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Biomedical subjects

D Mechanic

Publications and source records attributed to D Mechanic.

At least 73 records · Page 4Linked to original sources
PubMed1994

Psychiatric reimbursement reform in New York State: lessons in implementing change.

The failure of an innovative and ambitious reform in the psychiatric reimbursement system of New York State is examined for specific lessons of value for other states as they implement new payment strategies to encourage improved treatment of the mentally ill in general hospitals and community settings. The New York payment system was comprehensive, embracing both inpatient and outpatient care, and had significant support in the hospital and professional communities. Still, its impact on hospital performance was small and only partially consistent with its goals. For mental health reimbursement reform to succeed, state administrators must provide more clear, sustained, and forceful signals that take account of the real barriers to implementation; they must also ensure that the financial incentives and rewards are recognized by those who carry out the actions needed to translate goals into reality.

Episode of Care↗
PubMed1993

Chronic fatigue syndrome and the treatment process.

Fatigue is a common complaint in general practice and is often associated with psychiatric and psychosocial problems and demoralization. Although the Centers for Disease Control definition of chronic fatigue syndrome (CFS) excludes pre-existing psychiatric illness, common psychosocial problems short of a clinical disorder (such as irritability, difficulty in thinking, inability to concentrate, depression and sleep disturbance) overlap with the criteria for CFS. Psychological states can affect the course of CFS or become confused in the patient's and doctor's mind with the course of infection. The core dilemma in practice is how aggressively to pursue a possible basis for CFS when it persists in the absence of an identifiable external cause. Possibilities for exploration are numerous and potentially expensive. In practice, the persistence of doctors depends on the patient's illness behaviour, on financial and organizational factors, and on the culture of medical care and practice styles. It is essential to differentiate the appropriate management of CFS from scientific study where intensive investigation may be warranted. In practice doctors should proceed in a manner that conveys concern, supports function, and avoids dysfunctional illness behaviour and inadvertent legitimization and reinforcement of disability.

Cost of Illness↗
PubMed1993

Social research in health and the American sociopolitical context: the changing fortunes of medical sociology.

The fortunes of medical sociology, like other public policy-relevant disciplines, are shaped by political dynamics and prevailing values and attitudes. In the 1980s the field, which views disease and disability as consequences to a substantial degree of material conditions, social stratification, and inequalities among varying strata, lost ground to economics as societal attention focused on cost containment issues. Sociological concern with social structures clashed with dominant conservative and individualistic perspectives and the increased focus on personal responsibility and market strategies. There was decreasing tolerance in policy circles for the view that health, and the problems affecting disenfranchised groups such as the poor, the homeless, the uninsured and people with disabilities, were more due to our politics and social arrangements than the personal characteristics of those affected. Thus, little attention has been given in public health discourse to how life imperatives and social opportunities and constraints shape behavior. The paper documents the important role of the social sciences in health services research with special attention to examining the social context of the RAND Health Insurance Experiment. Although many of the questions medical sociology address sit on the periphery of policy-makers' concerns, a strong case is made for the revitalization of a critical scholarly role in medical sociology. I conclude, given the short and longterm problems we face in medicine and health, that we would have to invent a vigorous critical medical sociological enterprise if we did not already have one.

Forecasting↗
PubMed1993

Inpatient treatment of schizophrenia in general hospitals.

OBJECTIVE: To improve treatment of schizophrenic patients in short-term inpatient units, the authors review studies of interventions that have been implemented with schizophrenic patients during brief hospitalizations and suggest areas for future research. METHODS: The review is organized around seven general treatment domains, including the therapeutic alliance, continuity of care, family involvement, procurement of community services, psychosocial rehabilitation, medication compliance, and substance abuse treatment. RESULTS AND CONCLUSIONS: Because schizophrenic patients have traditionally been treated in long-term settings, little literature exists to inform interventions on short-term units. The authors suggest that general hospital staff strengthen the treatment alliance between patients and outpatient clinicians, aggressively pursue community supports, work to ensure patients' follow-up with outpatient care, and consider depot medications and patient education to promote medication compliance.

