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Biomedical subjects

H A Pincus

Publications and source records attributed to H A Pincus.

At least 19 recordsLinked to original sources
PubMed1998

Use of ECT for the inpatient treatment of recurrent major depression.

OBJECTIVE: The authors' goals were to determine the frequency and distribution of ECT for general hospital inpatients with recurrent major depression and to estimate the effects of prompt ECT on the length and cost of inpatient care. METHOD: Data from the 1993 Healthcare Cost and Utilization Project were analyzed to determine the rate of ECT use for adult inpatients with a principal discharge diagnosis of major depression, recurrent. Associations between prompt initial use of ECT (in the first 5 hospital days) and length and cost of inpatient care were examined before and after control for sociodemographic, diagnostic, and hospital organizational characteristics. RESULTS: An estimated 9.4% of general hospital adult inpatients with a principal diagnosis of recurrent major depression received ECT in the survey year. A majority (59.2%) of these received their initial ECT session within the first 5 days after hospital admission. In univariate analyses, the likelihood of receiving ECT was greater for older patients, whites, privately insured individuals, and patients who lived in more affluent areas. Patients who received ECT tended to have relatively long and costly admissions. After control for several demographic, diagnostic, and hospital organizational characteristics, prompt ECT (as compared with delayed ECT or none) was associated with significantly shorter and less costly inpatient care. CONCLUSIONS: The longer stays and higher treatment costs associated with ECT may be a consequence of patient selection. When patient selection is taken into account, prompt administration of ECT is associated with shorter and less costly hospital stays. Nonetheless, economically disadvantaged patients are relatively unlikely to receive this treatment.

Adolescent↗
PubMed1997

Self-reported anxiety, general medical conditions, and disability bed days.

OBJECTIVE: This study examined the effect of self-reported anxiety on the number of days persons with various general medical conditions spend in bed owing to disability. METHOD: Self-reported medical illness and disability data from a nationally representative household survey sample (N = 20,884) were analyzed. RESULTS: Among respondents with general medical conditions, those with self-reported anxiety had a nearly fourfold greater length of disability (mean = 18.0 bed days) than the nonanxious respondents (mean = 4.8 bed days). After adjustment for differences in demographic characteristics and burden of general medical illness, anxiety was associated with an additional 3.8 bed days. CONCLUSIONS: Self-reported anxiety in combination with general medical conditions may be associated with extensive functional impairment.

Adult↗
PubMed1997

Practice-based research in psychiatry.

OBJECTIVE: The authors describe the APA Practice Research Network (PRN), a national research initiative that ultimately will engage 1,000 practicing psychiatrists in collaborative clinical and services research. The PRN is designed to generate practice-relevant information and to inform future service delivery, policy, and financing decisions pertinent to psychiatry. METHOD: The authors review the relative strengths and limitations of practice-based research compared with other widely used research methods. They also describe the structure of the PRN and its procedures for recruiting network members and for identifying and developing specific network studies. The three primary sources of data for the PRN are 1) the biannual National Survey of Psychiatric Practice, which provides not only a mechanism for randomly recruiting the two-thirds of network participants who are not volunteers but also a baseline for assessing the generalizability of PRN findings; 2) separate biannual studies of psychiatric patients and treatments to characterize the network patient/treatment denominator, which is used to monitor trends in psychiatric practice and plan network studies; and 3) specific studies. RESULTS: Pilot data from the PRN have yielded detailed information on the diagnostic and clinical characteristics of 725 patients and on the treatments provided by network psychiatrists. CONCLUSIONS: The APA PRN offers a powerful complement to traditional clinical and health services research approaches. The PRN will help psychiatry improve its ability to meet patients needs in a context of rapidly evolving scientific and clinical progress and legislative and economic forces affecting health care delivery.

Confidentiality↗
PubMed1997

Clinical and psychopharmacologic practice patterns of psychiatrists in routine practice.

As part of the American Psychiatric Association's national Practice Research Network (PRN), this pilot study tested a data collection instrument designed to systematically characterize the sociodemographic and diagnostic characteristics of psychiatric patients and the specific treatments they received, including specific psychopharmacologic medications. Ninety-five percent of the PRN members (148 of 156 psychiatrists), who practice in a broad range of settings, completed a 21-page data collection instrument that generated detailed diagnostic, clinical, and treatment data on 290 psychiatric patients. Mood disorders constituted the most common principal DSM-IV diagnostic category, affecting 53 percent of the patients in this pilot study. The majority of patients had significant psychiatric and general medical co-occurring conditions; 20 percent of the patients had at least three DSM-IV Axis I mental disorders. Ninety percent of all patients in the sample received at least one psychopharmacologic medication, with each patient, on average, receiving 1.8 (SD = 1.2). After adjustment for patients' diagnostic and clinical characteristics, the mean number of medications prescribed per patient in this pilot study sample did not vary by health plan type or payment source. However, the combinations of treatments provided by psychiatrists (i.e., psychotherapy and medications) did vary by health plan type and payment source.

Adult↗
PubMed1996

Peering into the 'black box'. Measuring outcomes of managed care.

Research on the impact of managed care on access, quality, outcomes, and costs of mental health and substance abuse services has been limited because of the lack of generalizability of studies, the "black box" focus of much of the research, the dynamic changes in mental health and substance abuse managed care, and the proprietary nature of the health care industry. This article provides a framework for understanding the organizational, financial, and procedural features of health plans and the effect of these features on the characteristics and flow of patients through health plans and the selection and utilization of treatments. The diverse research priorities of key stakeholders, i.e., public and private purchasers, managed care organizations, providers, and patients and their families, are described along with a broader societal agenda for delineating the outcomes of health care plans. Critical research and methodologic issues in studying the effects of managed care are outlined, including issues related to identifying and selecting appropriate outcome measures and developing appropriate methods for risk adjustment to adequately control for patient selection bias. This article asserts that government, purchasers, health care plans, providers, consumers, and researchers must collaboratively develop resources and research approaches to fully evaluate the effects of managed care. To realize this objective, auspices with reasonable objectivity are needed along with access to necessary data within the black box of health care systems, a cadre of trained investigators, and sufficient research funding, including the development of an all payers fund to support clinical and health services research.

Delivery of Health Care↗
PubMed1996

Outpatient mental health care in nonhospital settings: distribution of patients across provider groups.

OBJECTIVE: A national overview of outpatient mental health care in nonhospital settings is provided, focusing on the distribution of patients among psychiatrists, psychologists, general medical physicians, and other health professionals. METHOD: Data from the household section of the 1987 National Medical Expenditure Survey were analyzed to determine the volume and characteristics of patients receiving mental health care from these four professional groups. RESULTS: In 1987 an estimated 4.1% of noninstitutionalized Americans (9.0 million) made 84 million outpatient mental health visits to nonhospital settings. Psychiatrists provided significantly more visits than psychologists for schizophrenia, bipolar disorder, substance abuse, and depression, but significantly fewer visits for anxiety disorders and symptoms such as "nervousness." General medical physicians provided the most visits for adjustment disorders and substance abuse, while the other professionals provided the most visits for childhood mental disorders and mental retardation. CONCLUSIONS: In 1987 important differences existed between the outpatients who received mental health care from psychologists, psychiatrists, general medical physicians, and other health professionals.

Adolescent↗