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Philippou A, Birhanu B, Biello A, Keefer L, Gorbenko K. A Mixed-methods Assessment of the Impact of Insurance Issues on the Emotional and Physical Health of Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2022; 28:1851-1858. [PMID: 35191977 DOI: 10.1093/ibd/izac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND In patients with inflammatory bowel disease (IBD), failure to adhere to treatment regimens due to insurance issues can lead to disease complications. Our aim was to examine patients' perceptions of the impact of insurance issues on their health. METHODS Twenty-nine patients with IBD at a large US academic center and an insurance issue participated in a mixed-methods study. Retrospective chart review and an online questionnaire were completed to collect demographic information, IBD characteristics, and validated resilience scores. Semistructured interviews were completed for insurance experiences, which were coded independently by 2 coders for themes. RESULTS Twenty-nine patients completed the interview, and 24 completed the online survey. Sixteen had Crohn's disease, 13 had ulcerative colitis, and 66% were female. The most common insurance issue was lapsed insurance. Many experienced physical consequences, with 58% having flares, 14% undergoing surgery, and 14% developing antibodies. All emotional responses were negative, with the majority feeling stressed (38%). Providers were uninformed of insurance issues in 28% of cases. When asked about perceived resilience, 41% felt incapable of managing the situation, and 45% gave up trying to solve the problem. When asked how to improve going forward, 38% requested an easily accessible advocate to guide them. CONCLUSIONS A large proportion of our cohort chose not to inform their provider, felt incapable of managing on their own, and gave up on resolving their insurance issue. This highlights the need to consider restructuring the insurance system, to identify those at risk for insurance issues, and to make advocates available to avoid devastating consequences.
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Affiliation(s)
- Alicia Philippou
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Beselot Birhanu
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anthony Biello
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laurie Keefer
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ksenia Gorbenko
- Institute for Health Care Delivery Science, Mount Sinai Health System, New York, New York, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Green AS, Ruchman SG, Birhanu B, Wu S, Katz CL, Singer EK, Baranowski KA. Immigration Judges' Perceptionsof Telephonic and In-Person Forensic Mental Health Evaluations. J Am Acad Psychiatry Law 2022; 50:240-251. [PMID: 35444056 DOI: 10.29158/jaapl.210075-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Clinicians affiliated with medical human rights programs throughout the United States perform forensic evaluations of asylum seekers. Much of the best practice literature reflects the perspectives of clinicians and attorneys, rather than the viewpoints of immigration judges who incorporate forensic reports into their decision-making. The purpose of this study was to assess former immigration judges' perspectives on forensic mental health evaluations of asylum seekers. We examined the factors that immigration judges use to assess the affidavits resulting from mental health evaluations and explored their attitudes toward telehealth evaluations. We conducted semistructured interviews in April and May 2020 with nine former judges and systematically analyzed them using consensual qualitative research methodology. Our findings were grouped in five domains: general preferences for affidavits; roles of affidavits in current legal climate; appraisal and comparison of sample affidavits; attitudes toward telephonic evaluations; and recommendations for telephonic evaluations. Forensic evaluators should consider the practice recommendations of judges, both for telephonic and in-person evaluations, which can bolster the usefulness of their evaluations in the adjudication process. To our knowledge, this is the first published study to incorporate immigration judges' perceptions of forensic mental health evaluations, and the first to assess judges' attitudes toward telephonic evaluations.
