Search PubMed⌕ Search

Biomedical subjects

L Dixon

Publications and source records attributed to L Dixon.

At least 37 records · Page 2Linked to original sources
PubMed2001

Predictors of dissemination of family psychoeducation in community mental health centers in Maine and Illinois.

OBJECTIVE: The aim of this study was to determine whether it is possible at the time of staff training to predict whether a mental health center will succeed in implementing family psychoeducation services. METHODS: Fifteen mental health agencies in Maine and 51 in Illinois in which clinicians and administrators were trained in multifamily psychoeducation were studied. Participants were surveyed immediately after their initial training sessions and nine months later. Participants' demographic characteristics, agency characteristics, and principal components derived from the survey data were analyzed to identify factors associated with implementation of family psychoeducation services. RESULTS: The regression model successfully predicted which sites would succeed. Success was more likely at sites where the treatment model was viewed more positively at the outset, where real and perceived resource limitations were addressed, where inducements to implementation were seen as less important, and where attention was paid to the difference between new and existing treatment methods. Nearly all the Maine sites (14, or 93 percent) implemented multifamily psychoeducation services, whereas only five of the Illinois sites (10 percent) implemented this form of treatment. The Maine trainees were less skeptical about family psychoeducation and more interested in receiving supervision and consultation. In Maine there was wide-ranging and local consensus before and during implementation, and more federal funding was available than in Illinois. CONCLUSIONS: Surveys of clinicians allowed prediction of which sites would successfully implement family psychoeducation services. Consensus building and funding appeared to be critical to successful outcomes.

Adult↗
PubMed2001

Pilot study of the effectiveness of the family-to-family education program.

This study assessed the efficacy of the Family-to-Family Education Program, a structured 12-week program developed by the National Alliance for the Mentally Ill. A total of 37 family members who participated in the program were evaluated by an independent research team of trained family member assessors at baseline, after completing the program, and six months after program completion. After completing the program, the participants demonstrated significantly greater family, community, and service system empowerment and reduced displeasure and worry about the family member who had a mental illness. These benefits were sustained at six months.

Adult↗
PubMed2001

Variables associated with disparities in treatment of patients with schizophrenia and comorbid mood and anxiety disorders.

OBJECTIVE: The study compared self-reported comorbid affective and anxiety disorder diagnoses and treatments of African-American and Caucasian subjects in a large sample of patients who had a diagnosis of schizophrenia. METHODS: A total of 685 patients receiving treatment for schizophrenia were interviewed as part of the Schizophrenia Patient Outcomes Research Team study. The associations of race with past and current diagnoses and with current treatment for depression, mania, and anxiety disorders were assessed with multivariate analyses. RESULTS: African Americans were significantly less likely than Caucasians to report having a past or current diagnosis of depression, manic-depression, or anxiety disorder and to be receiving current treatment for these disorders. Gender, education, and marital status were also associated with presence of a comorbid diagnosis and receipt of treatment. CONCLUSIONS: The study suggests the possibility of racial and other disparities in the diagnosis and treatment of patients with schizophrenia and comorbid affective and anxiety disorders. Although various causal explanations are plausible, all point toward the need for enhanced cross-cultural competence at all levels of mental health care, especially in the diagnosis and treatment of comorbid psychiatric illnesses.

Adult↗
PubMed2001

Urinary diversions: a review of nursing care.

The nurse plays an important part in the preoperative and postoperative management of the patient with a urinary diversion. Although urinary diversion as a surgical alternative has been performed since the mid 1800s, improvements in technique and management over the past 10 years warrant discussion. Three types of urinary diversion procedures are discussed along with suggestions for optimal nursing management during the postoperative period.

Humans↗
PubMed2000

Financial analysis of telecardiology used in a correctional setting.

The aim of this study is to evaluate the cost savings of 3 years of telecardiology used in a prison. This study compares the cost per visit of providing cardiology services by telemedicine (telecardiology) to patients at Powhatan Correctional Center of the Virginia Department of Corrections (PCC) and the cost of providing traditional cardiology services at the cardiology clinic of the Medical College of Virginia Campus of Virginia Commonwealth University (MCV Campus). During 1996 to 1998, telecardiology visits increased from 24 per year to 86. In this study, lower use of telecardiology services in 1996 resulted in higher cost per visit of $189. This was $45 more than the cost of traditional cardiology in the cardiology clinic at the MCV Campus. In 1997 and 1998, however, higher utilization of telecardiology services decreased the cost per visit to $135 and $132, respectively. This resulted in a cost saving with telecardiology of $15 per visit in 1997 and $46 per visit in 1998. Because the vast proportion of telemedicine operating costs are fixed, increased utilization causes reduced cost per visit and results in a cost saving compared with providing these services via a non-telemedicine program.

Cardiology↗
PubMed2000

Update on family psychoeducation for schizophrenia.

