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Bernal-Sobrino JL, Arias-Horcajadas F, Varela-Rodríguez C, Losada-Pérez C, Blanco-Echevarría A, Xsdel Yerro Alvarez MJ, Martín-Mayor M, Rubio G. A 3-Year Retrospective Study of the Impact of Integrating an Addiction Liaison Team into an Outpatient Alcoholism Treatment Programme. Alcohol Alcohol 2023; 58:515-522. [PMID: 36760095 DOI: 10.1093/alcalc/agad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 11/19/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The number of inpatients with alcohol and other substance-related problems (ASRP) in the general hospital population at any time is vast. To meet the needs of those patients, most hospitals have an Addiction Liaison Team (ALT) that diagnoses and initiates the treatment of the addictive disorder. In our hospital, this team is part of a more extensive and intensive Outpatient Alcoholism Treatment Programme that facilitates the continuity of care. AIM the main goal of this study is to evaluate the performance and effectiveness of our inpatient ALT. METHODOLOGY we carried out an observational cohort study of patients with ASRP admitted to the hospital from 2015 to 2017. We evaluated the performance and effectiveness of our ALT: referrals to the programme, inpatients mortality, readmissions to hospital, hospital length of stay (LOS) and medical or surgical treatment adherence. RESULTS out of 133,181 admissions, 17,387 (13.14%) were positive for ASRP, and 615 (3.54%) were referred to the ALT. Referred patients had less in-hospital mortality, shorter LOS and lower risk of readmissions during the first year of follow-up. Subjects treated in the programme had better therapeutic adherence. CONCLUSIONS integrating the ALT into an outpatient programme facilitates an earlier detection and initiation of treatment during the hospital stay and the continuity of care. Alcohol misuse conditions affect the patient's prognosis and health outcomes, so appropriate care is needed. Inclusion in the programme was associated with less risk of hospital mortality, fewer readmissions and a lower LOS.
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Affiliation(s)
- José L Bernal-Sobrino
- Control Management Department, Hospital Universitario 12 de Octubre, Carretera de Córdoba s/n 28041, Madrid, Spain
- Instituto de investigación Biomédica i+12, Carretera de Córdoba s/n 28041, Madrid, Spain
| | - Francisco Arias-Horcajadas
- Instituto de investigación Biomédica i+12, Carretera de Córdoba s/n 28041, Madrid, Spain
- Psiquiatry Department, Hospital Universitario 12 de Octubre, Carretera de Córdoba s/n 28041, Madrid, Spain
- Medical School at Universidad Complutense de Madrid, Pl. de Ramón y Cajal, s/n, 28040 Madrid, Spain
- Addictive-Disorders Research Network (Red de Trastornos adictivos-RETICS) at Instituto de Salud Carlos III, C/ Sinesio Delgado, 4 28029 - Madrid, Spain
| | - Carolina Varela-Rodríguez
- Instituto de investigación Biomédica i+12, Carretera de Córdoba s/n 28041, Madrid, Spain
- Quality of Care Unit, Hospital Universitario 12 de Octubre, Carretera de Córdoba s/n 28041, Madrid, Spain
| | - Cristina Losada-Pérez
- Instituto de investigación Biomédica i+12, Carretera de Córdoba s/n 28041, Madrid, Spain
- Psiquiatry Department, Hospital Universitario 12 de Octubre, Carretera de Córdoba s/n 28041, Madrid, Spain
| | - Agustín Blanco-Echevarría
- Instituto de investigación Biomédica i+12, Carretera de Córdoba s/n 28041, Madrid, Spain
- Medical School at Universidad Complutense de Madrid, Pl. de Ramón y Cajal, s/n, 28040 Madrid, Spain
- Internal Medicine Department, Hospital Universitario 12 de Octubre, Carretera de Córdoba s/n 28041, Madrid, Spain
| | - María J Xsdel Yerro Alvarez
- Instituto de investigación Biomédica i+12, Carretera de Córdoba s/n 28041, Madrid, Spain
- Psiquiatry Department, Hospital Universitario 12 de Octubre, Carretera de Córdoba s/n 28041, Madrid, Spain
| | - Marta Martín-Mayor
- Instituto de investigación Biomédica i+12, Carretera de Córdoba s/n 28041, Madrid, Spain
- Psiquiatry Department, Hospital Universitario 12 de Octubre, Carretera de Córdoba s/n 28041, Madrid, Spain
- Medical School at Universidad Complutense de Madrid, Pl. de Ramón y Cajal, s/n, 28040 Madrid, Spain
| | - Gabriel Rubio
- Instituto de investigación Biomédica i+12, Carretera de Córdoba s/n 28041, Madrid, Spain
- Psiquiatry Department, Hospital Universitario 12 de Octubre, Carretera de Córdoba s/n 28041, Madrid, Spain
- Medical School at Universidad Complutense de Madrid, Pl. de Ramón y Cajal, s/n, 28040 Madrid, Spain
- Addictive-Disorders Research Network (Red de Trastornos adictivos-RETICS) at Instituto de Salud Carlos III, C/ Sinesio Delgado, 4 28029 - Madrid, Spain
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2
