We conducted focus groups with Latinos enrolled in a Medicaid health plan in order to ask about the barriers to and facilitators of depression treatment in general as well as barriers to participation in depression telephone care management. Telephone care management has been designed for and tested in primary care settings as a way of assisting physicians with caring for their depressed patients. It consists of regular brief contacts between the care manager and the patient; the care manager educates, tracks, and monitors patients with depression, coordinates care between the patient and primary care physician, and may provide short-term psychotherapy. We conducted qualitative analyses of four focus groups (n = 30 participants) composed of Latinos who endorsed having been depressed themselves or having had a close friend or family member with depression, stress, nervios, or worries. Within the area of barriers and facilitators of receiving care for depression, we identified the following themes: vulnerability, social connection and engagement, language, culture, insurance/money, stigma, disengagement, information, and family. Participants discussed attitudes toward: importance of seeking help for depression, specific types of treatments, healthcare providers, continuity and coordination of care, and phone calls. Improved understanding of barriers and facilitators of depression treatment in general and depression care management in particular for Latinos enrolled in Medicaid should lead to interventions better able to meet the needs of this particular group.
Receipt of care consistent with the PCMH was not significantly associated with differences in healthcare services utilization or expenditures compared to having a non-PCMH USC. Research assessing whether the PCMH is cost-effective for non-elderly adults with mental illness is needed.
BackgroundPatient-centered medical homes (PCMHs) may improve outcomes for non-elderly adults with mental illness, but the extent to which PCMHs are associated with preventive care and healthcare quality for this population is largely unknown. Our study addresses this gap by assessing the associations between receipt of care consistent with the PCMH and preventive care and healthcare quality for non-elderly adults with mental illness.MethodsThis surveillance study used self-reported data for 6,908 non-elderly adults with mental illness participating in the 2007–2012 Medical Expenditure Panel Survey. Preventive care and healthcare quality measures included: participant rating of all healthcare; cervical, breast, and colorectal cancer screening; current smoking; smoking cessation advice; flu shot; foot exam and eye exam for people with diabetes; and follow-up after emergency room visit for mental illness. Multiple logistic regression models were developed to compare the odds of meeting preventive care and healthcare quality measures for participants without a usual source of care, participants with a non-PCMH usual source of care, and participants who received care consistent with the PCMH.ResultsCompared to participants without a usual source of care, those with a non-PCMH usual source of care had better odds of meeting almost all measures examined, while those who received care consistent with the PCMH had better odds of meeting most measures. Participants who received care consistent with the PCMH had better odds of meeting only one measure compared to participants with a non-PCMH usual source of care.ConclusionsCompared with having a non-PCMH usual source of care, receipt of care consistent with the PCMH does not appear to be associated with most preventive care or healthcare quality measures. These findings raise concerns about the potential value of the PCMH for non-elderly adults with mental illness and suggest that alternative models of primary care are needed to improve outcomes and address disparities for this population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1676-z) contains supplementary material, which is available to authorized users.
Background: Mild induced therapeutic hypothermia (TH) is currently recommended for survivors of out-of-hospital cardiac arrest (OHCA) who meet specified criteria. If TH were fully implemented in the US, 2298 additional OHCA victims every year could be expected to survive. Despite a 2006 meta-analysis clearly demonstrating a decrease in mortality and an improvement in neurological outcome (with no treatment-limiting side effects) for TH, clinicians have been reluctant to adopt the therapy, often citing cost as a reason. The aim of this study was to determine the cost-effectiveness (CE) of TH after OHCA relative to supportive care. Methods: Monte Carlo simulation was used to approximate the cost per in-hospital death prevented, the cost per poor neurological outcome averted, and annual hospital costs. Estimates of effectiveness and resource use were extracted from secondary data sources. Included variables were: in-hospital mortality, neurological status, ICU and hospital ward length-of-stay (LOS), ICU and hospital ward cost/day, equipment costs, physician time, and medications. For our base case, we calculated the CE of treating 60 patients/year using a moderate cost method. We did sensitivity analyses through systematic bidirectional adjustments of selected variables’ costs, by reducing the treated patients/year to 12, and by excluding the cost of medications and physician time. All analyses were done from a US hospital perspective and reported in 2008 US$. Results: LOS dominated the difference in cost. The median cost per death prevented was $280,092 [IQR $202,279-$386,215] and per poor neurological outcome averted it was $147,314 [IQR $118,009-$182,251]. The median annual cost to treat 60 patients/year using a moderate cost method was $1,588,730 [IQR $1,322,343-$1,865,462]. Reducing the number of patients treated per year to 12 lowered the annual cost to $319,759 [IQR $268,122-$373,670]. The results of all other sensitivity analyses were similar to the base case. Assuming a mean duration of survival following hospital discharge of 6.13 years, TH had a cost/life-year saved of $45,692, which compares favorably to other life-saving health and social interventions. Conclusion: TH after OHCA is a relatively cost-effective treatment modality.
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