The Schizophrenia Patient Outcomes Research Team and others have previously included family psychoeducation and family support in best practices guidelines and treatment recommendations for persons with schizophrenia. In this article we review in detail 15 new studies on family interventions to consider issues around the implementation of family interventions in current practice. The data supporting the efficacy of family psychoeducation remain compelling. Such programs should remain as part of best practices guidelines and treatment recommendations. However, assessment of the appropriateness of family psychoeducation for a particular patient and family should consider (1) the interest of the family and patient; (2) the extent and quality of family and patient involvement; (3) the presence of patient outcomes that clinicians, family members, and patients can identify as goals; and (4) whether the patient and family would choose family psychoeducation instead of alternatives available in the agency to achieve outcomes identified.

Cognitive Behavioral Therapy↗
PubMed2000

Prevalence and correlates of diabetes in national schizophrenia samples.

People with schizophrenia may be at increased risk for Type II diabetes because of the side effects of antipsychotic medication, poorer overall physical health, less healthy lifestyles, and poorer health care. The present study uses data bases collected by the Schizophrenia Patient Outcomes Research Team (PORT) to assess the prevalence and demographic and clinical correlates of diabetes within large populations of persons receiving treatment for schizophrenia. In the Schizophrenia PORT, Medicaid and Medicare data from 1991 and more recent interview data were collected regarding the comorbidity of schizophrenia and diabetes: prevalence, quality of life, physical health, and services utilization and costs. The study found that rates of diagnosed diabetes exceeded general population statistics well before the widespread use of the new antipsychotic drugs. Risk factors for diabetes were similar to those observed in the general population. The linkage of diabetes to poor physical health, medical morbidity, and increased service use and cost requires attention. This study of diabetes in the early 1990s suggests that even before the widespread use of the atypical antipsychotic drugs, diabetes was a major problem for persons with schizophrenia.

Adult↗
PubMed2000

Therapists' contacts with family members of persons with severe mental illness in a community treatment program.

Thirty-six therapists at an urban community mental health center responded to a survey about contacts with family members of 214 clients with serious mental illness. For 61 percent of the clients, the therapists reported at least one past-year contact with a family member or someone acting as a family member. Contacts were typically by telephone and often took place during crises. The focus was on problem solving rather than on providing family therapy. Therapists perceived significant benefit from the contacts, which were achieved with little effort on their part. The results suggest that informal-and perhaps nonbillable-brief services to families are common. Such informal services fall short of recommended best-practice standards.

Adult↗
PubMed1999

Dual diagnosis of substance abuse in schizophrenia: prevalence and impact on outcomes.

Comorbid substance abuse disorders have emerged as one of the greatest obstacles to the effective treatment of persons with schizophrenia. Estimates of the prevalence of such comorbidity vary, but as many as half of persons with schizophrenia may suffer from a comorbid drug or alcohol disorder. Younger age, male gender, and lower educational attainment are associated with greater risk for addiction. Persons with schizophrenia and comorbid addiction tend to have an earlier onset of schizophrenia than do those without comorbid addiction. Research does not support a link between specific symptoms of schizophrenia and choice of abused drugs. Rather, drug choice is correlated with the pattern of ambient drug use in the community. Comorbid substance disorders are associated with a variety of poorer outcomes, including increased psychotic symptoms, poorer treatment compliance, violence, housing instability and homelessness, medical problems (including human immunodeficiency virus infection), poor money management, and greater use of crisis-oriented services that result in higher costs of care. Considerable progress has been made over the past decade in understanding the need to integrate substance abuse treatment and mental health treatment to provide more effective care for this population.

Alcoholism↗
PubMed1999

Quality of care in services to family members of people with serious mental illnesses.

This paper discusses the current status, importance, and future directions of quality of care work regarding support and information services for family members of people with serious mental illnesses. In reviewing existing literature, it highlights the need for research that documents the services currently received by family members in more depth and detail, the importance of including family-member services in quality-of-care standards and evaluations, and the necessity of grappling with fundamental questions such as who defines "quality" and "optimal" care, whose outcomes are foregrounded in such inquiry, and the development of methodologies to advance this area of inquiry.

Family↗
PubMed1999

The association of medical comorbidity in schizophrenia with poor physical and mental health.

This study determined the prevalence of medical comorbidities in a cohort of persons receiving treatment for schizophrenia and the association of medical comorbidity with physical and mental health status. A total of 719 persons with schizophrenia sampled from a variety of community and treatment settings as part of the schizophrenia Patient Outcomes Research Team (PORT) participated in a survey interview. Multiple regression analyses were used to assess sociodemographic factors associated with the number of current medical comorbidities and the association of medical comorbidity count with patient ratings of physical health, mental health, symptoms, and quality of life. The majority of patients reported at least one medical problem. Problems with eyesight, teeth, and high blood pressure were most common. A greater number of current medical problems independently contributed to worse perceived physical health status, more severe psychosis and depression, and greater likelihood of a history of a suicide attempt. This study underscores the need to attend to somatic health care for persons with schizophrenia as well as the linkage of physical and mental health status.