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Falkowski A, Ciminata G, Manca F, Bouttell J, Jaiswal N, Farhana Binti Kamaruzaman H, Hollingworth S, Al-Adwan M, Heggie R, Putri S, Rana D, Mukelabai Simangolwa W, Grieve E. How Least Developed to Lower-Middle Income Countries Use Health Technology Assessment: A Scoping Review. Pathog Glob Health 2023; 117:104-119. [PMID: 35950264 PMCID: PMC9970250 DOI: 10.1080/20477724.2022.2106108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Health Technology Assessment (HTA) is a multidisciplinary tool to inform healthcare decision-making. HTA has been implemented in high-income countries (HIC) for several decades but has only recently seen a growing investment in low- and middle-income countries. A scoping review was undertaken to define and compare the role of HTA in least developed and lower middle-income countries (LLMIC). MEDLINE and EMBASE databases were searched from January 2015 to August 2021. A matrix comprising categories on HTA objectives, methods, geographies, and partnerships was used for data extraction and synthesis to present our findings. The review identified 50 relevant articles. The matrix was populated and sub-divided into further categories as appropriate. We highlight topical aspects of HTA, including initiatives to overcome well-documented challenges around data and capacity development, and identify gaps in the research for consideration. Those areas we found to be under-studied or under-utilized included disinvestment, early HTA/implementation, system-level interventions, and cross-sectoral partnerships. We consider broad practical implications for decision-makers and researchers aiming to achieve greater interconnectedness between HTA and health systems and generate recommendations that LLMIC can use for HTA implementation. Whilst HIC may have led the way, LLMIC are increasingly beginning to develop HTA processes to assist in their healthcare decision-making. This review provides a forward-looking model that LLMIC can point to as a reference for their own implementation. We hope this can be seen as timely and useful contributions to optimize the impact of HTA in an era of investment and expansion and to encourage debate and implementation.
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Affiliation(s)
- Anna Falkowski
- Division of Communicable Disease, Michigan Department of Health and Human Services, State of Michigan, USA
| | - Giorgio Ciminata
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Francesco Manca
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Janet Bouttell
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Nishant Jaiswal
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Hanin Farhana Binti Kamaruzaman
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow.,Malaysian Health Technology Assessment Section (MaHTAS), Ministry of Health Malaysia, Putrajaya
| | | | - Mariana Al-Adwan
- F. Hoffman-La Roche Ltd, Amman, Jordan and Jordan ISPOR Chapter, Amman, Jordan
| | - Robert Heggie
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Septiara Putri
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow.,Health Policy and Administration Department, Faculty of Public Health, University of Indonesia, Depok, West Java, Indonesia
| | - Dikshyanta Rana
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Warren Mukelabai Simangolwa
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa and Patient and Citizen Involvement in Health, Lusaka, Zambia
| | - Eleanor Grieve
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
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3
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Paddock SM, Hepner KA, Hudson T, Ounpraseuth S, Schrader AM, Sullivan G, Watkins KE. Association Between Process-Based Quality Indicators and Mortality for Patients With Substance Use Disorders. J Stud Alcohol Drugs 2018; 78:588-596. [PMID: 28728641 DOI: 10.15288/jsad.2017.78.588] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Substance use disorders (SUDs) are associated with elevated rates of mortality. Little is known about whether receiving appropriate care is associated with lower mortality for patients with SUDs. This study examined the association between the receipt of care for SUDs and subsequent 12- and 24-month mortality. METHOD This was a retrospective cohort study of veterans who received care for SUDs paid for by the Veterans Health Administration during October 2006- September 2007 (n = 339,966). Logistic regressions were used to examine the association between quality indicators measuring receipt of care and mortality while controlling for patient characteristics and facility service area. RESULTS There were four quality indicators: SUD treatment initiation, SUD treatment engagement, SUD-related psychosocial treatment, and SUD-related psychotherapy. Outcomes measured were mortality 12 and 24 months after the end of the observation period, through September 2009. Receipt of indicated care ranged from 26.5% to 58.6%, and 12- and 24-month mortality rates were 3% and 6%, respectively. Adjusted odds ratios [95% CI] of 12-month mortality by indicator were: initiation, 0.86 [0.79, 0.93]; engagement, 0.65 [0.58, 0.74]; psychosocial treatment, 0.88 [0.84, 0.92]; and psychotherapy, 0.84 [0.79, 0.89]. For the 24-month mortality outcome, adjusted odds ratios were: initiation, 0.88 [0.84, 0.93]; engagement, 0.78 [0.71, 0.85]; psychosocial treatment, 0.91 [0.88, 0.94]; and psychotherapy, 0.87 [0.83, 0.91]. Results were similar when controlling for facility service area. CONCLUSIONS Receiving appropriate care is associated with lower mortality for patients with SUDs. Significant overall and within-facility service area associations of quality indicators and mortality support their use in encouraging providers to deliver the indicated care. These indicators should be prioritized above others lacking comparably strong process-outcome associations.