Combined Modality Therapy↗
PubMed1993

Mental health services in the context of health insurance reform.

Health care reform offers opportunities to improve the care of persons with serious mental illness, but it also can lead to the disruption of innovative systems of care that have been developed in recent years through Medicaid and other public programs. The care of mentally ill persons must be organized to maximize possible trade-offs between inpatient and other community services in a way that will promote function and satisfactory adjustment. An indemnity approach emphasizes controls on demand; instead, better design of supply-side approaches is required, using incentives to integrate services through case management and other methods. Considerable capacity development is needed to integrate long-term care appropriately into the mainstream, but serious barriers include control of risk selection and the difficulties of fairly adjusting capitation rates for high-utilization patients. Issues in mental health care are paradigmatic of many other areas of medical care and reflect changing family and community organizations and new challenges in care and rehabilitation.

Chronic Disease↗
PubMed1992

Health and illness behavior and patient-practitioner relationships.

Health is a product of culture and social structure. The routine organization and constraints of everyday settings shape our health. Socio-economic status is of major importance in determining exposure to disease risk and in shaping health and illness behavior responses. Lay explanations of illness affect illness appraisal, self-treatment, decisions to seek care and changes in daily regimen. Somatization of psychosocial stressors is a common concern in primary care systems throughout the world, and doctors are commonly frustrated by such patients. Somatizing patients are often enmeshed in environments of great psychosocial difficulty or are depressed, and many cultural and social factors affect how depression is expressed. Although depression has devastating disabling effects on patients, it is often neither recognized by doctors nor treated. But doctor-patient relationships are often the context for appropriate management of such problems, and how they are handled affect the future trajectory of illness and disability. Doctors' responses are conditioned by their attitudes, training, interviewing and psychosocial skills, and organizational and financial factors. Patient flow is an important intervening variable affecting the management of psychosocial difficulties and depression.

Depression↗
PubMed1992

Research resources.

Explore the source record for details and available documents.

Community Mental Health Services↗
PubMed1992

Correlates of using mental health services: implications of using alternative definitions.

BACKGROUND: Studies using varying definitions of mental health visits result in widely divergent estimates. This analysis examines the stability of a predictive model using three varying definitions based on provider type, diagnosis, psychotherapy, and psychotropic medication use. METHODS: Interview and questionnaire data and claims records from the RAND Health Insurance Experiment are used to test these models among 3138 enrollees. RESULTS: Estimates of visits, and factors associated with them, are highly sensitive to definitions. Depression was the only symptom/life situation variable, and education the only sociodemographic measure, predictive across all three models. Risk indicators such as suicide thoughts and drinking problems were only significant for the traditional (mental health specialty) model. While patients within the traditional model definition were significantly younger than other enrollees, those within the model using the most expansive definition were significantly older. Varying the definition also led to different results in respect to experimental manipulations, geographic sites and some specific types of comorbidity. CONCLUSIONS: A reasonable definition, consistent with medical standards, requires, at least, a mental health diagnostic judgment and some form of psychotherapeutic or drug treatment. Studies of the content of mental health care are needed.

Adult↗
PubMed1991

Body awareness and medical care utilization among older adults in an HMO.

This study investigated the association between the disposition of body awareness and medical care utilization among older adult members of a health maintenance organization (HMO). Results indicated that higher levels of body awareness are associated significantly with longitudinal increases in the volume of patient-initiated illness visits to the HMO, and with a greater likelihood of patient-initiated contact with the hospital emergency room, controlling for prior utilization, self-reported health status, and other factors. In contrast, body awareness was not associated significantly with longitudinal changes in physician-initiated follow-up visits, internal referrals, external referrals, or hospital inpatient days. Other findings indicated that higher levels of patient-initiated utilization were associated with greater physician-initiated utilization, controlling for prior utilization. These results illustrate how patient-initiated utilization may influence subsequent physician-initiated utilization.

Aged↗