Literature Collection | The Integration Academy

11021

The Concordance of Electronic Health Record Diagnoses and Substance use Self-Reports Among Reproductive Aged Women Enrolled in a Community-Based Addiction Reduction Program

Type: Journal Article

Authors: A. G. Campbell, S. Naz, S. Gharbi, J. Chambers, S. Denne, D. K. Litzelman, S. E. Wiehe

Year: 2024

Abstract:

Substance use disorders among reproductive aged women are a major public health issue. There is little work investigating the validity and reliability of electronic health record (EHR) data for measuring substance use in this population. This study examined the concordance of self-reported substance use with clinical diagnoses of substance use, substance abuse and substance use disorder in EHR data. Reproductive age women enrolled in the Community-Based Addiction Reduction (CARE) program were interviewed by peer recovery coaches (PRC) at enrollment. That survey data was linked with EHR data (n = 102). Concordance between self-reported substance use and clinical diagnoses in the EHR was examined for opioids, cannabis/THC, and cocaine. Cohen's kappa, sensitivity, and specificity were calculated. The survey captured a higher number of women who use substances compared to the EHR. The concordance of self-report with EHR diagnosis varied by substance and was higher for opioids (17.6%) relative to cannabis/THC (8.8%), and cocaine (3.0%). Additionally, opioids had higher sensitivity (46.2%) and lower specificity (76.2%) relative to cannabis/THC and cocaine. Survey data collected by PRCs captured more substance use than EHRs, suggesting that EHRs underestimate substance use prevalence. The higher sensitivity and lower specificity of opioids was due to a larger number of women who had a diagnosis of opioid use in the EHR who did not self-report opioid use in the self-report survey relative to cannabis/THC and cocaine. Opioid self-report and diagnosis may be influenced by research setting, question wording, or receipt of medication for opioid use disorder.

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11022

The Connecticut Latino Behavioral Health System: A culturally informed community-academic collaboration

Type: Journal Article

Authors: Manuel Paris Jr, Michelle A. Silva, Esperanza Diaz, Luis E. Bedregal, Robert A. Cole, Luis M. Nava

Year: 2016

Publication Place: Washington

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11023

The construct and measurement equivalence of cocaine and opioid dependences: A National Drug Abuse Treatment Clinical Trials Network (CTN) study

Type: Journal Article

Authors: Li-Tzy Wu, Jeng-Jong Pan, Dan G. Blazer, Betty Tai, Robert K. Brooner, Maxine L. Stitzer, Ashwin A. Patkar, Jack D. Blaine

Year: 2009

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11024

The consultation conference: a new model of collaboration for child psychiatry and primary care

Type: Journal Article

Authors: M. I. Dobbins, N. Roberts, S. K. Vicari, D. Seale, R. Bogdanich, J. Record

Year: 2011

Publication Place: United States

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11025

The consultation process in primary care

Type: Book Chapter

Authors: Travis A. Cos, Robert A. DiTomasso, Carla Cirilli, Larry H. Finkelstein

Year: 2010

Publication Place: New York, NY, US

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11026

The contextualized technology adaptation process (CTAP): Optimizing health information technology to improve mental health systems

Type: Journal Article

Authors: Aaron R. Lyon, Jessica Knaster Wasse, Kristy Ludwig, Mark Zachry, Eric J. Bruns, Jurgen Unutzer, Elizabeth McCauley

Year: 2016

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11027

The continued rise of methamphetamine use among people who use heroin in the United States

Type: Journal Article

Authors: J. C. Strickland, W. W. Stoops, K. E. Dunn, K. E. Smith, J. R. Havens

Year: 2021

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11028

The Continuum of Intervention Models in Integrated Behavioral Health

Type: Journal Article

Authors: A. W. Sullivan, S. Lozowski-Sullivan

Year: 2021

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11029

The contribution of a mobile mental health unit to the promotion of primary mental health in rural areas in Greece: a 2-year follow-up

