (to May 2011). SELECTION CRITERIA: Randomised controlled trials of counselling for mental health and psychosocial problems in primary care. DATA COLLECTION AND ANALYSIS: Data were extracted using a standardised data extraction sheet by two reviewers. Trials were rated for quality by two reviewers using Cochrane risk of bias criteria, to assess the extent to which their design and conduct were likely to have prevented systematic error. Continuous measures of outcome were combined using standardised mean differences. An overall effect size was calculated for each outcome with 95% confidence intervals (CI). Continuous data from different measuring instruments were transformed into a standard effect size by dividing mean values by standard deviations. Sensitivity analyses were undertaken to test the robustness of the results. Economic analyses were summarised in narrative form. There was no assessment of adverse events. MAIN RESULTS: Nine trials were included in the review, involving 1384 randomised participants. Studies varied in risk of bias, although two studies were identified as being at high risk of selection bias because of problems with concealment of allocation. All studies were from primary care in the United Kingdom and thus comparability was high. The analysis found significantly greater clinical effectiveness in the counselling group compared with usual care in terms of mental health outcomes in the short-term (standardised mean difference -0.28, 95% CI -0.43 to -0.13, n = 772, 6 trials) but not in the long-term (standardised mean difference -0.09, 95% CI -0.27 to 0.10, n = 475, 4 trials), nor on measures of social function (standardised mean difference -0.09, 95% CI -0.29 to 0.11, n = 386, 3 trials). Levels of satisfaction with counselling were high. There was some evidence that the overall costs of counselling and usual care were similar. There were limited comparisons between counselling and other psychological therapies, medication, or other psychosocial interventions. AUTHORS' CONCLUSIONS: Counselling is associated with significantly greater clinical effectiveness in short-term mental health outcomes compared to usual care, but provides no additional advantages in the long-term. Participants were satisfied with counselling. Although some types of health care utilisation may be reduced, counselling does not seem to reduce overall healthcare costs. The generalisability of these findings to settings outside the United Kingdom is unclear.

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348

Counselling in primary care: A study of the psychological impact and cost benefits for four chronic conditions

Type: Journal Article

Authors: Peter Spurgeon, Carolyn Hicks, Fred Barwell, Ian Walton, Tom Spurgeon

Year: 2005

Publication Place: United Kingdom: Taylor & Francis

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349

Creating clinical and economic "wins" through integrated case management: Lessons for physicians and health system administrators

Type: Journal Article

Authors: R. G. Kathol, C. Lattimer, W. Gold, R. Perez, D. Gutteridge

Year: 2011

Publication Place: United States

Abstract: The 5% of patients using 50% of health resources commonly have interacting and persistent multimorbid illnesses; concurrent mental health problems; impaired social networks; and/or difficulties in accessing care through the health system. To improve outcomes in these patients, it is necessary to overcome clinical and nonclinical barriers that lead to poor health, treatment resistance, high health care cost, and disability. This article describes an innovative complexity-based and outcome-oriented approach using integrated case management. It helps treating physicians and health administrators understand how to incorporate value-based case managers to optimize care for complex patients while better utilizing resources.

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350

Creating Evidence-Based Youth Mental Health Policy in Sub-Saharan Africa: A Description of the Integrated Approach to Addressing the Issue of Youth Depression in Malawi and Tanzania

Type: Journal Article

Authors: S. Kutcher, K. Perkins, H. Gilberds, M. Udedi, O. Ubuguyu, T. Njau, R. Chapota, M. Hashish

Year: 2019

Publication Place: Switzerland

Abstract: Addressing depression in young people is a health-care policy need in sub-Saharan Africa. There exists poor mental health literacy, high levels of stigma, and weak capacity at the community level to address this health-care need. These challenges are significant barriers to accessing mental health care for depression, soon to be the largest single contributor to the global burden of disease. We here describe an innovative approach that addresses these issues simultaneously while concurrently strengthening key mental health components in existing education and health-care systems as successfully applied in Malawi and replicated in Tanzania. Improving the pathway to care for young people with depression requires the following: improving mental health literacy (MHL) of communities, youth, and teachers; enhancing case identification and linking schools to community health clinics; improving the capacity of community health-care providers to identify, diagnose, and effectively treat depression in youth. Funded by Grand Challenges Canada, we developed and applied a program called "An Integrated Approach to Addressing the Challenge of Depression Among the Youth in Malawi and Tanzania" (IACD). This was an example of, a horizontally integrated pathway to care model designed to be applied in low-resource settings. The model is designed to 1) improve awareness/knowledge of mental health and mental disorders (especially depression) in communities; 2) enhance mental health literacy among youth and teachers within schools; 3) enhance capacity for teachers to identify students with possible depression; 4) create linkages between schools and community health clinics for improved access to mental health care for youth identified with possible depression; and 5) enhance the capacity of community-based health-care providers to identify, diagnose, and effectively treat youth with depression. With the use of interactive, youth-informed weekly radio programs, mental health curriculum training for teachers and peer educators in secondary schools, and a clinical competency training program for community-based health workers, the innovation created a "hub and spoke" model for improving mental health care for young people. Positive results obtained in Malawi and replicated in Tanzania suggest that this approach may provide an effective and potentially sustainable framework for enhancing youth mental health care, thus providing a policy ready framework that can be considered for application in sub-Saharan Africa.

