Publications by authors named "Walter Mathis"

Article Synopsis
  • The study examined how COVID-19 restrictions influenced the duration of untreated psychosis (DUP) among first-time psychosis patients in Connecticut.
  • During the early pandemic, the median DUP significantly dropped from 208 days to 56 days, but later increased to 154 days.
  • The time from when psychosis began to starting antipsychotic medication also decreased from 117 days to 35 days, indicating that tighter pandemic restrictions led to quicker treatment responses and could inform future early detection strategies.
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Background: Large language models (LLMs) are generative artificial intelligence that have ignited much interest and discussion about their utility in clinical and research settings. Despite this interest there is sparse analysis of their use in qualitative thematic analysis comparing their current ability to that of human coding and analysis. In addition, there has been no published analysis of their use in real-world, protected health information.

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This paper presents TimelinePTC, a web-based tool developed to improve the collection and analysis of Pathways to Care (PTC) data in first episode psychosis (FEP) research. Accurately measuring the duration of untreated psychosis (DUP) is essential for effective FEP treatment, requiring detailed understanding of the patient's journey to care. However, traditional PTC data collection methods, mainly manual and paper-based, are time-consuming and often fail to capture the full complexity of care pathways.

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Article Synopsis
  • * Using a large sample, researchers found that 80.6% of individuals had optimal access to pharmacies, but significant disparities existed, especially for Black, Hispanic, and Indigenous individuals in rural areas.
  • * The results indicated that these inequities also varied by region, with certain groups having lower odds of optimal pharmacy access depending on whether they lived in suburban or rural areas.
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We investigated the impact of COVID-19 restrictions on the duration of untreated psychosis (DUP). First-episode psychosis admissions (n=101) to STEP Clinic in Connecticut showed DUP reduction (p=.0015) in the pandemic, with the median reducing from 208 days during the pre-pandemic to 56 days in the early pandemic period and subsequently increasing to 154 days (p=.

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Individuals with severe mental illness and substance use disorders face complex barriers to achieving physical health. This study aims to explore the barriers and facilitators of primary care access among an Assertive Community Treatment (ACT) team. Semi-structured qualitative interviews were conducted with 14 clients and 7 clinicians from an ACT team at a community mental health center in Connecticut.

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Pharmacy accessibility is critical for equity in medication access and is jeopardized by pharmacy closures, which disproportionately affect independent pharmacies. We conducted a geographic information systems analysis to quantify how many individuals across the US do not have optimal pharmacy access or solely rely on independent pharmacies for access. We generated service areas of pharmacies using OpenStreetMap data.

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Individuals with serious mental illness are vulnerable to extreme heat due to biological, social, and place-based factors. We examine the spatial correlation of prevalence of individuals treated at a community mental health center to heat vulnerability. We applied a heat vulnerability index (HVI) to the catchment of the Connecticut Mental Health Center in New Haven, Connecticut.

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The aim of this study was to quantify access disparities by examining the impact of a medical clinic relocation on travel time differences for patients using private cars versus public transit. Longitude and latitude of patient home addresses were extracted from electronic medical records for the 4 years before the clinic move. Using offline, open-source, and HIPAA-compliant routing software, roundtrip travel times were computed from each home address to the old and new clinic locations via car and bus.

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Objective: An extensive international literature demonstrates that understanding pathways to care (PTC) is essential for efforts to reduce community Duration of Untreated Psychosis (DUP). However, knowledge from these studies is difficult to translate to new settings. We present a novel approach to characterize and analyze PTC and demonstrate its value for the design and implementation of early detection efforts.

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Community mental healthcare around the world has been strained as people need more help and experience more barriers to access due to COVID-19. The rapid shift to telehealth services necessitated by the pandemic has made these difficulties even more pronounced. While this transition presented challenges for nearly every healthcare system, it has proven especially difficult for low resource settings such as community health centers.

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Background: In the United States, geographic access is a major driver of health care disparities. Studies have shown that pharmacy deserts are prevalent in the United States, even in major metropolitan areas. However, one limitation often cited by these studies is the use of distance rather than travel time to define pharmacy deserts.

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Objective: Duration of Untreated Psychosis (DUP) remains unacceptably long and limits effectiveness of care. To determine whether an early detection campaign ("Mindmap") can reduce DUP in a US community setting.

Methods: In this nonrandomized controlled trial, Mindmap targeted the catchment of one specialty first-episode service or FES (STEP, Greater New Haven) from 2015 to 2019, while usual detection efforts continued at a control FES (PREP, Greater Boston).

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Aims: First-episode services (FES) improve outcomes in recent onset psychosis, but there is growing concern about how patients fare after discharge from these time-limited services.

Methods: A quality improvement approach (QI) was used to improve patient engagement in the discharge planning process (disposition), and successful engagement in care 3 months after discharge from the FES (transfer). Data from 144 consecutive discharges over 62 months are presented.

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Purpose: Delay in receiving effective treatment for psychosis adversely impacts outcomes. We investigated the timing of the first help-seeking attempt in individuals with recent onset non-affective psychosis by comparing those who sought help during the prodrome to those who sought help after psychosis onset across sociodemographic and clinical characteristics, overall functioning, and occurrence of aversive events during their pathways to care.

Methods: Patients were admitted from February 1st, 2014 to January 31st, 2019 to the Program for Specialized Treatment Early in Psychosis (STEP) in New Haven, CT.

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Aim: To apply spatial analytics to an underway first episode psychosis program to identify areas of significant variation in the geographical distribution of program enrollees from an underlying at-risk population.

Methods: Adaptive bandwidth kernel smoothing was used to estimate spatial density functions from program enrollee home addresses and a control population computed from US Census data. A relative risk surface derived from the ratio of these functions was used to discover under-represented areas, or areas from which fewer enrollees where produced than suggested by the underlying population density at the P < .

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Chronic administration of drugs of abuse leads to a dopamine deficient state in the mesolimbic system, causing dysphoria in abstinence and contributing to craving and return to use. Recent functional imaging studies have shown that listening to personally pleasing music activates the mesolimbic reward system in a fashion similar to drugs of abuse. It has been proposed that such activation could ameliorate the dysphoria and craving of the hypodopaminergic state.

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