Type: Journal Article

Authors: V. Peritogiannis, C. Mantas, D. Alexiou, V. Fotopoulou, V. Mouka, T. Hyphantis

Year: 2011

Publication Place: France

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11030

The conversation revolution. Interview by Susan Solomon

Type: Journal Article

Authors: D. deBronkart

Year: 2013

Publication Place: United States

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11031

The Cost Effectiveness of Embedding a Behavioral Health Clinician into an Existing Primary Care Practice to Facilitate the Integration of Care: A Prospective, Case-Control Program Evaluation

Type: Journal Article

Authors: K. M. Ross, B. Klein, K. Ferro, D. A. McQueeney, R. Gernon, B. F. Miller

Year: 2019

Publication Place: United States

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11032

The cost effectiveness of embedding a behavioral health clinician into an existing primary care practice to facilitate the integration of care: A prospective, case–control program evaluation

Type: Journal Article

Authors: Kaile M. Ross, Betsy Klein, Katherine Ferro, Debra A. McQueeney, Rebecca Gernon, Benjamin F. Miller

Year: 2018

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11033

The Cost of Generalized Anxiety Disorder in Primary Care Settings: Results of the ANCORA Study

Type: Journal Article

Authors: Joan Rovira, Guillermina Albarracin, Luis Salvador, Javier Rejas, Eduardo Sanchez-Iriso, Juan M. Cabases

Year: 2012

Publication Place: Netherlands

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11034

The cost-effectiveness of expanded HIV counselling and testing in primary care settings: A first look

Type: Journal Article

Authors: K. A. Phillips, S. Fernyak

Year: 2000

Publication Place: ENGLAND

Abstract: OBJECTIVE: To estimate the cost-effectiveness of approaches to expanded HIV counselling and testing. DESIGN: A cost-effectiveness analysis. SETTING: Primary care practices in the USA. PARTICIPANTS: New patient visits. INTERVENTIONS: Two approaches were examined: (i) requesting all patients to complete an HIV-risk screening instrument, with counselling as well as testing offered only to patients disclosing risk factors ('risk histories' option); and (ii) routine offering of voluntary testing to all patients, with consent obtained but no pre-test counselling ('routine testing'). MAIN OUTCOME MEASURES: The primary outcome was the cost per infection identified. We also examined: (i) the costs and numbers of infections averted if individuals change their risk behaviours; and (ii) the additional years of life and quality-adjusted life years (QALY) gained as a result of earlier HIV testing and treatment for infected individuals. RESULTS: Routine testing is the most cost-effective approach to identifying infected individuals at an incremental cost of US$4200 per infection identified. Although using risk histories is more costly and less effective than routine testing, it becomes similarly cost-effective using plausible ranges for sensitivity analyses. If at least 10% of HIV-positive individuals change their behavior, both routine testing and using risk histories would save money. If testing identifies infected individuals one year earlier than they otherwise would have been diagnosed, routine testing would cost US$22000 per QALY gained. CONCLUSION: Routine testing is the most cost-effective approach to identifying new HIV infections. However, using risk histories may be similarly cost-effective under various assumptions. Both routine testing and using risk histories are more cost-effective than current practices.

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11035

The cost-effectiveness of group cognitive behavioral therapy compared with routine primary care for women with postnatal depression in the UK

