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Biomedical subjects

G L Tischler

Publications and source records attributed to G L Tischler.

At least 19 recordsLinked to original sources
PubMed1997

Preparing psychiatric residents for managed care. Values, proficiencies, curriculum, and implications for psychotherapy training.

As managed care psychiatric service systems become increasingly prominent in academic centers and the larger world of psychiatric practice, residency programs find themselves having to adapt to the value systems and training paradigms necessary for preparing house staff to deal with these systems. Many of the values and some of the necessary proficiencies differ considerably from those of traditional fee-for-service psychiatric practice. This article delineates the value systems under which managed care systems operate, the clinical proficiencies that will be needed by psychiatrists practicing in such settings, the experiential and didactic curriculum necessary to prepare today's psychiatric residents for adapting to managed care-oriented practices, and the implications of these changes for psychotherapy education and training.

Curriculum↗
PubMed1995

Issues and approaches in evaluating managed mental health care.

Data on the ways in which alternative forms of managed care affect the costs, quality, and outcomes of mental health are needed to inform health policy and clinical care decisions. Such evaluations, however, are difficult to implement for conceptual and practical reasons. The definition of managed mental health care is reviewed, alternative forms are described, and the activities and procedures that constitute managed care are identified. Examples from existing studies are used to describe the common roadblocks to implementing evaluations and to suggest methods for dealing with these barriers.

Cost-Benefit Analysis↗
PubMed1990

Utilization management of mental health services by private third parties.

The author describes approaches to utilization management and the growth of this segment of the health care industry. Issues posed for the mental health field by introducing a third party as the arbiter of care include professional uncertainty and the discretionary behavior of practitioners and third parties, the availability of clinically appropriate alternative services, shifting of costs between the public and private sectors, safeguarding privacy, accountability and the integrity of the review process, financial risk versus professional responsibility, and the impact of utilization management on the outcome of care.

Cost Control↗
PubMed1990

Utilization management and the quality of care.

Utilization management is a mechanism for managing health care costs by assessing the appropriateness of care and influencing decisions about its provision to ensure the least costly but most effective treatment. Thus while primarily focused on reducing costs, utilization management also affects quality of care. The author reviews the historical development of utilization management, summarizes the review procedure, and suggests ways to enhance understanding of the effect of utilization management on quality of care.

Managed Care Programs↗
PubMed1988

Affective disorders in five United States communities.

Results on the age/sex specific prevalence of DSM-III affective disorders from the NIMH Epidemiologic Catchment Area Study (ECA), a probability sample of over 18,000 adults from five United States communities, are presented. The cross-site means for bipolar disorder ranged from 0.7/100 (2 weeks) to 1.2/100 (lifetime), with a mean age of onset of 21 years and no sex difference in rates. The cross-site means for major depression ranged from 1.5/100 (2 weeks) to 4.4/100 (lifetime), with a mean age onset of 27 years and higher rates in women. The cross-site means for dysthymia, a chronic condition, was 3.1/100 with a higher rate in women. There was reasonable consistency in prevalence rates among sites. The implications of these findings for understanding psychopathology are discussed.

Adolescent↗
PubMed1988

Factors affecting the utilization of specialty and general medical mental health services.

This study compares the extent to which need, predisposing, and enabling factors affect the use of mental health services in the specialty and general medical health sectors during a 6-month period. Data are drawn from the first wave of interviews of the Epidemiological Catchment Area (ECA) project at the Yale University site. The results indicate that 1) in the general population, factors affecting use of the two sectors differ; 2) among those using any mental health services, factors affecting use of the two sectors differ; 3) indicators of need have the strongest relationships with utilization; and 4) the effects of predisposing and enabling factors are contingent upon the presence of need.

Adult↗
PubMed1987

The relationship between demographic factors and attitudes toward mental health services.

Considerable effort has been exerted in recent years toward educating the public concerning mental illness and the efficacy of various treatment modalities. Most previous studies of attitudes have focused solely on attitudes toward the mentally ill. In this study we investigated attitudes toward mental health services and found that most people are positively disposed toward the use of these services. Attitudes toward the use of mental health services were affected by the age, sex, race, education, and income of the subjects. In general, differences of attitude lie in the direction that would tend to inhibit utilization among those most at risk.

Adolescent↗
PubMed1987

Psychiatric diagnoses of medical service users: evidence from the Epidemiologic Catchment Area Program.