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Affiliation(s)
| | | | - Teresa Hudson
- University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Veterans Affairs Center for Mental Healthcare and Outcomes Research, Little Rock, Arkansas
| | - Songthip Ounpraseuth
- University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Veterans Affairs Center for Mental Healthcare and Outcomes Research, Little Rock, Arkansas
| | - Amy M Schrader
- University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Veterans Affairs Center for Mental Healthcare and Outcomes Research, Little Rock, Arkansas
| | - Greer Sullivan
- University of California Riverside School of Medicine, Riverside, California
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4
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Han B, Compton WM, Blanco C, Colpe L, Huang L, McKeon R. National Trends in the Prevalence of Suicidal Ideation and Behavior Among Young Adults and Receipt of Mental Health Care Among Suicidal Young Adults. J Am Acad Child Adolesc Psychiatry 2018; 57:20-27.e2. [PMID: 29301664 DOI: 10.1016/j.jaac.2017.10.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 09/26/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study examined national trends in the prevalence of suicidal ideation and behavior among young adults and receipt of mental health care among suicidal young adults. METHOD We examined restricted data from 145,800 persons aged 18 to 25 years who participated in the 2009 to 2015 National Surveys on Drug Use and Health. Descriptive analyses and bivariable and multivariable logistic regressions were applied. RESULTS Among US young adults during 2009 to 2015, the 12-month prevalence of suicidal ideation increased from 6.1% to 8.3%, the 12-month prevalence of suicide plan increased from 2.0% to 2.7%, and 12-month prevalence of suicide attempt increased from 1.1% to 1.6%. After adjusting for personal factors and changes in residing county's population characteristics, we found upward trends in suicidal ideation among non-Hispanic whites and Hispanics, an upward trend in suicide plan among young adults overall, and an upward trend in suicide attempt among those without major depressive episodes (MDE). Among young adults with MDE, the prevalence of suicide attempt remained high and unchanged. During 2009 to 2015, trends in receipt of mental health care remained unchanged among most suicidal young adults and declined slightly among uninsured suicidal young adults. The annual average prevalence of receipt of mental health care was 36.2% among suicidal young adults. CONCLUSION During 2009 to 2015, suicidal ideation, suicide plan, and suicide attempt increased among young adults overall, but receipt of mental health care among suicidal young adults did not increase. Our results suggest that effective efforts are needed for suicide prevention and promotion of mental health care among young adults.
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Affiliation(s)
- Beth Han
- Substance Abuse and Mental Health Services Administration, Rockville, MD.
| | - Wilson M Compton
- National Institute on Drug Abuse of the National Institutes of Health, Bethesda, MD
| | - Carlos Blanco
- National Institute on Drug Abuse of the National Institutes of Health, Bethesda, MD
| | - Lisa Colpe
- National Institute of Mental Health, Bethesda
| | - Larke Huang
- Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Richard McKeon
- Substance Abuse and Mental Health Services Administration, Rockville, MD
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5
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Affiliation(s)
- Austin B Frakt
- From the Veterans Affairs Boston Healthcare System, Department of Veterans Affairs, and Boston University - both in Boston (A.B.F.); and the University of Michigan Law School and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (N.B.)