Type: Journal Article

Authors: M. D. Stevenson, A. Scope, P. A. Sutcliffe

Year: 2010

Publication Place: United States

Abstract: OBJECTIVE: To assess the cost-effectiveness of group cognitive behavior therapy (gCBT) in comparison with routine primary care for women with postnatal depression in the UK. METHODS: Our analysis was based on a systematic literature review of the relative clinical effectiveness of gCBT compared with routine primary care and further reviews, supplemented with expert opinion of the likely cost of providing gCBT and the duration of comparative advantage for gCBT. Raw data were used to estimate a statistical relationship between changes in the Edinburgh Postnatal Depression Score (EPDS) values and changes in short-form six dimensions' (SF-6D) values. A mathematical model was constructed, and probabilistic sensitivity analyses were undertaken to estimate the mean cost per quality-adjusted life-year (QALY) and to evaluate the expected value of perfect information (EVPI). RESULTS: The mean cost per QALY from the stochastic analysis was estimated to be pound36,062; however, there was considerable uncertainty around this value. The EVPI was estimated to be greater than pound64 million; the key uncertainties were in the cost per woman of providing treatment and in the statistical relationship between changes in EPDS values and changes in SF-6D values. The expected value of perfect partial information for both of these parameters was in excess of pound25 million. CONCLUSIONS: Given the current information, the use of gCBT does not appear to be cost-effective; however, this decision is uncertain. The value of information analyses conducted indicates that further research to provide robust information on key parameters is needed and appears justified in cost-effective terms.

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11036

The cost-effectiveness of mirtazapine versus paroxetine in treating people with depression in primary care

Type: Journal Article

Authors: R. Romeo, A. Patel, M. Knapp, C. Thomas

Year: 2004

Publication Place: England

Abstract: Currently, there are no data available comparing cost-effectiveness of two antidepressants in the primary care setting in the UK. Alongside a randomized, double-blind, 24-week study of mirtazapine and paroxetine, data were prospectively collected on patients' use of hospital and non-hospital services and days off work. Costs were estimated in each treatment arm from National Health Service (NHS) and societal perspectives, and were compared with selected outcome measures (numbers of 17-item Hamilton Rating Scale for Depression (17-HAMD) responders and changes in Quality of Life in Depression Scale scores between baseline and 24-week endpoint) to explore and compare relative cost-effectiveness. Mirtazapine treatment resulted in a statistically significantly greater improvement in quality of life than paroxetine at endpoint (P=0.021). Although the 17-HAMD response rates were higher for the mirtazapine users at endpoint, the difference (7%) was not statistically significant (P=0.31). However, mean total societal costs per patient were 375 pounds less with mirtazapine (1850 pounds) compared to paroxetine (2225 pounds; P=0.32). Mean total NHS costs per patient were also lower (120 pounds) with mirtazapine (1408 pounds) compared to paroxetine (1528 pounds). The advantage for mirtazapine remained present on all variables analysed after performing sensitivity analyses. The results suggest that mirtazapine may be a cost-effective treatment choice compared to paroxetine for depression in a primary care setting.

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11037

The Costs and Cost-effectiveness of Collaborative Care for Adolescents With Depression in Primary Care Settings: A Randomized Clinical Trial

Type: Journal Article

Authors: D. R. Wright, W. L. Haaland, E. Ludman, E. McCauley, J. Lindenbaum, L. P. Richardson

Year: 2016

Publication Place: United States

Abstract: Importance: Depression is one of the most common adolescent chronic health conditions and can lead to increased health care use. Collaborative care models have been shown to be effective in improving adolescent depressive symptoms, but there are few data on the effect of such a model on costs. Objective: To evaluate the costs and cost-effectiveness of a collaborative care model for treatment of adolescent major depressive disorder in primary care settings. Design, Setting, and Participants: This randomized clinical trial was conducted between April 1, 2010, and April 30, 2013, at 9 primary care clinics in the Group Health system in Washington State. Participants were adolescents (age range, 13-17 years) with depression who participated in the Reaching Out to Adolescents in Distress (ROAD) collaborative care intervention trial. Interventions: A 12-month collaborative care intervention included an initial in-person engagement session, delivery of evidence-based treatments, and regular follow-up by master's level clinicians. Youth in the usual care control condition received depression screening results and could access mental health services and obtain medications through Group Health. Main Outcomes and Measures: Cost outcomes included intervention costs and per capita health plan costs, calculated from the payer perspective using administrative records. The primary effectiveness outcome was the difference in quality-adjusted life-years (QALYs) between groups from baseline to 12 months. The QALYs were calculated using Child Depression Rating Scale-Revised scores measured during the clinical trial. Cost and QALYs were used to calculate an incremental cost-effectiveness ratio. Results: Of those screened, 105 youths met criteria for entry into the study, and 101 were randomized to the intervention (n = 50) and usual care (n = 51) groups. Overall health plan costs were not significantly different between the intervention ($5161; 95% CI, $3564-$7070) and usual care ($5752; 95% CI, $3814-$7952) groups. Intervention delivery cost an additional $1475 (95% CI, $1230-$1695) per person. The intervention group had a mean daily utility value of 0.78 (95% CI, 0.75-0.80) vs 0.73 (95% CI, 0.71-0.76) for the usual care group. The net mean difference in effectiveness was 0.04 (95% CI, 0.02-0.09) QALY at $883 above usual care. The mean incremental cost-effectiveness ratio was $18239 (95% CI, dominant to $24408) per QALY gained, with dominant indicating that the intervention resulted in both a net cost savings and a net increase in QALYs. Conclusions and Relevance: Collaborative care for adolescent depression appears to be cost-effective, with 95% CIs far below the strictest willingness-to-pay thresholds. These findings support the use of collaborative care interventions to treat depression among adolescent youth. Trial Registration: clinicaltrials.gov Identifier: NCT01140464.

