The relationship between a worksite wellness clinic and hospital emergency department visits.

Objective: To assess the relationship between the provision of episodic medical care at the worksite and nonadmission emergency department (ED) visits.

Methods: A historical cohort design was used to study the differences of nonadmission ED visits among insurance plan participants employed at two acute care hospitals, one with a worksite wellness clinic and one without over an 8-year period.

Results: A significant reduction in the risk of an insurance plan member visiting the ED in the time period after the clinic was opened among plan members with access to a worksite wellness clinic was observed.

Improving urban African Americans' blood pressure control through multi-level interventions in the Achieving Blood Pressure Control Together (ACT) study: a randomized clinical trial.

Background: Given their high rates of uncontrolled blood pressure, urban African Americans comprise a particularly vulnerable subgroup of persons with hypertension. Substantial evidence has demonstrated the important role of family and community support in improving patients' management of a variety of chronic illnesses. However, studies of multi-level interventions designed specifically to improve urban African American patients' blood pressure self-management by simultaneously leveraging patient, family, and community strengths are lacking.

Adapting hypertension self-management interventions to enhance their sustained effectiveness among urban African Americans.

African Americans suffer disproportionately poor hypertension control despite the availability of efficacious interventions. Using principles of community-based participatory research and implementation science, we adapted established hypertension self-management interventions to enhance interventions' cultural relevance and potential for sustained effectiveness among urban African Americans. We obtained input from patients and their family members, their health care providers, and community members.

Facilitators and barriers to hypertension self-management in urban African Americans: perspectives of patients and family members.

Introduction: We aimed to inform the design of behavioral interventions by identifying patients' and their family members' perceived facilitators and barriers to hypertension self-management.

Materials And Methods: We conducted focus groups of African American patients with hypertension and their family members to elicit their views about factors influencing patients' hypertension self-management. We recruited African American patients with hypertension (n = 18) and their family members (n = 12) from an urban, community-based clinical practice in Baltimore, Maryland.

Chronic care improvement in primary care: evaluation of an integrated pay-for-performance and practice-based care coordination program among elderly patients with diabetes.

Objective: To examine the effects of an intervention comprising (1) a practice-based care coordination program, (2) augmented by pay for performance (P4P) for meeting quality targets, and (3) complemented by a third-party disease management on quality of care and resource use for older adults with diabetes.

Data Sources/study Setting: Claims files of a managed care organization (MCO) for 20,943 adults aged 65 and older with diabetes receiving care in Alabama, Tennessee, or Texas, from January 2004 to March 2007.

Study Design: A quasi-experimental, longitudinal study in which pre- and postdata from 1,587 patients in nine intervention primary care practices were evaluated against 19,356 patients in MCO comparison practices (>900).

Examining the effectiveness of hydroxyurea in people with sickle cell disease.

This study investigated hydroxyurea use in people with sickle cell disease (SCD) outside of a research setting. Pharmacy data, outpatient visits, hospital admissions, and length of stay were assessed for all patients with SCD enrolled in a Medicaid managed care organization in Maryland. Three hundred and ninety (390) people with SCD were covered between the years 2001-2005.

Evaluating a palliative care case management program for cancer patients: the Omega Life Program.

Purpose: This study evaluated a cancer case management pilot program focusing on palliative care, the Omega Life Program (OLP), by assessing whether the program was associated with reduced hospital utilization.

Methods: A retrospective observational study of patients with cancer who enrolled in the OLP (intervention) compared to those who chose not to enroll (comparison) from January 1, 2005 to February 28, 2007. Patients were included in the primary analyses if they died by the end of the study period and were enrolled in the program at least 1 week before death.

Pedophilia.

This article addresses the risk factors associated with the psychiatric disorder pedophilia, its treatment, and treatment outcomes. It addresses physician responsibilities associated with case identification of victims and possible roles in the medical management of pedophilia. The essential feature of pedophilia is that an individual is sexually attracted exclusively or in part to prepubescent children.

Alexithymia in patients attending a sexual disorders clinic.

We measured alexithymic traits with the Toronto Alexithymia Scale (TAS; Bagby, Taylor, & Parker, 1988) in 170 individuals attending a sexual disorders clinic. We diagnosed 114 of the subjects with a sexual dysfunction and 56 with paraphilic disorders. We determined that 20.

A model for managed behavioral health care in an academic department of psychiatry.

In response to the effects of the managed care environment on patient flow and care, the department of psychiatry and behavioral sciences of the Johns Hopkins School of Medicine developed and has been managing a capitated behavioral health care program. The program is responsible for providing mental health and substance abuse services for 22,000 members of the TRICARE Uniformed Services Family Health Plan (USFHP), directed by the U.S.

Erectile dysfunction and depression: category or dimension?

Depression, as a risk factor for erectile dysfunction (ED), has received minimal systematic attention. One-hundred twenty men with ED evaluated in a sexual behaviors clinic were studied. The categorical Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) diagnosis of a depressive disorder was found in only 14 subjects (14.