Biomedical subjects

F C Blow

Publications and source records attributed to F C Blow.

At least 37 records · Page 2Linked to original sources

PubMed2000

Treatment of older women with alcohol problems: meeting the challenge for a special population.

As a larger proportion of the U.S. population reaches late life, there are new challenges to providing quality health care services for this group. Record numbers of adults over 60 are seeking health care for acute and chronic conditions. Older women represent the largest single group of health care users in this country. Twelve percent of older women regularly drink in excess of recommended guidelines (no more than one drink per day or seven drinks per week) and can be considered at-risk drinkers. Problems related to alcohol use and misuse can seriously affect many of the health concerns common among older women, including chronic illnesses and depression. Older women have specific risks and vulnerabilities to alcohol use, which include a swifter progression to alcohol-related illness. However, women in later life who have alcohol problems are underscreened and underdiagnosed, have significant barriers in accessing health care, and respond differentially to standard specialized treatment protocols. To date, research on these topics has been limited. Furthermore, there is a paucity of research focused on treatment outcomes for elderly adults with alcohol problems, with almost no emphasis on women. This paper presents the state of knowledge about alcohol health services for older women and provides recommendations for necessary future health services research on this vulnerable population.

Aged↗

PubMed2000

Race, psychiatric diagnosis, and mental health care utilization in older patients.

To evaluate the impact of race on mental health care utilization among older patients within given clinical psychiatric diagnoses, the authors examined a retrospective sample of 23,718 elderly veterans treated in Department of Veterans Affairs inpatient facilities in 1994. Significant racial differences in mental health care utilization found over a subsequent 2-year period were related to outpatient (but not inpatient) care; for instance: 1) African American patients with psychotic disorders had significantly fewer outpatient psychiatric visits; and 2) African American patients with substance abuse disorders had significantly more psychiatric visits than Caucasian patients in their respective groups. Although inpatient utilization appeared to be similar among races, findings related to outpatient utilization may be associated with such factors as compliance, treatment efficacy, access to health care, or possible clinician bias.

Black or African American↗

PubMed2000

Does acute alcohol ingestion and/or chronic alcohol use among motor vehicle crash victims lead to a more complicated hospital course?

Given a certain severity of crash and of injury, it is unclear whether acute and/or chronic alcohol use leads to increased morbidity, mortality or a more complicated hospital course after motor vehicle collisions. 496 patients admitted to a trauma service were retrospectively evaluated to assess the effects of acute alcohol ingestion and chronic alcohol use on outcome. Results suggest that patients with acute or chronic alcohol abuse have increased needs for nursing services in the hospital. Alcohol use did not play a role in modifying other outcome measures.

Accidents, Traffic↗

PubMed1999

Health care utilization by older patients with coexisting dementia and depression.

OBJECTIVE: Few studies have examined the course of coexisting dementia and depression. The purpose of this study was to compare elderly patients who had coexisting dementia and depression with elderly patients who had either disorder alone in terms of their utilization of inpatient and outpatient services. METHOD: The study group included 7,115 veterans aged 60 years or older who had been discharged from Department of Veterans Affairs inpatient units in 1992 with diagnoses of major depression, dementia, or both. Outcome measures were analyzed for a 2-year period following the index hospitalization for each diagnostic study group. RESULTS: Patients with coexisting dementia and depression had significantly more psychiatric inpatient days than the other two study groups and more medical inpatient days and nursing home readmissions than patients with depression alone. Patients with coexisting dementia and depression had significantly more total inpatient days than the other two groups. Notably, patients with coexisting dementia and depression did not utilize more outpatient resources than the other study groups; in fact, they had significantly fewer medical, psychiatric, and total visits than patients with depression alone. CONCLUSIONS: The findings suggest that patients with coexisting dementia and depression are high utilizers of inpatient services, with a course of illness that may resemble dementia in terms of nursing home and inpatient medical care utilization and depression in terms of inpatient psychiatric care utilization; however, these patients utilized significantly fewer outpatient resources than the group with depression alone. Aggressive outpatient treatment approaches might reduce utilization of inpatient care for patients with coexisting depression and dementia.