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11038

The costs incurred by the NHS in England due to the unnecessary prescribing of dependency-forming medications

Type: Journal Article

Authors: J. Davies, R. E. Cooper, J. Moncrieff, L. Montagu, T. Rae, M. Parhi

Year: 2022

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11039

The costs of crime during and after publicly funded treatment for opioid use disorders: a population-level study for the state of California

Type: Journal Article

Authors: E. Krebs, D. Urada, E. Evans, D. Huang, Y. I. Hser, B. Nosyk

Year: 2017

Publication Place: England

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11040

The course of newly presented unexplained complaints in general practice patients: a prospective cohort study

Type: Journal Article

Authors: H. Koch, M. A. van Bokhoven, P. J. Bindels, T. van der Weijden, G. J. Dinant, ter Riet

Year: 2009

Publication Place: England

Abstract: OBJECTIVE: Newly presented unexplained complaints (UCs) are common in general practice. Factors influencing the transition of newly presented into persistent UCs have been scarcely investigated. We studied the number and the nature of diagnoses made over time, as well as factors associated with UCs becoming persistent. Finally, we longitudinally studied factors associated with quality of life (QoL). METHODS: Prospective cohort study in general practice of patients presenting with a new UC. Data sources were case record forms, patient questionnaires and electronic medical registries at inclusion, 1, 6 and 12 months. Presence of complaints and diagnoses made over time were documented. Potential risk factors were assessed in mixed-effect logistic and linear regression models. RESULTS: Sixty-three GPs included 444 patients (73% women; median age 42) with unexplained fatigue (70%), abdominal complaints (14%) and musculoskeletal complaints (16%). At 12 months, 43% of the patients suffered from their initial complaints. Fifty-seven percent of the UCs remained unexplained. UCs had (non-life-threatening) somatic origins in 18% of the patients. QoL was often poor at presentation and tended to remain poor. Being a male [odds ratio (OR) 0.6; 95% confidence interval (CI) 0.4-0.8] and GPs' being more certain about the absence of serious disease (OR 0.9; 95% CI 0.8-0.9) were the strongest predictors of a diminished probability that the complaints would still be present and unexplained after 12 months. The strongest determinants of complaint persistence [regardless of (un)explicability] were duration of complaints >4 weeks before presentation (OR 2.6; 95% CI 1.6-4.3), musculoskeletal complaint at baseline (OR 2.3; 1.2-4.5), while the passage of time acted positively (OR 0.8 per month; 95% CI 0.78-0.84). Musculoskeletal complaints, compared to fatigue, decreased QoL on the physical domain (4.6 points; 2.6-6.7), while presence of psychosocial factors decreased mental QoL (5.0; 3.1-6.9). CONCLUSION: One year after initial presentation, a large proportion of newly presented UCs remained unexplained and unresolved. We identified determinants that GPs might want to consider in the early detection of patients at risk of UC persistence and/or low QoL.

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