Differences in managed care.
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Cost Control↗
Biomedical subjects
G L Tischler
Publications and source records attributed to G L Tischler.
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↗
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↗
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↗
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↗
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↗
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↗
The differential effect of attitudes on the use of mental health services.
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Adolescent↗
Mentoring relationships in the careers of mental health administrators.
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Data Collection↗
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↗
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↗
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↗
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↗
Social factors related to psychiatric disorder: the Yale Epidemiologic Catchment Area study.
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Adolescent↗
The epidemiology of depression. An update on sex differences in rates.
Data from the New Haven, CT, Standard Metropolitan Statistical Area, site of the NIMH Epidemiologic Catchment Area (ECA) study, a multi-site collaborative community survey of psychiatric disorders is presented. The 6-month prevalence rates based on the Diagnostic Interview Schedule (DIS) interview and the DSM-III found that major depression was more frequent in women than men (2.4:1). The sex ratios for bipolar disorder were about equal. The sex ratios for major depression were fairly consistent at different time periods retrospectively assessed. There appeared to be a birth cohort effect with cohort's born after 1936 having an earlier age of onset and higher rates of major depression but not a change in sex ratios. These findings must be considered in light of the methodologic limitations of retrospective recall.
Adolescent↗
Trends in psychiatric practice, 1965-1980.
The authors compare the results of a study of the practice activities of psychiatrists conducted in 1979-1980 with one conducted in 1965. Although office-based practice has remained the core activity of the profession, psychiatrists in 1979 had a greater tendency to divide their time among multiple practice sites and activities during the work week. As a consequence, the percentage of practitioners working part-time in a variety of organized care settings has increased substantially. These findings support a view of psychiatry as a profession that is far more diversified than it was 15 years ago. The authors discuss major factors affecting trends in psychiatric practice.
Academic Medical Centers↗
Use of a structured diagnostic interview to identify bipolar disorder in adolescent inpatients: frequency and manifestations of the disorder.
The authors interviewed 17 adolescent inpatients and their mothers with the Schedule for Affective Disorders and Schizophrenia for School-Aged Children and Adolescents, Epidemiological Version (K-SADS-E), a semistructured interview that generates RDC and DSM-III diagnoses for major affective disorders and nonaffective psychoses and DSM-III diagnoses for dysthymic, cyclothymic, and other selected disorders. Five of the patients (29%) satisfied DSM-III criteria for bipolar disorder or atypical bipolar (bipolar II) disorder, although these diagnoses had not been identified in the hospital charts. These data support previous findings that bipolar disorder occurs moderately frequently in adolescent inpatients, although it is often unrecognized. Moreover, the disorder can be readily identified with structured diagnostic methods.
Adolescent↗
Utilization of mental health services. I. Patienthood and the prevalence of symptomatology in the community.
We explored the association between patienthood and prevalence of symptomatology in the community. Base line data on prevalence were obtained through the use of a household survey. Characteristics of survey respondents (N equals 938) and patients admitted from the surveyed area to a Connecticut Mental Health Center during a 12-month period (N equals 808) were compared. High utilization of facilities was associated with the prevalence of symptoms in the community, particularly where defining characteristics were descriptors of disadvantaged social status. A second set of variables correlated with mental health center use but not with the prevalence of symptoms in the community. By and large, these characteristics describe a lack of social supports not necessarily related to social status. Finally, certain groups were underrepresented as patients even though comprising polulations-at-risk in terms of levels of symptom impairment in the community.
Adult↗