Age Factors↗

PubMed1999

Repeated assaults by patients in VA hospital and clinic settings.

OBJECTIVE: The study aim was to determine the prevalence of repeated assaults on staff and other patients and characteristics of patients who commit repeated assaults in the Veterans Health Administration of the Department of Veterans Affairs. METHODS: Patients in VA medical centers and freestanding outpatient clinics who committed two or more assaults in fiscal years 1995 and 1996 were identified through a survey of facility quality or risk managers. For each repeatedly assaultive patient, structured information, including incident reports, was obtained for all assault occasions. RESULTS: A total of 153 VA facilities responded, for a response rate of 99 percent. The survey identified 8,968 incidents of repeated assault by 2,233 patients, for a mean of 4.02 assaults per patient in the two-year study period. In 92 percent of the incidents, the assaultive patient had a primary or secondary psychiatric diagnosis. The mean age of the repeat assaulters was 62 years. Ninety-eight percent of the repeat assaulters were male, and 76.6 percent were Caucasian. At least 16 percent of the assaulters, 22 percent of the patients assaulted, and 20 percent of the staff assaulted required medical attention for injuries, which, along with the number of lost work days, indicates that repeated assaults are costly. CONCLUSIONS: Repeatedly assaultive patients represent major challenges to their own safety as well as to that of other patients and staff. Identifying patients at risk for repeated assaults and developing intervention strategies is critically important for ensuring the provision of health care to the vulnerable population of assaultive patients.

Adult↗

PubMed1999

Gender differences in the relationships among SES, family history of alcohol disorders and alcohol dependence.

OBJECTIVE: Potential moderator and mediator roles of several measures of socioeconomic status (SES) were investigated for the relationship between a family history of alcoholism (FH) and alcohol dependence symptoms in adulthood. METHOD: These analyses were performed with a sample of 931 men and 385 women participating in studies at the Alcohol Research Center, University of Michigan. Hierarchical multiple regression equations were used to assess whether SES mediated and moderated relationships between FH and alcohol dependence symptoms. RESULTS: In general, measures of SES (education, occupation, personal and household income) were more important predictors of alcohol dependence symptoms among men, while FH was a stronger predictor among women. In the female sample, measures of personal and household income interacted with family history such that the influence of family history on adult alcohol dependence symptoms was significantly stronger among low income women. Measures of SES and FH were additively related to alcohol dependence symptoms among men. Education partially meditated the relationship between family history and alcohol dependence symptoms among men, indicating that the influence of family history on subsequent alcohol problems among men may be partially due to familial alcoholism's negative effect on educational attainment. CONCLUSIONS: The results of this study suggest the influence of FH on alcohol dependence varies according to SES and gender, and point to the usefulness of examining potential moderators and mediators of family history of alcohol use disorders.

Adult↗

PubMed1999

Concurrent treatment of patients with depression in the community: provider practices, attitudes, and barriers to collaboration.

BACKGROUND: In randomized controlled trials, patients with major depression who receive broad-based collaborative treatment by both primary care physicians (PCPs) and mental health providers (MHPs) have better outcomes than patients who receive usual care. However, little is known about the concurrent treatment of patients with depression in the community. This study describes the perceptions of PCPs of the frequency of concurrent treatment in community settings, the degree of collaboration between co-treating providers, and factors associated with greater interaction and collaboration. METHODS: A survey was distributed to a stratified, random sample of 276 eligible family physicians in Michigan. Primary analyses were descriptive statistics (point estimation) of PCP practice patterns. Secondary analyses explored predictors of collaboration with multivariable regression. RESULTS: A total of 162 eligible PCPs (59%) returned the survey. PCPs reported that they co-treated approximately 30% of their depressed patients with MHPs. They made contact with co-treating MHPs in approximately 50% of shared cases; however, provider contact seldom included joint treatment planning. PCPs perceived collaborative treatments to be more problematic when patients were enrolled in managed care programs. In multivariable regression, co-location of MHP and PCP practices (in the same building) was strongly associated with increased interaction and collaboration (P <.001). CONCLUSIONS: Concurrent treatment of depressed patients is common in the community, but these treatments are less interactive and collaborative than the treatment models proven effective in randomized controlled trails. If concurrent treatments are to become more collaborative-with regular contact and effective communication-co-location of practices appears important.