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6
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Johnson CE, Bush RL, Harman J, Bolin J, Evans Hudnall G, Nguyen AM. Variation in Utilization of Health Care Services for Rural VA Enrollees With Mental Health-Related Diagnoses. J Rural Health 2015; 31:244-53. [PMID: 25599892 DOI: 10.1111/jrh.12105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Rural-dwelling Department of Veterans Affairs (VA) enrollees are at high risk for a wide variety of mental health-related disorders. The objective of this study is to examine the variation in the types of mental and nonmental health services received by rural VA enrollees who have a mental health-related diagnosis. METHODS The Andersen and Aday behavioral model of health services use and the Agency for Healthcare Research and Quality Medical Expenditure Panel Survey (MEPS) data were used to examine how VA enrollees with mental health-related diagnoses accessed places of care from 1999 to 2009. Population survey weights were applied to the MEPS data, and logit regression was conducted to model how predisposing, enabling, and need factors influence rural veteran health services use (measured by visits to different places of care). Analyses were performed on the subpopulations: rural VA, rural non-VA, urban VA, and urban non-VA enrollees. FINDINGS For all types of care, both rural and urban VA enrollees received care from inpatient, outpatient, office-based, and emergency room settings at higher odds than urban non-VA enrollees. Rural VA enrollees also received all types of care from inpatient, office-based, and emergency room settings at higher odds than urban VA enrollees. Rural VA enrollees had higher odds of a mental health visit of any kind compared to urban VA and non-VA enrollees. CONCLUSIONS Based on these variations, the VA may want to develop strategies to increase screening efforts in inpatient settings and emergency rooms to further capture rural VA enrollees who have undiagnosed mental health conditions.
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Affiliation(s)
- Christopher E Johnson
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Ruth L Bush
- College of Medicine, Texas A&M Health Science Center, Round Rock, Texas
| | - Jeffrey Harman
- Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Jane Bolin
- Southwest Rural Health Research Center, Texas A&M Health Science Center, College Station, Texas
| | - Gina Evans Hudnall
- South Central Mental Illness, Research, Education and Clinical Center and Houston Center for Quality of Care and Utilization Studies, Michael E. Debakey VA Medical Center, Houston, Texas.,Health Services Research and Development Section, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ann M Nguyen
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
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7
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Huang H, Chan YF, Bauer AM, Suzuki J, Katon W, Russo J, Hogan D, Unützer J. Specialty behavioral health service use among chronically ill medicare advantage patients with substance use problems. PSYCHOSOMATICS 2013; 54:546-51. [PMID: 23932530 DOI: 10.1016/j.psym.2013.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 05/07/2013] [Accepted: 05/09/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study examines the use of substance abuse and mental health services among older adults with substance use disorders. METHODS Participants were members of Humana Cares, a subsidiary of Humana, Inc., a care management program for chronically ill Medicare Advantage members, between 2008 and 2010. All adults aged 65 and older with a substance use disorder identified with International Classification of Diseases-9 codes were included. We compared utilization of substance abuse and mental health services among participants with no psychiatric comorbidity (n = 585), with comorbid depression (n = 605), and with comorbid severe and persistent mental illness (severe and persistent mental illness, n = 95). RESULTS Twenty-eight percent utilized substance abuse services and 36% utilized mental health services. After adjusting for covariates, comorbid depression (odds ratio = 4.27, 95% confidence interval: 3.22-5.65) and severe and persistent mental illness (odds ratio = 10.75, 95% confidence interval: 5.22-20.13) were independently associated with specialty service use (either substance abuse or mental health services). CONCLUSION Although few chronically ill older adults with substance use disorders in this Medicare Advantage program received any specialty substance abuse or mental health services, utilization was higher among those who had concurrent psychiatric disorders.
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Affiliation(s)
- Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA.
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8
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Choi NG, DiNitto DM. Heavy/binge drinking and depressive symptoms in older adults: gender differences. Int J Geriatr Psychiatry 2011; 26:860-8. [PMID: 20886659 PMCID: PMC3641839 DOI: 10.1002/gps.2616] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 07/13/2010] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The purpose of this study was to examine gender similarity/difference in the association between depressive symptoms (11-item Center for Epidemiologic Scale for Depression (CES-D) scores), on the one hand, and frequency and amount of alcohol use, on the other, among older adults. METHODS Data came from the National Social Life, Health, and Aging Project (NSHAP), Wave 1, which included a nationally representative probability sample (n = 2924) of community-dwelling individuals aged 57-85. Heavy/binge drinking was defined as the consumption of 4+ drinks for men and 3+ drinks for women per drinking day. The relationship between CES-D scores and the frequency and amount of alcohol consumption was tested using gender-separate, 2-step ordinary least squares (OLS) regression analyses. RESULTS A significant proportion of both men (67.7%) and women (52.2%) had consumed alcohol in the preceding 3 months, and 12.3% of male and 8.4% of female drinkers were heavy/binge drinkers. Substantial differences between male and female heavy drinkers were found in sociodemographics, health status, and social support and social engagement. Regression results show that both frequency of drinking and heavy/binge drinking, as opposed to abstinence, were significantly positively associated with men's CES-D scores, but not with women's. CONCLUSION Heavy/binge-drinking older men may use alcohol to cope with depressive mood, and heavy drinking might also contribute to their social isolation and depressive symptoms. Depression screening and treatment for older men should be accompanied by alcohol screening and treatment and vice versa.
