This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.
Similarities and differences among EMS systems participating in the ROC network were described. The framework used in this analysis may serve as a template for future EMS research.
Objective While recent studies have documented high-risk drinking occurring during Spring Break (SB), particularly on SB trips with friends, published intervention studies are few. The present study evaluated the efficacy of Event Specific Prevention (ESP) strategies for reducing SB drinking among college students, compared to general prevention strategies and an assessment-only control group, as well as evaluated inclusion of peers in interventions and mode of intervention delivery (in-person vs. web). Method Participants included 783 undergraduates (56.1% women, average age 20.5) intending to go on a SB trip with friends as well as to drink heavily on at least one day of SB. Participants completed assessments prior to SB and were randomized to one of five intervention conditions: SB in-person BASICS, SB web BASICS, SB in-person BASICS with friend, SB web BASICS with friend, general BASICS, or an attention control condition. Follow-up assessment was completed one week after SB. Results While the SB web BASICS (with and without friends) and general BASICS interventions were not effective at reducing SB drinking, results indicated significant intervention effects for SB in-person BASICS in reducing SB drinking, particularly on trip days. Follow-up analyses indicated change in descriptive norms mediated treatment effect and reductions in drinking, while SB drinking intentions and positive expectancies did not. Conclusions Overall, results suggest an in-person SB-specific intervention is effective at reducing SB drinking, especially during trips. In contrast, interventions that contain non-SB related content, are web-based, or seek to involve friends may be less effective at reducing SB drinking.
Community paramedicine (CP) uses emergency medical services (EMS) providers to help rural communities increase access to primary care and public health services. This study examined goals, activities, and outcomes of 31 rural-serving CP programs through structured interviews of program leaders and document review. Common goals included managing chronic disease (90.3%); and reducing emergency department visits (83.9%), hospital admissions/readmissions (83.9%), and costs (83.9%). Target populations included the chronically ill (90.3%), post-hospital discharge patients (80.6%), and frequent EMS users (64.5%). Community paramedicine programs engaged in bi-directional referrals most often with primary care facilities (67.7%), hospitals (54.8%), and home health (38.7%). Programs provided assessment, testing, preventive care, and post-discharge services. Reported outcomes were promising, but few programs used rigorous evaluation methods. Rural-serving CP programs provided services to shift costs to less expensive settings and provide appropriate care where vulnerable patients live, but more evidence is needed that care is safe, effective, and economical.
Background Exposing residents to rural training encourages future rural practice, but unified accreditation of allopathic and osteopathic graduate medical education under one system by 2020 has uncertain implications for rural residency programs. Objective We describe training locations and rural-specific content of rural-centric residency programs (requiring at least 8 weeks of rurally located training) before this transition. Methods In 2015, we surveyed residency programs that were rurally located or had rural tracks in 7 specialties and classified training locations as rural or urban using Rural-Urban Commuting Area (RUCA) codes. Results Of 1849 residencies in anesthesiology, emergency medicine, general surgery, internal medicine, obstetrics and gynecology, pediatrics, and psychiatry, 119 (6%) were rurally located or offered a rural track. Ninety-seven programs (82%) responded to the survey. Thirty-six programs required at least 8 weeks of rural training for some or all residents, and 69% of these rural-centric residencies were urban-based and 53% were osteopathic. Locations were rural for 26% of hospital rotations and 28% of continuity clinics. Many rural-centric programs (35%) reported only urban ZIP codes for required rural block rotations; 54% reported only urban ZIP codes for required rural clinic sessions, and 31% listed only urban ZIP codes in reporting rural full-time training locations. Programs varied widely in coverage of rural-specific training in 6 core competencies. Conclusions In multiple specialties important for rural health care systems, little rurally located residency training and rural-specific content was available. Substantial proportions of training locations reported to be rural were actually urban according to a common rural definition.
To describe the mix of health professionals who care for rural and urban seniors suffering from mood and/or anxiety disorders, the quantity of services they receive, and to understand where beneficiaries receive care for mood and/or anxiety disorders and the distance and time they travel for care. Methods:We used 2014 Medicare administrative claims data to examine access to health care for fee-for-service Medicare beneficiaries aged ≥ 65 years who received outpatient services for mood and anxiety disorders. We classified providers into 9 categories: (1) family physicians/general practice, (2) internists, (3) nurse practitioners (NPs) and physician assistants (PAs), (4) psychiatrists, (5) psychologists, (6) clinical social workers, (7) emergency medicine physicians, (8) other physicians, and (9) other providers. We calculated the 1-way driving distance and travel time between the beneficiary residence and provider location. We classified beneficiaries into 1 of 4 geographic categories based on their residence ZIP Code.Findings: Urban beneficiaries had an average of 2.7 visits for mood and anxiety disorders, while rural beneficiaries had 2.4. Generalist physicians and NPs/PAs provided 50.8% of all visits. Urban beneficiaries saw more behavioral health specialists (34.3%) than rural beneficiaries (16.1%). NPs and PAs provided more than twice as much of the care for rural beneficiaries (14.8%) as for urban beneficiaries (6.4%). Rural beneficiaries travelled about twice as far as urban beneficiaries.Conclusions: Rural and urban Medicare beneficiaries received care for mood/anxiety disorders from different mixes of health care providers, and ensuring access for rural populations will require innovative solutions.
Today's college students have grown up with legalized gambling and access to a variety of gambling venues. Compared to the general adult population, rates of disordered gambling among college students are nearly double. Previous research suggests that the desire to win money is a strong motivator to gamble (Neighbors et al. in J Gambl Stud 18:361-370, 2002a); however, there is a dearth of literature on attitudes towards money in relation to gambling behavior. The current study evaluated the association between the four subscales of the Money Attitude Scale (Yamauchi and Templer in J Pers Assess 46:522-528, 1982) and four gambling outcomes (frequency, quantity, consequences and problem severity) in a sample of college students (ages 18-25; N = 2534) using hurdle negative binomial regression model analyses. Results suggest that college students who hold high Power-Prestige or Anxiety attitudes toward money were more likely to gamble and experience greater consequences related to their gambling. Distrust attitudes were negatively associated with gambling behaviors. Retention-Time attitudes were not significantly associated with gambling behaviors and may not be directly relevant to college students, given their often limited fiscal circumstances. These findings suggest that money attitudes may be potential targets for prevention programs in this population.
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