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Biomedical subjects

H A Pincus

Publications and source records attributed to H A Pincus.

At least 55 records · Page 3Linked to original sources
PubMed1998

Psychiatrist and nonphysician mental health provider staffing levels in health maintenance organizations.

OBJECTIVE: This study attempts to determine the ratio of full-time-equivalent psychiatrists to members and that of nonphysician mental health professionals to psychiatrists in staff and group model health maintenance organizations (HMOs), and to compare the psychiatrist-to-member ratio with previous estimates of the required psychiatrist-to-population ratios in fee-for-service and managed care environments. METHODS: The Group Health Association of America (now the American Association of Health Plans) collected data on mental health staffing, enrollments, and other characteristics for 30 staff and group model HMOs. The authors evaluated the number of full-time-equivalent psychiatrists and nonphysician mental health professionals per 100,000 HMO members, and the ratio of full-time-equivalent nonphysician mental health professionals to psychiatrists. RESULTS: The overall mean number of full-time-equivalent psychiatrists and nonphysician mental health professionals per 100,000 members in the responding HMOs was 6.8 and 22.9, respectively. The overall mean ratio of nonphysician professionals to psychiatrists was 4.5. The overall number of psychiatrists per 100,000 members is less than half the requirement estimated by the Graduate Medical Education National Advisory Committee in 1980, which assumed a fee-for-service environment, but it is about 40% to 80% greater than that estimated by other studies under the assumption of a managed care environment. CONCLUSIONS: Although a practice environment dominated by managed care may not require as high a psychiatrist-to-population ratio as a predominantly fee-for-service environment, it may well support a greater number of psychiatrists than previous studies have suggested.

Career Choice↗
PubMed1998

The classification of mental disorders in primary care: a guide through a difficult terrain.

BACKGROUND: Primary care physicians traditionally have a strong interest in the mental health of their patients. Three classification systems are available for them to diagnose, label, and classify mental disorders: 1) The ICD-10 approach with three options, 2) The DSM-IV approach with two options, and 3) the ICPC approach with two options. This article lists important similarities and differences between the systems to help potential users choose the option that best meets their needs. METHODS: Definitions for depressive disorder, anxiety disorder, and somatization disorder are compared on five characteristics of classification: 1. the domain, 2. the scope, 3. the nature of the definitions, 4. focus on episodes of care, and 5. clinical guidelines. RESULTS: Primary care physicians and psychiatrists have different perspectives, reflected in different classifications. Each system has specific possibilities and limitations with regard to the diagnosis of mental disorders. For common mental disorders it is possible, however, to choose codes from one system while maintaining compatibility with the other two. Comparability as to the diagnostic content of the different classes, however, is more difficult to establish. The available classification systems give both primary care physicians and psychiatrists options to diagnose, label, and to classify mental disorders from their own perspective, but once a system has been chosen the clinical comparability of a patient with the same diagnosis in other systems is limited. CONCLUSION: Compatibility among systems can be optimized by strictly following a number of rules. The conversion between ICPC and ICD-10 (and consequently DSM-IV) allows simultaneous use of ICPC and ICD-10 as a classification and DSM-IV as the standard nomenclature. This is of particular interest for computer based patient records in primary care. The clinical comparability of the same diagnosis in different systems however is limited by the characteristics of the different system.

Anxiety Disorders↗
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

Measuring treatment effectiveness. Part two: Newly emerging outcomes databases for individual practitioners.

Individual practitioners are under pressure from the provider and managed care organizations with which they contract to participate in the provider's outcomes measurement initiatives. While many practitioners respect the potential value of outcomes measurement, they can experience these requirements as burdensome and of little benefit to their own professional work. This section describes two research networks initiated and supported by professional associations. The goals of networks are to address research questions that will advance the field and to give clinicians feedback that is of immediate help in their clinical practice.

Data Collection↗
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↗