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Affiliation(s)
- Namkee G. Choi
- Professor School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Diana M. DiNitto
- Cullen Trust Centennial Professor in Alcohol Studies and Education, School of Social Work, University of Texas at Austin, Austin, TX, USA
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9
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Choi NG, DiNitto DM. Psychological Distress, Binge/Heavy Drinking, and Gender Differences among Older Adults. Am J Addict 2011; 20:420-8. [DOI: 10.1111/j.1521-0391.2011.00149.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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10
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Abstract
The number of older adults needing substance abuse treatment is projected to rise significantly in the next few decades. This paper will focus on the epidemic of prescription use disorders in older adults. Particular vulnerabilities of older adults to addiction will be considered. Specifically, the prevalence and patterns of use of opioids, stimulants, and benzodiazepines will be explored, including the effects of these substances on morbidity and mortality. Treatment intervention strategies will be briefly discussed, and areas for future research are suggested.
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Affiliation(s)
- Raj K Kalapatapu
- Department of Psychiatry, Division on Substance Abuse, New York State Psychiatric Institute, Columbia University, New York, New York 10032, USA.
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11
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Predisposing Characteristics, Enabling Resources and Need as Predictors of Utilization and Clinical Outcomes for Veterans Receiving Mental Health Services. Med Care 2010; 48:288-95. [DOI: 10.1097/mlr.0b013e3181cafbe3] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Banerjea R, Sambamoorthi U, Smelson D, Pogach LM. Chronic Illness with Complexities: Mental Illness and Substance Use Among Veteran Clinic Users with Diabetes. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 33:807-21. [DOI: 10.1080/00952990701653701] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Vandivort R, Teich JL, Cowell AJ, Chen H. Utilization of substance abuse treatment services under Medicare, 2001–2002. J Subst Abuse Treat 2009; 36:414-9. [DOI: 10.1016/j.jsat.2008.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 08/22/2008] [Accepted: 08/23/2008] [Indexed: 10/21/2022]
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St John PD, Montgomery PR, Tyas SL. Alcohol misuse, gender and depressive symptoms in community-dwelling seniors. Int J Geriatr Psychiatry 2009; 24:369-75. [PMID: 18837057 DOI: 10.1002/gps.2131] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Alcohol misuse in seniors has been studied in clinical samples and in small communities, but relatively few studies are population-based. Objectives are: (1) to describe the characteristics of seniors who score 1 or more on the CAGE (Cut down; Annoyed; Guilty; Eye-opener) questionnaire of alcohol problems; (2) to determine if depressive symptoms are associated with alcohol misuse after accounting for other factors. METHODS Cross-sectional study of community-dwelling older people (65+ years) sampled from a representative population registry in Manitoba, Canada. Participants were initially interviewed in 1991-1992 and reinterviewed in 1996-1997. Data from Time 2 were used; 1,028 persons were included in the analyses. Sociodemographic characteristics, the CAGE questionnaire, Activities of Daily Living (ADLs) and instrumental ADLs (IADLs), the Center for Epidemiologic Studies-Depression (CES-D) scale and the Mini-Mental State Examination (MMSE) were assessed by trained interviewers. RESULTS Males were more likely to score positive on the CAGE questionnaire. After adjusting for gender, age, and education, there was a strong association between depressive symptoms and alcohol misuse. Poor self-rated health and impairments in IADLs were also associated with alcohol misuse. CONCLUSIONS Male gender, depressive symptoms, and poor functional status were associated with alcohol misuse in this population-based study. Attention to depressive symptoms and functional status may be important in the care of seniors with alcohol misuse. Alternatively, physicians should enquire about alcohol use in seniors with functional impairment or depressive symptoms.