Community Mental Health Services↗

PubMed1999

Birth cohort differences in features of antisocial alcoholism among men and women.

BACKGROUND: This study examines the relations between birth cohort, gender, and family history of alcohol problems on alcohol dependence, and on the endorsement of alcohol abuse/dependence symptoms related to antisocial behavior. METHODS: Men (n = 1,365) and women (n = 625) were recruited from the community, hospitals, and other treatment sites and were given a structured diagnostic interview. Data were analyzed by using logistic regression. RESULTS: Age of first regular alcohol use was lower in more recent birth cohorts for both men and women, with those born in the most recent cohort reporting earliest regular use. The decline across cohort was more dramatic in women than in men. For those participants with a diagnosis of alcohol dependence, being born in a more recent cohort was associated with increased risk of dependence onset before age 25. Among those participants with onset of alcohol dependence before age 25 (n(men) = 400; n(women) = 51), being born in a more recent cohort was associated with increased risk of fights while drinking, police involvement, and drunk driving trouble as well as with increased risk for a diagnosis of abuse or dependence on another drug. CONCLUSIONS: These results suggest that the prevalence of antisocial alcoholism may be increasing for both men and women. These data exemplify how societal change may affect expression of underlying vulnerability for traits thought to be genetically influenced.

Accident Proneness↗

PubMed1998

Functional impairment and co-occurring psychiatric disorders in medically hospitalized men.

BACKGROUND: Although previous research has described a high prevalence of psychiatric comorbidity among general medical and surgical patients, prevalence estimates based on diagnostic criteria and the assessment of health care outcomes including functional status has not been conducted for a broad range of psychiatric disorders. METHODS: A random sample of male medical and surgical admissions to 3 Department of Veterans Affairs Medical Centers was enrolled in the study. Subjects were administered a computerized structured psychiatric diagnostic interview and completed a multidimensional measure of health-related functioning, the Medical Outcomes Study 36-Item Short-Form Health Survey. RESULTS: Of 1007 medical and surgical inpatients, almost half (46.6%) met lifetime criteria for at least 1 Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition disorder, most commonly for alcohol abuse or dependence (32.5%), posttraumatic stress disorder (10.0%), and major depression or dysthymia (9.0%). Almost one fifth reported recent symptoms, most frequently for major depression or dysthymia (7.0%). Co-occurring psychiatric disorders were associated with substantial and significant (P<.001) impairment on all dimensions of functioning, with the greatest decrements observed in physical and emotional role functioning. Anxiety and mood disorders were associated with the most and somewhat similar reductions in functioning. CONCLUSIONS: The prevalence of co-occurring psychiatric disorders was substantial but consistent with other studies of populations receiving health services. Given the observed additional burden of psychiatric disorders on functioning in medically hospitalized patients, the study indicates the importance of identification and treatment of co-occurring psychiatric disorders in this high-risk and clinically challenging group of patients.

Adult↗

PubMed1998

Evaluating measures of family history of alcoholism: density versus dichotomy.