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351

Creating Evidence-Based Youth Mental Health Policy in Sub-Saharan Africa: A Description of the Integrated Approach to Addressing the Issue of Youth Depression in Malawi and Tanzania

Type: Journal Article

Authors: S. Kutcher, K. Perkins, H. Gilberds, M. Udedi, O. Ubuguyu, T. Njau, R. Chapota, M. Hashish

Year: 2019

Publication Place: Switzerland

Abstract: Addressing depression in young people is a health-care policy need in sub-Saharan Africa. There exists poor mental health literacy, high levels of stigma, and weak capacity at the community level to address this health-care need. These challenges are significant barriers to accessing mental health care for depression, soon to be the largest single contributor to the global burden of disease. We here describe an innovative approach that addresses these issues simultaneously while concurrently strengthening key mental health components in existing education and health-care systems as successfully applied in Malawi and replicated in Tanzania. Improving the pathway to care for young people with depression requires the following: improving mental health literacy (MHL) of communities, youth, and teachers; enhancing case identification and linking schools to community health clinics; improving the capacity of community health-care providers to identify, diagnose, and effectively treat depression in youth. Funded by Grand Challenges Canada, we developed and applied a program called "An Integrated Approach to Addressing the Challenge of Depression Among the Youth in Malawi and Tanzania" (IACD). This was an example of, a horizontally integrated pathway to care model designed to be applied in low-resource settings. The model is designed to 1) improve awareness/knowledge of mental health and mental disorders (especially depression) in communities; 2) enhance mental health literacy among youth and teachers within schools; 3) enhance capacity for teachers to identify students with possible depression; 4) create linkages between schools and community health clinics for improved access to mental health care for youth identified with possible depression; and 5) enhance the capacity of community-based health-care providers to identify, diagnose, and effectively treat youth with depression. With the use of interactive, youth-informed weekly radio programs, mental health curriculum training for teachers and peer educators in secondary schools, and a clinical competency training program for community-based health workers, the innovation created a "hub and spoke" model for improving mental health care for young people. Positive results obtained in Malawi and replicated in Tanzania suggest that this approach may provide an effective and potentially sustainable framework for enhancing youth mental health care, thus providing a policy ready framework that can be considered for application in sub-Saharan Africa.

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352

Current strategies and barriers in integrated health care: A survey of publicly funded providers in Texas

Type: Journal Article

Authors: K. Sanchez, S. Thompson, L. Alexander

Year: 2010

Publication Place: United States

Abstract: OBJECTIVE: This study aimed to assess the extent to which publicly funded behavioral health and primary care providers in Texas have integrated physical and mental health care, the strategies used in implementation efforts and barriers encountered in integration. METHOD: A survey of behavioral health and primary care providers in Texas was conducted to examine providers' perceptions of efforts to integrate physical and mental health care in their organizations. Integration strategies utilized, health conditions targeted and barriers to implementation were evaluated. Descriptive analyses were conducted to determine organizations' current integration strategies and perceived clinical, organizational and financial barriers to integration. RESULTS: Out of 382 surveys initially distributed, a final subsample of 84 organizations with complete data was examined, a response rate of 22%. Among this sample of behavioral health and primary care providers, many shared integration practice strategies and endorsed similar barriers to integration. CONCLUSION: The findings from this study suggest that publicly funded organizations in Texas attempting to integrate physical and mental health care were aware of and employing practice strategies considered essential to the successful treatment of mental health issues in primary care settings. Attention to barriers that still exist, especially regarding workforce and funding issues, will be critical for organizations considering and attempting integration.