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Affiliation(s)
- Philip D St John
- Section of Geriatric Medicine, Department of Medicine, Centre on Aging, University of Manitoba, Winnipeg, Canada.
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Abstract
The purpose of this review is to highlight some of the issues that need to be addressed to optimally use functional neuroimaging as a clinical tool to predict outcomes in substance use disorders. First, the importance of recognizing the clinical heterogeneity of the substance use disorders population is highlighted. We also emphasize that empirical and theoretical analyses support the idea that the courses of substance use disorders are relatively independent of the types of substance being used. Second, various approaches to the measurement and characterization of the longitudinal courses of substance use disorders are summarized. Third, predictors of outcomes are reviewed and their limitations are discussed. Within this context, we describe aspects of our work that focus on using functional magnetic resonance imaging to predict outcomes. Fourth, we discuss future directions, critical experiments, and the utility of functional neuroimaging as a clinical tool.
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Affiliation(s)
- Martina Reske
- Department of Psychiatry, University of California San Diego, La Jolla, CA92037-0985, USA
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16
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Woodward AM, Raskin IE, Blacklow B. A profile of the substance abuse treatment industry: organization, costs, and treatment completion. Subst Use Misuse 2008; 43:647-79. [PMID: 18393082 DOI: 10.1080/10826080601096640] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Nationally representative data from the Alcohol and Drug Services Study, conducted between 1996 and 1999, are used to explore the structure and operation of the substance user treatment industry in the United States. The empirical relationship among client (N=4945) retention and completion, types and use of counseling and medical personnel, diagnostic mix, client demographics, the level of services used, and the cost of treatment in different treatment settings is discussed using tabular presentation and tests of significance. Limitations of the analysis are outlined. This information and analysis are expected to help the research community understand the potential of the ADSS data in addressing many important questions about substance user treatment.
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Siqueira MMD, Barbosa DA, Laranjeira R, Hopkins K. Psychoactive substances and the provision of specialized care: the case of Espirito Santo. REVISTA BRASILEIRA DE PSIQUIATRIA 2007; 29:315-23. [PMID: 17713702 DOI: 10.1590/s1516-44462006005000043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2006] [Accepted: 01/09/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: In this study, we conducted a survey of all the institutions that provide treatment for psychoactive substances in the state of Espirito Santo, Brazil during the period 2004-2005. METHOD: We used a snowball sampling technique to include all the treatment facilities in our State in which we employed a semi-structured interview instrument for key informants at each institution. We present descriptive results and test differences between groups using the Chi-square test. RESULTS: In Espirito Santo, 250 institutions provide treatment for psychoactive substances and are distributed as follows: governmental (17.6%), nongovernmental (22.8%), and self-help groups (59.6%). Of these 250 institutions, 85 provide direct care, with the majority found in the Central region (70.6%) and followed by the Northern (15.3%) and Southern (14.1%) regions. The majority of those that provide direct care are private nonprofit centers (16.8%) institutions with ties to religious organizations make up nearly one-third (30.6%) of direct care providers. The drugs most consumed by those seeking care are alcohol (82.4%), tobacco (81.2%) and marijuana (68.2%). The institutions generally give assistance to people in the 26-45 years age group (89.4%); with regard to gender, the institutions take care of: men (31.8%), women (5.9%), and both sexes (56.5%). The treatment models most used are psychosocial (58.8%), therapeutic community (47.1%) and biomedical (43.5%) and the work is evaluated through the team technique (72.9 %). CONCLUSIONS: In the state of Espirito Santo, indirect care services are many times greater than those that offer direct care and the majority of all services are in the Central region. The populations in the mainland have a comparative disadvantage when it comes to treatment options for psychoactive substance use. We observed that a significant number of institutions that provide drug abuse treatment have financial support from religious organizations. The Espirito Santo State survey demonstrates the necessity of a decentralized provision of specialized care for psychoactive substance users, with substantially more services directed to the Northern and Southern regions of the state. Moreover, the emphasis of these new institutions should be on outpatient care.