AIMS: Studies have used myriad measures of family history of alcoholism (FH) making it difficult to compare them directly. Commonly used FH measures partition samples into the well known positive (FH+) and negative (FH-) dichotomy, although quantitative measures of density potentially provide more information. A standard FH measure would facilitate between-study comparisons. The purpose of this study is to evaluate a quantitative FH measure, called Family History Density (FHD), that has theoretical and practical advantages over currently used measures. DESIGN: Logistic regression equations were estimated for FHD and six commonly used FH measures on alcohol dependence diagnosis, and two measures of alcoholism severity (i.e. withdrawal and tolerance). PARTICIPANTS: Subjects recruited for studies (254 men and 97 women) completed a structured clinical assessment. MEASUREMENTS: Alcoholism diagnosis and endorsement of tolerance or withdrawal symptoms were obtained using the alcohol module from the NIMH Diagnostic Interview Schedule III-R (DIS III-R). Family history of alcoholism was coded using the criteria from the Family Informant Schedule and Criteria (FISC). FINDINGS: All FH measures were associated with alcohol dependence diagnosis, development of tolerance and experiencing withdrawal symptoms in men. In women, only FHD and Parent were significantly associated with all three outcomes. CONCLUSIONS: FHD is a good candidate to be a standard FH measure because it is quantitative, based on familial relatedness and capable of accounting for significant variation in alcoholism diagnosis and two indices of alcoholism severity in men and in women.

Alcoholism↗

PubMed1998

Psychiatric diagnosis and intervention in older and younger patients in a primary care clinic: effect of a screening and diagnostic instrument.

OBJECTIVES: To determine whether patient age is associated with psychiatric diagnosis or provider intervention in a busy primary care clinic, and, if so, whether a screening and diagnostic tool, the PRIME-MD, modifies age-related differences. DESIGN, SETTING, AND PARTICIPANTS: PRIME-MD use, psychiatric diagnosis, and provider interventions for psychiatric conditions were recorded for eligible patients attending a Veterans Affairs Medical Center primary care clinic. Data from 952 younger (<65 years) and 1135 older patients (> or =65 years) were analyzed to determine whether there were age-related differences in diagnosis/intervention and if use of the PRIME-MD modified these differences. INTERVENTION: Implementation of the PRIME-MD, a two-step instrument consisting of a self-administered patient questionnaire and a provider-administered structured diagnostic interview. MEASUREMENTS: Outcome measures were rates of (1) PRIME-MD use, (2) overall psychiatric diagnosis, (3) new psychiatric diagnosis, and (4) provider intervention for psychiatric conditions. RESULTS: There was no association between patient age and PRIME-MD use. Older patients were less likely to receive a psychiatric diagnosis in analyses that adjusted for "highly positive" screening questionnaires (OR = .45; P<.001). Older patients were also less likely to receive an intervention for a psychiatric condition in analyses that adjusted for whether a psychiatric diagnosis (OR = .62, P = .015) or a new psychiatric diagnosis (OR = .36, P<.001) was made during the study visit. The PRIME-MD increased rates of diagnosis and intervention but did not alter age-related disparities. CONCLUSIONS: Decreased rates of psychiatric diagnosis and intervention in older primary care patients are of concern. Implementing the PRIME-MD will likely increase rates of diagnosis and intervention but will need to be accompanied by additional measures to eliminate age-related disparities.

Adult↗

PubMed1998

Agreement between seriously mentally ill veterans and their clinicians about medication compliance.

