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

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.

Increasing time costs and copayments for prescription drugs: an analysis of policy changes in a complex environment.

Objective: To estimate the effect of two separate policy changes in the North Carolina Medicaid program: (1) reduced prescription lengths from 100 to 34 days' supply, and (2) increased copayments for brand name medications.

Data Sources/study Setting: Medicaid claims data were obtained from the Centers for Medicare and Medicaid Services for January 1, 2000-December 31, 2002.

Study Design: We used a pre-post controlled partial difference-in-difference-in-differences design to examine the effect of the policy change on adults in North Carolina; adult Medicaid recipients from Georgia served as controls.

Cost-effectiveness of integrated care for elderly depressed patients in the PRISM-E study.

Background: One proposed strategy to improve outcomes associated with depression and other behavioral health disorders in primary care settings is to strengthen collaboration between primary care and specialty mental health care through integrated care (IC).

Aims: We compare the cost-effectiveness of IC in primary care to enhanced specialty referral (ESR) for elders with behavioral health disorders from the Primary Care Research in Substance Abuse and Mental Health study, which was a randomized trial conducted between 2000 and 2002, using a societal perspective.

Methods: The IC model had a behavioral health professional co-located in the primary care setting, and the primary care provider continued involvement in the mental health/substance abuse care of the patient.

Antidepressant and antipsychotic use and adherence among Medicaid youths: differences by race.

The purpose of our study is to use Medicaid data to examine the relationship between race and (a) whether youth with schizophrenia or depression diagnoses receive anti-psychotic and antidepressant prescriptions and (b) adherence to anti-psychotics and antidepressants. The analysis is based on claims files from January 1, 2000 through June 30, 2001. To assess adherence, we used the Proportion of Days Covered (PDC) measure.

Old wine in new skins: the sensitivity of established findings to new methods.

Findings from an evaluation of a model system for delivering mental health services to youth were reassessed to determine the robustness of key findings to the use of methodologies unavailable to the original analysts. These analyses address a key concern about earlier findings-that the quasi-experimental design involved the comparison of two noncomparable groups. The authors employed propensity score methodology to reconsider between-group baseline differences in observed characteristics of participating families.

Use of complementary and alternative medicine among patients with arthritis.

Introduction: Previous studies suggest that people with arthritis have high rates of using complementary and alternative medicine (CAM) approaches for managing their arthritis, in addition to conventional treatments such as prescription medications. However, little is known about the use of CAM by diagnosis, or which forms of CAM are most frequently used by people with arthritis. This study was designed to provide detailed information about use of CAM for symptoms associated with arthritis in patients followed in primary care and specialty clinics in North Carolina.

Comparison of assertive community treatment programs in urban Massachusetts and rural North Carolina.

In this pilot study, we compared teams in rural North Carolina (NC) and urban Massachusetts (MA) to examine the how sites vary the implementation of the Assertive Community Treatment (ACT) model to respond to state and local circumstances. We analysed and compared data on: client characteristics using the NC-TOPPS and a modified survey in MA; Regional Demographics and; Team Characteristics. Issues such as driving distances, lack of qualified clinical staff, scarcity of physicians, and more limited oversight created impediments to fidelity in rural NC, despite higher per patient funding.

Contrasting measures of adherence with simple drug use, medication switching, and therapeutic duplication.

Background: Multiple measures of adherence have been reported in the research literature and it is difficult to determine which is best, as each is nuanced. Occurrences of medication switching and polypharmacy or therapeutic duplication can substantially complicate adherence calculations when adherence to a therapeutic class is sought.

Objective: To contrast the Proportion of Days Covered (PDC) adherence metric with 2 variants of the Medication Possession Ratio (MPR, truncated MPR).

Medical skepticism and the use of complementary and alternative health care providers by patients followed by rheumatologists.

Background: Our understanding of the determinants of use of complementary and alternative (CAM) providers is limited, especially in regard to medical skepticism (ie, doubt in the ability of conventional medical care to appreciably alter health status).

Objectives: To determine whether medical skepticism was associated with CAM provider use in patients with arthritis and to explore the association between medical skepticism and demographic and health-related characteristics of persons with arthritis.

Methods: A cross-sectional analysis of data from patients (N = 721) with osteoarthritis, rheumatoid arthritis, or fibromyalgia who completed a questionnaire about their health, health care use, and health-related attitudes/behaviors, including medical skepticism.

Evaluations of community mental health care in low- and middle-income countries: a 10-year review of the literature.

Community-based models of providing mental health services are widely considered effective ways of serving individuals diagnosed with mental illness, but more comprehensive literature on these models in low- and middle-income countries is needed. This study is a systematic review of the effects of community-based models on health outcomes of adults with depression, schizophrenia, panic disorder, or bipolar disorders in middle- and low-income countries. PubMed, PsycINFO, and Cochrane Reviews were searched, returning 500 articles.

Complementary and alternative medicine use in musculoskeletal disorders: does medical skepticism matter?

Medical skepticism is the reservation about the ability of conventional medical care to significantly improve health. Individuals with musculoskeletal disorders seeing specialists usually experience higher levels of disability; therefore it is expected they might be more skeptical of current treatment and thus more likely to try Complementary and Alternative Medicine (CAM). The goal of this study was to define these relationships.