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Affiliation(s)
- Marluce Miguel de Siqueira
- Núcleo de Estudos sobre o álcool e outras Drogas, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
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Woodward A, Das A, Raskin IE, Morgan-Lopez AA. An exploratory analysis of treatment completion and client and organizational factors using hierarchical linear modeling. EVALUATION AND PROGRAM PLANNING 2006; 29:335-351. [PMID: 17950862 DOI: 10.1016/j.evalprogplan.2006.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Data from the Alcohol and Drug Services Study (ADSS) are used to analyze the structure and operation of the substance abuse treatment industry in the United States. Published literature contains little systematic empirical analysis of the interaction between organizational characteristics and treatment outcomes. This paper addresses that deficit. It develops and tests a hierarchical linear model (HLM) to address questions about the empirical relationship between treatment inputs (industry costs, types and use of counseling and medical personnel, diagnosis mix, patient demographics, and the nature and level of services used in substance abuse treatment), and patient outcomes (retention and treatment completion rates). The paper adds to the literature by demonstrating a direct and statistically significant link between treatment completion and the organizational and staffing structure of the treatment setting. Related reimbursement issues, questions for future analysis, and limitations of the ADSS for this analysis are discussed.
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Affiliation(s)
- Albert Woodward
- Department of Research & Development, American College of Cardiology, 2400 N St. NW, Washington, DC, 20037, USA
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19
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Monras M, Mondon S, Ortega L, Gual A. [Alcoholism in the general hospital: 4 years mortality and hospitalization]. Med Clin (Barc) 2006; 125:441-7. [PMID: 16216198 DOI: 10.1157/13079609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE We aimed to analyze the mortality, and emergency room and hospital admissions in a sample of alcohol dependent patients during the four years following their identification in a general hospital. PATIENTS AND METHOD 198 inpatients from a general hospital who where identified as alcohol dependent and referred during 1998 to the liaison-psychiatry service. RESULTS 30.8% had died, at a mean age of 57.5 (11.3). Deaths had a direct relationship to the illness responsible for the initial admission to hospital. 42.6% of patients had previous admissions, and 74% had been previously attended at emergency room departments. During the 4 years of follow up, there were new hospital admissions (54.6%), emergency room visits (72.7%) and repeated liaison-psychiatry consultations (20%). Previous admissions to hospital predicted future admissions. Acceptance of alcohol treatment did not reduce the mortality rates. Mortality correlated with age, it was increased in patients with cognitive deficits and was reduced in those with psychiatric co-morbidity. CONCLUSIONS Late detection of alcohol dependence leads to pour outcomes both in the treatment of alcohol dependence and the concomitant somatic diseases. Early detection strategies of hazardous and harmful alcohol consumption should be implemented in hospital settings.
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Affiliation(s)
- Miquel Monras
- Unidad de Alcohología, Instituto de Neurociencias, Hospital Clínico, Barcelona, Spain.
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20
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Oslin DW, Slaymaker VJ, Blow FC, Owen PL, Colleran C. Treatment outcomes for alcohol dependence among middle-aged and older adults. Addict Behav 2005; 30:1431-6. [PMID: 16022937 DOI: 10.1016/j.addbeh.2005.01.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2004] [Revised: 01/07/2005] [Accepted: 01/21/2005] [Indexed: 11/23/2022]
Abstract
AIMS The purpose of this study was to examine differences in the clinical presentation and treatment outcomes of older adults with a diagnosis of alcohol dependence compared to middle-aged adults. DESIGN The study is a prospective naturalistic study. Participants included 1358 patients admitted to a residential rehabilitation program for alcohol dependence. RESULTS Older adults entering an alcohol rehabilitation program are less impaired on a number measures of psychiatric distress and addiction severity but more impaired in somatic health. While there were no significantly different outcomes in abstinence rates at 1 month, older adults engaged in formal post-discharge aftercare less than middle-aged adults. CONCLUSIONS These results confirm impressions that older adults seeking alcohol treatment may have a lower severity of alcohol dependence compared to those at younger ages. However, results suggest that traditional outpatient substance abuse care is not accepted at the same rates as middle-aged adults. The low rates of engagement suggest the need for age appropriate treatment options and are potentially of concern if treatment is necessary to maintain short-term success.
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Affiliation(s)
- David W Oslin
- Section of Geriatric Psychiatry, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, United States.
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21
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Monras M, Ortega L, Mondon S, Balcells M, Gual A. Enfermedades relacionadas con el consumo de alcohol: seguimiento a los dos años de la hospitalización. Med Clin (Barc) 2004; 123:521-6. [PMID: 15535923 DOI: 10.1016/s0025-7753(04)74584-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Our objective was to study the outcome and compliance of both medical and alcoholism treatment in alcoholics discharged from a general hospital. PATIENTS AND METHOD This was a 2 years prospective follow up study of a cohort of 100 inpatients referred to the Alcohol Unit during the first semester of 1998. RESULTS After 2 years, 9 patients had died and 14 had been referred to other hospitals. 15% of patients refused medical treatment from the beginning and alcoholism treatment was initially refused by 31% of alcoholics. At 2 years of follow up, compliance rates were 46% for medical treatment and 10% for alcoholism treatment. All patients under treatment for alcoholism were also good compliers of medical treatment. Survival analysis for alcoholism treatment at 2 years was 19%, with higher rates in patients with psychosocial problems and previous alcohol consultations. The probability of being alive was 89%. CONCLUSIONS Few alcoholics are detected. Most of them display high levels of severity and poor prognosis, with high mortality rates. Compliance with follow up treatment is low. There is a clear correlation between compliance of alcoholism and medical treatment.