OBJECTIVES: Levels of agreement about medication compliance in a large cohort of seriously mentally ill veterans and their clinicians were examined to determine whether agreement increased with exposure to enhanced treatment programs emphasizing compliance and whether compliance reports were associated with hospitalization. METHODS: A total of 1,369 seriously mentally ill patients and their treating clinicians at 14 Veterans Affairs medical centers rated medication compliance at enrollment in enhanced programs or comparison programs offering standard care. Patients and clinicians reassessed compliance one and two years after enrollment. Overall agreement, agreement about compliance and noncompliance, and kappa statistics were determined for concurrent assessments. RESULTS: Overall, patients rated themselves as significantly more compliant with medication than did clinicians at enrollment. Cohen's kappa at enrollment was .095, indicating little patient-clinician agreement beyond that expected by chance. Kappa values increased significantly at one and two years for patients in the enhanced programs but continued to indicate poor-to-modest levels of agreement. Patient-clinician pairs in enhanced programs did not differ from those in comparison programs in overall agreement. Reports of good compliance by both patients and clinicians were associated with significantly decreased odds of hospital admission in the 30 days after the report was made. CONCLUSIONS: Seriously mentally ill patients and their clinicians showed little agreement about medication use beyond that expected by chance. Intensive programming appeared to have little effect on agreement. Both patients' and clinicians' compliance assessments predicted hospitalization and thus can be used in research models that attempt to predict relapse and readmission.

Adult↗

PubMed1997

Crash characteristics and injuries of victims impaired by alcohol versus illicit drugs.

Alcohol has long been associated with injury, but the relationship between other drugs and injury is less clear. Blood samples from 894 patients presenting to two Emergency Departments for treatment of motor vehicle injury sustained in passenger cars, station wagons, vans and pickup trucks, were tested for alcohol and other drugs. Results were related to demographic characteristics, including prior history of alcohol and drug use; crash characteristics; and injury characteristics. Alcohol was associated with more severe crashes, but other drugs, in the absence of alcohol, were not. The crashes involving drugs but no alcohol were very similar to those involving neither alcohol nor drugs.

Accidents, Traffic↗

PubMed1997

Alcohol abuse/dependence in motor vehicle crash victims presenting to the emergency department.

OBJECTIVE: 1) To determine the prevalence of current alcohol abuse/alcohol dependence (AA/AD) among the full injury range of ED motor vehicle crash (MVC) patients; and 2) compare AA/AD and non-AA/AD patient characteristics. METHODS: This was a prospective cohort study using a stratified random sample of MVC patients aged > or = 18 years presenting to a university hospital and university-affiliated community hospital ED from May 1, 1992, to August 30, 1994. A diagnosis of current AA/AD was based on the alcohol section of the Diagnostic Interview Survey (DIS). Other measurements included the presence of blood alcohol (BAC+), Injury Severity Score (ISS-85), occupant status (driver/passenger), age, gender, seat belt use, culpability for crash, and ED disposition (admitted vs released). A weighted prevalence was determined; subgroups were compared using t-tests, chi 2, 2-factor analysis, and logistic regression modeling; alpha = 0.05. RESULTS: 1,161 patients were studied. The weighted prevalence of current AA/AD was 22.5%; 53% of these patients were released from the ED. Almost 45% of the patients with current AA/AD were BAC-. When controlling for BAC and AA/AD, greater injury severity and culpability were associated with a BAC+, but not with current AA/AD. CONCLUSION: Almost 23% of ED MVC patients have current AA/AD; BAC testing does not accurately identify these patients. Intervention strategies must be directed to both admitted and released patients.

Accidents, Traffic↗

PubMed1997

Relationship between inpatient alcoholism treatment and longitudinal changes in health care utilization.

OBJECTIVE: The purpose of the study was to evaluate changes in health care utilization associated with inpatient alcoholism treatment in alcoholics of low socioeconomic status with different histories of treatment relapse. METHOD: The sample consisted of more than 85,000 male alcoholics using inpatient care in Department of Veterans Affairs medical centers in fiscal year 1987. Five treatment groups were identified to represent a continuum of length and intensity of alcoholism treatment, including formal inpatient alcoholism treatment, short detoxification and hospitalizations for primary diagnoses other than alcoholism. All inpatient and outpatient health services for 3 years before and 3 years after the index hospitalization were examined for differential changes in utilization associated with the five treatment groups after controlling for patient predisposing, enabling and need characteristics. RESULTS: Both total inpatient days and outpatient visits increased significantly for all treatment groups, with the greatest increases occurring in the group completing inpatient alcoholism treatment (both p < .0001). However, use of inpatient medical care decreased and substance abuse inpatient care increased significantly for most groups, with the largest increases in substance abuse care found for the completed treatment group. CONCLUSIONS: In a hospital system that does not deny care on the basis of ability to pay, certain groups of chronic alcoholics who cannot sustain prolonged remission will continue to be heavy utilizers of services. Alcoholism treatment may be associated with higher short-term costs but it remains to be seen whether provision of more focused treatment services is able to achieve longer term better outcomes and, ultimately, lower costs.