Based on data from the five sites of the National Institute of Mental Health-sponsored Epidemiologic Catchment Area (ECA) Program, this paper examines the prevalence of psychiatric disorder among recent medical service users versus nonusers, with a particular focus on affective disorders, substance abuse/dependence, and phobias. The rate of current Diagnostic Interview Schedule (DIS) disorders among medical users in all five ECA sites is 21.7 per cent (slightly higher than general population rates) versus 16.7 per cent among nonusers; there is generally no difference between users and nonusers with past DIS diagnoses. Affective disorders were among the most common mental disorders of medical service users, especially among females, with little variation between sites: females: users: 6.9 per cent to 9.3 per cent, nonusers: 3.4 per cent to 6.4 per cent, and males: users: 3.3 per cent to 6.5 per cent, nonusers: 1.2 per cent to 4.1 per cent. Rates of phobias among persons using medical services are also higher than among nonusers. Substance abuse disorders are at least as common among persons who use medical services (8 per cent to 14 per cent of male users) as among those who do not (9 per cent to 11 per cent of male nonusers). The high rates of affective disorders among women and of substance abuse among male medical service users underscore the need to increase the ability of general medical practitioners to recognize and manage or refer these conditions.

Catchment Area, Health↗
PubMed1985

Contact with health professionals for the treatment of psychiatric and emotional problems.

This study focuses on predisposing, enabling, and need factors affecting contact with health professionals for the treatment of psychiatric and emotional problems during a 6-month period. Data are from the first wave of the Yale Epidemiologic Catchment Area (ECA) Project. The study confirms the important relationship of psychopathology to both the likelihood of using mental health related services and the quantity of service contacts. Sex, age, race, education, marital status, usual source of medical care, and attitudes toward mental health services were found to exert independent effects on the likelihood of contact with a health professional after controlling for clinical status. Factors affecting the quality of service contacts among utilizers were psychiatric status, usual source of care, and attitudes.

Adult↗
PubMed1985

Psychiatric disorders (DSM-III) and cognitive impairment among the elderly in a U.S. urban community.

Results are presented on the current prevalence rates of psychiatric disorder in 2,588 non-institutionalized persons aged 65 and older who were drawn from a probability sample of New Haven, Connecticut, and 12 surrounding towns in South Central Connecticut. Based on the Diagnostic Interview Schedule (DIS), 6.7% of the respondents had a psychiatric diagnosis (DSM-III), and based on the Mini-Mental Status Exam (MMS), 3.4% had severe cognitive impairments during the past 6-month period. Therefore, more than 10% currently had either a psychiatric or a severe cognitive problem. Overall, these rates of psychiatric disorders are lower than those found in adult populations under age 65. As with younger samples, anxiety and affective disorders were among the most common psychiatric problems. The majority of elderly reported themselves in good emotional and physical health and felt they had sufficient finances to meet their needs. The rate of severe cognitive impairment did not increase until after age 79. Among those 80 years and older, cognitive impairments were more common in women than men, probably due to differential survival rates. Since less than 6% of the elderly sample are living in institutions these results among non-institutionalized elderly point to the relative psychiatric well-being of the majority of the elderly. However, in view of the longer life expectancy, the next decade will see an increase in the absolute number of persons with cognitive impairments.

Age Factors↗
PubMed1984

Six-month prevalence of psychiatric disorders in three communities 1980 to 1982.

Six-month prevalence rates for selected DSM-III psychiatric disorders are reported based on community surveys in New Haven, Conn, Baltimore, and St Louis. As part of the Epidemiologic Catchment Area program, data were gathered on more than 9,000 adults, employing the Diagnostic Interview Schedule to collect information to make a diagnosis. The most common disorders found were phobias, alcohol abuse and/or dependence, dysthymia, and major depression. The most common diagnoses for women were phobias and major depression, whereas for men, the most predominant disorder was alcohol abuse and/or dependence. Rates of psychiatric disorders dropped sharply after age 45 years.

Adolescent↗
PubMed1984

Utilization of health and mental health services. Three Epidemiologic Catchment Area sites.

Utilization of health and mental health services by non-institutionalized persons aged 18 years and older is examined based on interviews with probability samples of 3,000 to 3,500 persons in each of three sites of the National Institute of Mental Health Epidemiologic Catchment Area (ECA) program: New Haven, Conn, Baltimore, and St Louis. In all three ECAs, 6% to 7% of the adults made a visit during the prior six months for mental health reasons; proportions were considerably higher among persons with recent DSM-III disorders covered by the Diagnostic Interview Schedule (DIS) or severe cognitive impairment. Between 24% and 38% of all ambulatory visits by persons with DIS disorders were to mental health specialists. In seeking mental health services, men were more likely to turn to the specialty sector than to the generalist; women used both sectors about equally. The aged infrequently received care from mental health specialists. Visits for mental health reasons varied considerably depending on specific types of DIS disorder.

Adolescent↗