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Affiliation(s)
- Miquel Monras
- Unidad de Alcohología, Institut Clínic de Psiquiatria i Psicologia, Hospital Clínic de Barcelona, Barcelona, Spain.
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Oslin DW, Thompson R, Kallan MJ, TenHave T, Blow FC, Bastani R, Gould RL, Maxwell AE, Rosansky J, Van Stone W, Jarvik L. Treatment effects from UPBEAT: a randomized trial of care management for behavioral health problems in hospitalized elderly patients. J Geriatr Psychiatry Neurol 2004; 17:99-106. [PMID: 15157351 DOI: 10.1177/0891988703262539] [Citation(s) in RCA: 15] [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: 11/16/2022]
Abstract
The purpose of this study was to examine the impact of the Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) Program, an interdisciplinary mental health care management program, on the behavioral health symptoms of elderly veterans. Participants, 60 years and older, included 2637 veterans recruited from medical/surgical units who screened positively for significant depressive or anxiety symptoms and/or at-risk alcohol drinking. Participants were randomized to UPBEAT or to usual care. Primary outcomes were measured at baseline and at 6, 12, and 24 months. Participant nonadherence to the protocol was common and is a major limitation. There were no differences between UPBEAT and usual care patients on symptom or functional outcomes at any follow-up point. Exploratory analyses suggested that among participants with more physical health problems, there were greater improvements in depressive symptoms in those assigned to UPBEAT care. Despite a theoretical and practically sound intervention, participation was low and treatment outcomes, while generally good, appeared unaffected by the addition of the program.
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Affiliation(s)
- David W Oslin
- Section of Geriatric Psychiatry, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Room 3002, Philadelphia, PA 19104, USA.
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Robles RR, Matos TD, Colón HM, Deren S, Reyes JC, Andía J, Marrero CA, Sahai H. Determinants of Health Care Use among Puerto Rican Drug Users in Puerto Rico and New York City. Clin Infect Dis 2003; 37 Suppl 5:S392-403. [PMID: 14648454 DOI: 10.1086/377552] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This study was conducted to identify factors accounting for differences in health care and drug treatment utilization between Puerto Rican drug users residing in 2 separate locations. Survey findings from 334 drug users in Puerto Rico and 617 in New York City showed that those in Puerto Rico were 6 times less likely than their counterparts in New York to have used inpatient medical services and 13 to 14 times less likely to have used outpatient medical services or methadone. They also were less likely to have health insurance or past drug treatment. After site was controlled for, health insurance and previous use of physical or mental health services remained significant predictors of health care and drug treatment utilization during the study period. Although Puerto Rican drug users in Puerto Rico are not an ethnic minority, they reported significant disparities in health services use compared with Puerto Rican drug users in New York.
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Affiliation(s)
- Rafaela R Robles
- Center for Addiction Studies, Universidad Central del Caribe School of Medicine, Bayamón, Puerto Rico.
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Brennan PL, Nichol AC, Moos RH. Older and younger patients with substance use disorders: outpatient mental health service use and functioning over a 12-month interval. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2003; 17:42-8. [PMID: 12665080 DOI: 10.1037/0893-164x.17.1.42] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This observational study compared a nationwide sample of older patients with substance use disorders (n = 3,598; age > 55) with a demographically and diagnostically matched sample of younger patients on initial functioning, subsequent outpatient mental health service use, and 12-month follow-up outcomes. Older patents were initially functioning a well as or better than younger patients according to substance use, psychiatric, family, and legal criteria. The groups received comparable amounts of outpatient mental health care. At a 12-month follow-up, older patients generally had better substance use and functioning outcomes than did younger patients. The findings suggest that older patients with substance use disorders are keeping pace with demographically and diagnostically comparable younger patients in obtaining specialized outpatient mental health services and that they have positive treatment prognoses.
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Affiliation(s)
- Penny L Brennan
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.
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