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353

Delivering On Accountable Care: Lessons From A Behavioral Health Program To Improve Access And Outcomes

Type: Journal Article

Authors: R. M. Clarke, J. Jeffrey, M. Grossman, T. Strouse, M. Gitlin, S. A. Skootsky

Year: 2016

Publication Place: United States

Abstract: Patients with behavioral health disorders often have worse health outcomes and have higher health care utilization than patients with medical diseases alone. As such, people with behavioral health conditions are important populations for accountable care organizations (ACOs) seeking to improve the efficiency of their delivery systems. However, ACOs have historically faced numerous barriers in implementing behavioral health population-based programs, including acquiring reimbursement, recruiting providers, and integrating new services. We developed an evidence-based, all-payer collaborative care program called Behavioral Health Associates (BHA), operated as part of UCLA Health, an integrated academic medical center. Building BHA required several innovations, which included using our enterprise electronic medical record for behavioral health referrals and documentation; registering BHA providers with insurance plans' mental health carve-out products; and embedding BHA providers in primary care practices throughout the UCLA Health system. Since 2012 BHA has more than tripled the number of patients receiving behavioral health services through UCLA Health. After receiving BHA treatment, patients had a 13 percent reduction in emergency department use. Our efforts can serve as a model for other ACOs seeking to integrate behavioral health care into routine practice.

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354

Delivering opioid maintenance treatment in rural and remote settings

Type: Journal Article

Authors: L. Berends, A. Larner, D. I. Lubman

Year: 2015

Publication Place: Australia

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355

Dementia care costs and outcomes: a systematic review

Type: Journal Article

Authors: Martin Knapp, Valentina Iemmi, Renee Romeo

Year: 2012

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356

Demographics, Birth Parameters, and Social Determinants of Health Among Opioid-Exposed Mother-Infant Dyads Affected by Neonatal Abstinence Syndrome in Pennsylvania, 2018-2019

Type: Journal Article

Authors: C. M. Decker, M. Mahar, C. L. Howells, Z. Q. Ma, C. T. Goetz, S. M. Watkins

Year: 2023

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357

Depression and comorbid PTSD in veterans: Evaluation of collaborative care programs and impact on utilization and costs

Type: Web Resource

Authors: D. Chan

Year: 2007

Publication Place: United States -- Washington

Abstract: Depressed patients with comorbid posttraumatic stress disorder (PTSD) are often more functionally impaired and more severely mentally ill than patients with depression alone. However, few studies have examined depression and comorbid PTSD in primary care settings. This dissertation describes three studies of depressed Veterans in primary cam clinics across the U.S. Data were drawn from two group-randomized trials of collaborative care depression treatment: a multi-site trial in nine Veterans Affairs (VA) primary care clinics, and a second trial based in the Seattle VA General Internal Medicine clinic. The first, cross-sectional study, found that PTSD screen positive (PTSD+) depressed patients had more frequent mental health, primary care depression, and outpatient visits, and a higher proportion were prescribed antidepressants than PTSD screen negative (PTSD-) patients. PTSD+ patients had correspondingly higher mental health, primary care depression, outpatient, and antidepressant costs. The second study evaluated the effectiveness and cost-effectiveness of collaborative care depression treatment compared to usual care over 9 months. Under collaborative care, a mental health team developed an individualized treatment plan for primary care providers, a social worker telephoned patients to enhance adherence, and suggested treatment modifications. In PTSD+ depressed veterans, there was a trend toward collaborative care improving depression symptoms and functioning but findings were not statistically significant. Collaborative care was associated with more depression-free days and moderately increased treatment costs. The third, pre-post comparison study, assessed whether depression care manager assessment, a crucial component of collaborative care, changed patients' knowledge and attitudes regarding mental health treatment among PTSD+ depressed veterans. The depression care manager assessment was a 45-minute phone intervention monitoring patient symptoms and problem-solving around treatment barriers. We found that this one-time assessment did not lead to greater knowledge, more positive attitudes towards depression treatment or less stigma in PTSD+ depressed veterans. As service members return from war, providers will see more patients with PTSD and depression and can expect increased outpatient and mental health services use and costs. There were some indications from these studies that collaborative care may be an effective treatment approach for depressed patients with PTSD, but more research is needed to confirm these trends.

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Disclaimer:

This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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358

Depression care and treatment in a chronically ill Medicare population

Type: Journal Article

Authors: H. Huang, J. Russo, A. M. Bauer, Y. F. Chan, W. Katon, D. Hogan, J. Unutzer

Year: 2013

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359

Depression In primary care: Bringing behavioral health care into the mainstream

Type: Journal Article

Authors: Harold Alan Pincus, Jeanine Houtsinger, Bachman John Knox, Donna Keyser

Year: 2005

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360

Depression in primary care: learning lessons in a national quality improvement program

Type: Journal Article

Authors: H. A. Pincus, C. Pechura, D. Keyser, J. Bachman, J. K. Houtsinger

Year: 2006

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