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Affiliation(s)
- Aliza S Green
- Dr. Green is a first-year resident in the Internal Medicine Program, Brigham and Women's Hospital, Boston, MA. Dr. Ruchman is a first-year resident in the Internal Medicine-Pediatrics Program, University of Colorado, Aurora, CO. Ms. Birhanu and Ms. Wu are third-year medical students at the Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Katz is Clinical Professor in the Departments of Psychiatry, Medical Education, and Health System Design & Global Health and Faculty Director of the Mount Sinai Human Rights Program's Remote Evaluation Network, Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Singer is Director of the Mount Sinai Human Rights Program and Associate Professor in the Departments of Emergency Medicine and Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Baranowski is Associate Director of the Mount Sinai Human Rights Program and Faculty Director of Research, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samuel G Ruchman
- Dr. Green is a first-year resident in the Internal Medicine Program, Brigham and Women's Hospital, Boston, MA. Dr. Ruchman is a first-year resident in the Internal Medicine-Pediatrics Program, University of Colorado, Aurora, CO. Ms. Birhanu and Ms. Wu are third-year medical students at the Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Katz is Clinical Professor in the Departments of Psychiatry, Medical Education, and Health System Design & Global Health and Faculty Director of the Mount Sinai Human Rights Program's Remote Evaluation Network, Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Singer is Director of the Mount Sinai Human Rights Program and Associate Professor in the Departments of Emergency Medicine and Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Baranowski is Associate Director of the Mount Sinai Human Rights Program and Faculty Director of Research, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Beselot Birhanu
- Dr. Green is a first-year resident in the Internal Medicine Program, Brigham and Women's Hospital, Boston, MA. Dr. Ruchman is a first-year resident in the Internal Medicine-Pediatrics Program, University of Colorado, Aurora, CO. Ms. Birhanu and Ms. Wu are third-year medical students at the Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Katz is Clinical Professor in the Departments of Psychiatry, Medical Education, and Health System Design & Global Health and Faculty Director of the Mount Sinai Human Rights Program's Remote Evaluation Network, Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Singer is Director of the Mount Sinai Human Rights Program and Associate Professor in the Departments of Emergency Medicine and Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Baranowski is Associate Director of the Mount Sinai Human Rights Program and Faculty Director of Research, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stephanie Wu
- Dr. Green is a first-year resident in the Internal Medicine Program, Brigham and Women's Hospital, Boston, MA. Dr. Ruchman is a first-year resident in the Internal Medicine-Pediatrics Program, University of Colorado, Aurora, CO. Ms. Birhanu and Ms. Wu are third-year medical students at the Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Katz is Clinical Professor in the Departments of Psychiatry, Medical Education, and Health System Design & Global Health and Faculty Director of the Mount Sinai Human Rights Program's Remote Evaluation Network, Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Singer is Director of the Mount Sinai Human Rights Program and Associate Professor in the Departments of Emergency Medicine and Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Baranowski is Associate Director of the Mount Sinai Human Rights Program and Faculty Director of Research, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Craig L Katz
- Dr. Green is a first-year resident in the Internal Medicine Program, Brigham and Women's Hospital, Boston, MA. Dr. Ruchman is a first-year resident in the Internal Medicine-Pediatrics Program, University of Colorado, Aurora, CO. Ms. Birhanu and Ms. Wu are third-year medical students at the Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Katz is Clinical Professor in the Departments of Psychiatry, Medical Education, and Health System Design & Global Health and Faculty Director of the Mount Sinai Human Rights Program's Remote Evaluation Network, Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Singer is Director of the Mount Sinai Human Rights Program and Associate Professor in the Departments of Emergency Medicine and Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Baranowski is Associate Director of the Mount Sinai Human Rights Program and Faculty Director of Research, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Elizabeth K Singer
- Dr. Green is a first-year resident in the Internal Medicine Program, Brigham and Women's Hospital, Boston, MA. Dr. Ruchman is a first-year resident in the Internal Medicine-Pediatrics Program, University of Colorado, Aurora, CO. Ms. Birhanu and Ms. Wu are third-year medical students at the Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Katz is Clinical Professor in the Departments of Psychiatry, Medical Education, and Health System Design & Global Health and Faculty Director of the Mount Sinai Human Rights Program's Remote Evaluation Network, Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Singer is Director of the Mount Sinai Human Rights Program and Associate Professor in the Departments of Emergency Medicine and Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Baranowski is Associate Director of the Mount Sinai Human Rights Program and Faculty Director of Research, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kim A Baranowski
- Dr. Green is a first-year resident in the Internal Medicine Program, Brigham and Women's Hospital, Boston, MA. Dr. Ruchman is a first-year resident in the Internal Medicine-Pediatrics Program, University of Colorado, Aurora, CO. Ms. Birhanu and Ms. Wu are third-year medical students at the Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Katz is Clinical Professor in the Departments of Psychiatry, Medical Education, and Health System Design & Global Health and Faculty Director of the Mount Sinai Human Rights Program's Remote Evaluation Network, Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Singer is Director of the Mount Sinai Human Rights Program and Associate Professor in the Departments of Emergency Medicine and Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Baranowski is Associate Director of the Mount Sinai Human Rights Program and Faculty Director of Research, Icahn School of Medicine at Mount Sinai, New York, NY
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