Adult↗

PubMed1997

Adulthood functioning: the joint effects of parental alcoholism, gender and childhood socio-economic stress.

The popular literature has publicized the adjustment difficulties of adult children of an alcohol-dependent parent (ACOAs); however, empirical studies do not provide consistent support. We examined the impact of parental alcoholism, degree of childhood socio-economic stress and gender on three broad categories of adulthood functioning (psychopathology, socio-economic attainment and marital stability). These effects were investigated with a heterogeneous sample of 400 men and 226 women participating in studies at the University of Michigan Alcohol Research Center. Parental alcoholism and childhood socio-economic stress exerted significant independent effects on most adulthood functioning measures. Men and women differed substantially only on socio-economic attainment measures, and effects of parental alcoholism and childhood economic stress on men and women were generally similar. For marital stability, parental alcoholism and childhood socio-economic stress interacted. These results suggest that researchers who study the impact of family history for alcoholism on psychological functioning should consider other aspects of the family of origin that promote wellbeing. In addition, results of this study point to the need for more research on gender differences, protective factors that promote good adjustment and outcome measures reflecting general life adaptation.

Adult↗

PubMed1996

Utilization of acute inpatient services for alcohol detoxification.

This study indicates that the majority of patients admitted to VA hospitals for medical detoxification could have those services provided on an outpatient or less intensive basis. However, inpatient medical detoxification services appear to be appropriate for those alcoholics at risk for potential life-threatening complications of withdrawal such as delirium tremens, or those with concurrent associated medical conditions such as pancreatitis, gastrointestinal bleeding, or complications of cirrhosis. Data were obtained from a national random sample of hospitalizations in Department of Veterans Affairs (VA) inpatient medical and surgical units. Medical records for 144 alcoholism-related medical admissions to 35 VA medical centers were reviewed using the Appropriateness Evaluation Protocol (AEP), a clinically based utilization review instrument widely used in the private sector. The medical records for the admission and each day of medical/surgical inpatient stay were reviewed using clinical criteria for the appropriateness of acute inpatient care as opposed to lower levels of care.

Alcoholism↗

PubMed1996

Older adult controlled drinkers and abstainers.

Little is known about the lifetime course of alcohol problems, especially during late adulthood. Many individuals with a history of alcohol problems achieve remission of their symptoms through abstinence or controlled drinking. This study examined 135 older adults with a prior history of alcohol diagnoses who were symptom free for at least the past year. Two groups were identified based on their alcohol consumption within the past year: abstinent individuals (n = 92) and controlled drinkers (n = 43). The groups did not differ in age, racial composition, education, income, or years since their last alcohol-related symptom, but they did differ in gender composition, indices of alcoholism severity, history of formal and informal treatment, as well as lifetime alcohol consumption patterns. Abstinent individuals had more severe alcohol problems, consumed higher amounts of alcohol on drinking days, had more years of heavy alcohol consumption, and were more likely to have attended alcohol treatment and Alcoholics Anonymous (AA). The controlled drinkers had a longer history of moderate social drinking, and their current consumption habits appeared to be similar to symptom-free older adult drinkers. The results suggest that gender, alcoholism severity, history of formal and informal treatment, and past consumption patterns are associated with whether older adults with histories of alcoholism attain successful outcomes through abstinence or controlled drinking.

Adult↗