Literature Collection

11261

The Impact of Alternative Payment in Chronically Ill and Older Patients in the Patient-centered Medical Home

Type: Journal Article

Authors: C. A Salzberg, A. Bitton, S. R. Lipsitz, C. Franz, S. Shaykevich, L. P. Newmark, J. Kwatra, D. W. Bates

Year: 2017

Publication Place: United States

Abstract: BACKGROUND: Patient-centered medical home (PCMH) has gained prominence as a promising model to encourage improved primary care delivery. There is a paucity of studies that evaluate the impact of payment models in the PCMH. OBJECTIVES: We sought to examine whether coupling coordinated, team-based care transformation plan with a novel reimbursement model affects outcomes related to expenditures and utilization. RESEARCH DESIGN: Interrupted time-series model with a difference-in-differences approach to assess differences between intervention and control groups, across time periods attributable to PCMH transformation and/or payment change. RESULTS: Although results were modest and mixed overall, PCMH with payment reform is associated with a reduction of $1.04 (P=0.0347) per member per month (PMPM) in pharmacy expenditures. Patients with hypertension, hyperlipidemia, diabetes, and coronary atherosclerosis enrolled in PCMH without payment reform experienced reductions in emergency department visits of 2.16 (P<0.0001), 2.42 (P<0.0001), 3.98 (P<0.0001), and 3.61 (P<0.0001) per 1000 per month. Modest increases in inpatient admission were seen among these patients in PCMH either with or without payment reform. Patients 65 and older enrolled in PMCH without payment reform experienced reductions in pharmacy expenditures $2.35 (P=0.0077) PMPM with a parallel reduction in pharmacy standardized cost of $2.81 (P=0.0174) PMPM indicative of a reduction in the intensity of drug utilization. CONCLUSIONS: We conclude that PCMH implementation coupled with an innovative payment arrangement generated mixed results with modest improvements with respect to pharmacy expenditures, but no overall financial improvement. However, we did see improvement within specific groups, especially older patients and those with chronic conditions.

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11262

The impact of an emergency department peer navigator (EDPN) program in improving clinical outcomes and healthcare utilization in an urban setting

Type: Journal Article

Authors: C. Santos, C. Ramdin, J. Becceril, Al Kik, M. Jefri, L. Nelson

Year: 2023

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11263

The impact of an online educational intervention on attitudes of primary care clinicians toward managing patients with substance use disorders

Type: Journal Article

Authors: Miadette PhengPhal, Margaret Knight

Year: 2024

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11264

The impact of Assertive Community Treatment on utilization of primary care and other outpatient health services: the North Carolina experience

Type: Journal Article

Authors: E. Wiley-Exley, M. E. Domino, T. C. Ricketts, G. Cuddeback, B. J. Burns, J. Morrissey

Year: 2013

Publication Place: United States

Abstract: BACKGROUND: A number of states have implemented Assertive Community Treatment (ACT) teams statewide. The extent to which team-based care in ACT programs substitutes or complements primary care and other types of health services is relatively unknown outside of clinical trials. OBJECTIVE: To analyze whether investments in ACT yield savings in primary care and other outpatient health services. DESIGN: Patterns of medical and mental health service use and costs were examined using Medicaid claims files from 2000 to 2002 in North Carolina. Two-part models and negative binomial models compared individuals on ACT (n = 1,065 distinct individuals) with two control groups of Medicaid enrollees with severe mental illness not receiving ACT services (n = 1,426 and n = 41,717 distinct individuals). RESULTS: We found no evidence that ACT affected utilization of other outpatient health services or primary care; however, ACT was associated with a decrease in other outpatient health expenditures (excluding ACT) through a reduction in the intensity with which these services were used. Consistent with prior literature, ACT also decreased the likelihood of emergency room visits and inpatient psychiatric stays. CONCLUSIONS: Given the increasing emphasis and efforts toward integrating physical health and behavioral health care, it is likely that ACT will continue to be challenged to meet the physical health needs of its consumers. To improve primary care receipt, this may mean a departure from traditional staffing patterns (e.g., the addition of a primary care doctor and nurse) and expansion of the direct services ACT provides to incorporate physical health treatments.