Adult↗
PubMed1999

Co-occurring severe mental illness and substance use disorders: a review of recent research.

OBJECTIVE: Understanding the complex diagnostic and treatment issues posed by the co-occurrence of severe mental illness and substance use disorders has become a necessary exercise in current psychiatric practice. The authors reviewed research studies from the past six years that have contributed to our knowledge about effective assessment, diagnosis, course of illness, and treatment approaches. Research on special populations, including women, persons infected with HIV, and violent patients, is highlighted. METHODS: PsycINFO, Silver Platter, and MEDLINE were used to search for English-language studies published in the United States and other countries. To augment the search, selected bibliographies were reviewed with a focus on clinical standards. Information was sought on epidemiology, screening and assessment strategies, course of illness, models of treatment delivery, and cost of care. RESULTS AND CONCLUSIONS: Although estimates of the prevalence of substance use disorders vary by population, a higher prevalence among persons with severe mental illness has been confirmed. Routine screening for and assessment of substance use disorders among persons with severe mental illness has become the accepted standard of care. The course of severe mental illness is negatively influenced by a substance use disorder, and an integrated approach to the treatment of both disorders is generally accepted to be the most promising treatment strategy. Components of this strategy include harm reduction, treatment in stages, motivational interviewing, cognitive-behavioral interventions, and modified 12-step self-help groups.

Adult↗
PubMed1999

Services to families of adults with schizophrenia: from treatment recommendations to dissemination.

OBJECTIVE: Data from the Schizophrenia Patient Outcomes Research Team project were examined to determine the extent to which families of adults with schizophrenia receive services and whether training staff in the provision of family services increases service availability. METHODS: For patients with a diagnosis of schizophrenia, paid claims for family therapy were identified in 1991 in a nationally representative sample of Medicare data and one state's Medicaid data. In a field study in two states, 530 patients were asked about services received by their families. A quasiexperimental dissemination of a family intervention was done at nine agencies; staff at four agencies received a standard didactic presentation, and staff at five received that standard presentation paired with intensive training. RESULTS: In the representative national Medicare sample of 15,425 persons with schizophrenia, .7 percent (N=108) had an outpatient claim for family therapy. This figure was 7.1 percent in the Medicaid sample of 5,393 persons with schizophrenia in one state. Of the 530 patients in the field study who reported having contact with their families, 159 (30 percent) reported that their families had received information, advice, or support about their illness, and 40 (8 percent) responded that their families had attended an educational or support program. At the four agencies where staff received only didactic training, no changes in family services were found after one year. Three of the five agencies where staff participated in intensive training enhanced their family services. CONCLUSIONS: A minority of families of persons with schizophrenia receive information about the illness from providers. Implementation of model family interventions is possible with considerable technical assistance. A gap exists between best practices and standard practices for families of persons with schizophrenia.

Adult↗
PubMed1999

State policy and funding of services to families of adults with serious and persistent mental illness.

A survey of state mental health programs was conducted to determine the extent to which states are facilitating the delivery of services to families of adults with severe and persistent mental illness. Of the 44 responding states, 73 percent did not have a policy about the types of services delivered to families, but 80 percent reported that they funded a family support intervention. The large majority of interventions supported by the states were family-to-family programs such as those sponsored by the National Alliance for the Mentally Ill. This study draws attention to the gap in services by mental health professionals to families and underscores the importance of the advocacy movement in obtaining funding and support for services to families.

Adult↗
PubMed1999

Case managers' and clients' perspectives on a representative payee program.

OBJECTIVE: Clients with severe and persistent mental illnesses often require a representative payee to help manage benefit funds. This study compared the perceptions of clients and clinical case managers about the benefits of and problems with the representative payee relationship. METHODS: Fifty-four clients receiving assertive community treatment completed an interview that assessed satisfaction with their experience of having a representative payee and the resulting impact on their substance use, budgeting, and housing. The clients' clinical case managers completed a similar questionnaire. Analyses examined associations between providers' and clients' responses and clients' gender, race, diagnosis, previous experience with a representative payee, and duration of the current representative payeeship. RESULTS: Clients and case managers recognized benefits of the representative payeeship in the areas of housing, substance use, and budgeting. Although little evidence was found that the payeeship pervasively interfered with the therapeutic relationship, 44 percent of case managers reported incidents in which clients verbally abused them over management of their funds. Clients' satisfaction with the representative payeeship was initially low but grew over time. Longer duration of the current payeeship and clients' previous experience with representative payeeship were associated with greater satisfaction and fewer problems. Case managers overestimated clients' initial satisfaction and underestimated their current satisfaction. CONCLUSIONS: Findings suggest that both mental health professionals and clients value the representative payee process as helpful in improving outcomes, although the benefits of the arrangement may be more evident with time and experience.

Case Management↗