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11265

The impact of behavioral health consultations on medical encounter duration in pediatric primary care: A retrospective match-controlled study

Type: Journal Article

Authors: A. R. Riley, J. K. Paternostro, B. L. Walker, D. V. Wagner

Year: 2019

Publication Place: United States

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11266

The impact of benzodiazepine exposure on treatment retention in an open-access methadone program: A retrospective cohort study

Type: Journal Article

Authors: Kenneth L. Morford, Jeanette M. Tetrault, Bin Zhou, Fangyong Li, Brynna Gleeson, Jennifer Edelman, Michael D. Stein, Declan T. Barry, Lynn Madden

Year: 2022

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11267

The Impact of Brief Interventions on Functioning Among those Demonstrating Anxiety, Depressive, and Adjustment Disorder Symptoms in Primary Care: The Effectiveness of the Primary Care Behavioral Health (PCBH) Model

Type: Journal Article

Authors: K. M. Wilfong, J. L. Goodie, J. C. Curry, C. L. Hunter, P. C. Kroke

Year: 2022

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11268

The impact of buprenorphine on treatment of opioid dependence in a Medicaid population: Recent service utilization trends in the use of buprenorphine and methadone

Type: Journal Article

Authors: B. D. Stein, A. J. Gordon, M. Sorbero, A. W. Dick, J. Schuster, C. Farmer

Year: 2012

Publication Place: Ireland

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11269

The impact of cocaine use in patients enrolled in opioid agonist therapy in Ontario, Canada

Type: Journal Article

Authors: A. M. Franklyn, J. K. Eibl, G. J. Gauthier, D. Pellegrini, N. E. Lightfoot, D. C. Marsh

Year: 2017

Publication Place: Netherlands

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11270

The impact of cognitive challenges in major depression: the role of the primary care physician

Type: Journal Article

Authors: G. Mattingly, R. H. Anderson, S. G. Mattingly, E. Q. Anderson

Year: 2016

Publication Place: England

Abstract: Nearly 1 in 5 Americans will struggle with major depression in their lives; some will have recurring bouts. Recent psychiatric research has given new attention to the prevalence of cognitive deficits in major depression and the impact such deficits have on remission and overall life functioning. When depression is partially treated i.e., leaving residual symptoms, patients have higher rates of relapse and lower functional outcomes. Impaired cognitive functioning is a frequent residual symptom, persisting in about 45% of patients even when emotional symptoms have improved, and results in a disproportionate share of the functional impairment, particularly in the workplace. Patients with depression have disrupted circuitry in brain regions responsible for cognition and it is therefore important to screen depressed patients for cognitive as well as emotional symptoms. Cognitive dysfunction should be evaluated in every mood disordered patient with validated self-report scales such as the Patient Health Questionnaire-9 or the Beck Depression Inventory and objective measures of cognitive function are also very very useful. Two easily administered tests are the Trails B Test and the Digit Symbol Substitution Test. Each take less than two minutes and measure working memory, executive function, and processing speed and can track cognitive improvement in depressed patients. Treatment of cognitive dysfunction in major depression is complicated by the 'serotonin conundrum': SSRI's frequently do not treat to full remission, and can cause cognitive blunting-actually adding to cognitive problems. Based on recent data including results from a recently completed meta-analysis by McIntyre and colleagues, an evidence-based algorithm for treating cognitive symptoms in depression is presented. A hierarchy of antidepressants and augmentation strategies based on the best available evidence is discussed. In conclusion, cognitive symptoms in major depressive disorder have been recognized as a target of therapeutic improvement by the FDA and have become a focus of clinical importance.

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11271

The Impact of Collaborative Documentation on Person-Centered Care: Textual Analysis of Clinical Notes

Type: Journal Article

Authors: V. Stanhope, N. Yoo, E. Matthews, D. Baslock, Y. Hu

Year: 2024

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11272

The impact of comorbid psychiatric disorders on methadone maintenance treatment in opioid use disorder: A prospective cohort study

Type: Journal Article

Authors: Tea Rosic, Leen Naji, Monica Bawor, Brittany B. Dennis, Carolyn Plater, David C. Marsh, Lehana Thabane, Zainab Samaan

Year: 2017

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11273

The impact of comorbidity of mental and physical conditions on role disability in the US adult household population

Type: Journal Article

Authors: Kathleen R. Merikangas, Minnie Ames, Lihong Cui, Paul E. Stang, T. B. Ustun, Michael Von Korff, Ronald C. Kessler

Year: 2007

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11274

The Impact of COVID on Adolescent Anxiety: Trends, Clinical Considerations, and Treatment Recommendations

Type: Journal Article

Authors: I. Milaniak, S. Davidson, B. Leewiwatanakul, T. D. Benton

Year: 2024

Abstract:

Rates of clinical anxiety have increased during COVID and post-quarantine in youth, with older adolescent girls and youth with minorized racial, gender, and sexuality identities most vulnerable. Given that increased anxiety to a threatening/uncertain environment is adaptive, it is important to conceptualize anxiety from a balanced perspective, evaluating its functionality. For adolescents continuing to struggle with re-integration into their social environments and school avoidance, an exposure framework is necessary to encourage approach behaviors to recalibrate the social environment as safe. Disproportion between demand for services and available providers increased greatly due to the pandemic. Evidence-based treatments for anxiety can be delivered via telehealth, in school, or in primary care settings.

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11275

The impact of COVID-19 on healthcare delivery for people who use opioids: a scoping review

Type: Journal Article

Authors: K. Alexander, M. Pogorzelska-Maziarz, A. Gerolamo, N. Hassen, E. L. Kelly, K. L. Rising

Year: 2021

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11276

The impact of COVID-19 on opioid treatment programs in the United States

Type: Journal Article

Authors: L. A. Goldsamt, A. Rosenblum, P. Appel, P. Paris, N. Nazia

Year: 2021

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11277

The impact of COVID-19 on psychiatric clinical encounters among low-income racially-diverse children

Type: Journal Article

Authors: S. A. Rusk, J. DiBari, D. M. Mason, M. Li, X. Hong, G. Wang, C. Pearson, G. Mirolli, T. L. Cheng, M. D. Kogan, B. Zuckerman, X. Wang

Year: 2024

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11278

The Impact of Early Substance Use Disorder Treatment Response on Treatment Outcomes Among Pregnant Women With Primary Opioid Use

Type: Journal Article

Authors: M. Tuten, H. Fitzsimons, M. Hochheimer, H. E. Jones, M. S. Chisolm

Year: 2018

Publication Place: United States

Abstract: OBJECTIVES: This study examined the impact of early patient response on treatment utilization and substance use among pregnant participants enrolled in substance use disorder (SUD) treatment. METHODS: Treatment responders (TRs) and treatment nonresponders (TNRs) were compared on pretreatment and treatment measures. Regression models predicted treatment utilization and substance use. RESULTS: TR participants attended more treatment and had lower rates of substance use relative to TNR participants. Regression models for treatment utilization and substance use were significant. Maternal estimated gestational age (EGA) and baseline cocaine use were negatively associated with treatment attendance. Medication-assisted treatment, early treatment response, and baseline SUD treatment were positively associated with treatment attendance. Maternal EGA was negatively associated with counseling attendance; early treatment response was positively associated with counseling attendance. Predictors of any substance use at 1 month were maternal education, EGA, early treatment nonresponse, and baseline cocaine use. The single predictor of any substance use at 2 months was early treatment nonresponse. Predictors of opioid use at 1 month were maternal education, EGA, early treatment nonresponse, and baseline SUD treatment. Predictors of opioid use at 2 months were early treatment nonresponse, and baseline cocaine and marijuana use. Predictors of cocaine use at 1 month were early treatment nonresponse, baseline cocaine use, and baseline SUD treatment. Predictors of cocaine use at 2 months were early treatment nonresponse and baseline cocaine use. CONCLUSIONS: Early treatment response predicts more favorable maternal treatment utilization and substance use outcomes. Treatment providers should implement interventions to maximize patient early response to treatment.

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11279

The impact of electronic health record functions on patterns of depression treatment in primary care

Type: Journal Article

Authors: Elizabeth B. Matthews, Ayse Akincigil

Year: 2022

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11280

The Impact of Health and Social Care Integration on Children and Young People's Outcomes: What Can Be Determined from Scotland's Administrative Data?

Type: Journal Article

Authors: J. Soraghan, A. McTier, M. Anderson, C. A. Anderson, E. Young, A. Bowman, H. Ottaway

Year: 2025

Abstract:

INTRODUCTION: The integration of services is often driven by the belief that integration will lead to better outcomes for service users. However, there is a paucity of robust evidence exploring the relationship between integration and outcomes. This study sought to determine whether the integration of health and social care services via Health and Social Care Partnerships has led to a measurable change in outcomes for Scotland's children and young people. METHODS: Multilevel models were applied to routinely collected administrative data to determine whether different approaches to structural integration were related to changes in a range of outcomes for children and young people. The modelling approach accounted for confounding factors such as economic conditions and the COVID-19 pandemic. RESULTS: The analysis found no consistent evidence of an association between the structural integration of services and changes in outcomes for children and young people. However, external factors such as deprivation and the COVID-19 pandemic were found to be linked to changes in outcomes across various areas of children's lives. CONCLUSIONS: The findings highlight the complexity in attributing changes in outcomes to a specific intervention or reform, particularly in the presence of wider socio-economic factors. Understanding the influence of systems-level change may not be fully possible using routinely collected data alone, and any methods used to assess impact should be underpinned by an underlying theory of change.

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