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PubMed2003

The Bobo dilemma. Psychotherapeutic reflections on a contemporary myth.

This paper investigates the psychological consequences of a social ethos that has emerged in the 1990s; the Bourgeois Bohemian (in short, Bobo) that claims that the bourgeois striving for financial success and status can be reconciled with the Bohemian striving for creative self-expression. An extended case history shows how a man in his thirties grappled with the inherent complexity and contradictions of the Bobo ethos. The question is raised how, as psychotherapists, we can deal with the individual patient's search for a good life amidst the growing pressure of the Bobo ethos, to get the best of all possible lives, the combination of authenticity and success.

Adult↗
PubMed2006

Elimination of methadone benefits in the Oregon Health Plan and its effects on patients.

OBJECTIVES: This prospective study assessed the impacts of a policy change to Oregon's Medicaid program (Oregon Health Plan; OHP) that eliminated methadone benefits for 60 percent of active methadone patients. Recipients of OHP Standard (expanded Medicaid benefits, which were discontinued after the policy change) self-selected into two groups: those who paid for methadone after the policy change and those who terminated treatment. OHP Plus beneficiaries (traditional Medicaid) did not lose benefits. METHODS: A total of 149 patients participated in the study, and interviews were conducted at baseline (time of policy change) and one, three, and 12 months after the policy change. Patients were assessed with the Addiction Severity Index (ASI), Timeline Follow Back assessment, and chart review. RESULTS: Patients who left treatment because they were unable to pay for methadone services showed significant elevations in ASI composite scores for drug and legal problems at baseline and at two and three months after the policy change. The patients who attempted to self-pay experienced significantly more employment problems than the other two groups. The OHP Standard recipients who paid for their methadone treatment over the year were more likely to have additional resources to pay for methadone, be employed, and have stable housing. CONCLUSIONS: The elimination of methadone treatment benefits in the OHP had substantial negative impacts for patients with the greatest indicators of need.

Eligibility Determination↗
PubMed1975

Halfway houses for the mentally ill and alcoholics: a 1973 survey.

A survey of halfway houses made in October 1973 identified 209 facilities primarily for psychiatric patients and 597 for alcoholics. The facilities for alcoholics average fewer employees than the psychiatric halfway houses, and proportionately more of them are recovered patients. The alcoholism facilities serve older clients, most of them males. Patients admitted to psychiatric halfway houses are more likely to enter from a hospital than from the community, and they have longer stays than the alcoholic patients. The largest percentage of both groups return to independent living; 15 per cent of the psychiatric patients are readmitted to hospitals.

Adolescent↗
PubMed1976

The adult development program: an educational approach to the delivery of mental health services.

The adult development program is an intensive, shortterm program for individuals who want to change their behavior. It is based on an educational model; participants, who are called students, set their own behavior-change goals, and a multidisciplinary staff teach them techniques for reaching those goals. The program curriculum consists of about 20 seminars and workshops, which give the students an opportunity to learn and to practice new behaviors. Students pay fees that vary from $40 to $500 per month depending on the number of classes they take. Approximately 1750 students have participated in the program since it began six years ago.

Behavior Therapy↗
PubMed1988

Treatment of patients with no diagnosable mental disorders in CMHCs.

Community mental health centers (CMHCs) have been criticized for directing resources that should be used to treat the seriously mentally ill to the treatment of less impaired patients. Many of the latter group are assigned one of the DSM-III V codes for conditions that do not meet criteria for a mental disorder. This study compared patients with V-code conditions and those with diagnosed mental disorders on clinical, social, and economic variables. V-code patients were significantly less likely to have had prior care and to rely on third-party payments. They were significantly more likely to have been self-referred or referred by friends or family and to be white, well-educated, female, and married. CMHCs that treated fewer V-code patients reported proportionally more staff hours worked by physicians, indicating a greater medical orientation. The authors believe CMHCs should periodically evaluate whether, by serving patients with less serious conditions, they are diverting badly needed resources away from the seriously mentally ill.

Adolescent↗
PubMed2003

Willingness to pay for depression treatment in primary care.

OBJECTIVE: The authors analyzed data from 615 depressed primary care patients to determine their willingness to pay for depression treatment. METHODS: A sample of 615 adult patients from four primary care clinics participated in a randomized controlled trial of a disease management program for depression in primary care. Participants were asked at baseline interviews and six-month follow-up interviews how much they would be willing to pay per month for a six-month treatment that would eliminate their symptoms of depression. Multiple regression analyses were used to estimate the association between demographic and clinical factors and willingness to pay for depression treatment and to examine changes. RESULTS: The mean amount that participants were willing to pay for depression treatment at baseline was $270+/-187 per month, or about 9 percent of the participants' household income. Willingness to pay was significantly associated with household income and with the severity of depressive symptoms. Over six months, the amount that participants were willing to pay decreased along with their severity of depressive symptoms. CONCLUSIONS: The amount that participants were willing to pay was comparable to that reported for the treatment of other chronic medical disorders and higher than the actual cost of depression treatment. Measurements of willingness to pay may be a promising method for assessing the value of treatments for common mental disorders.

Adult↗
PubMedDate not supplied

Trends in total knee replacement surgeries and implications for public health, 1990-2000.

OBJECTIVES: Total joint replacements are important surgical interventions for treating severe arthritis of weight-bearing joints. The most common indication for total knee replacement (TKR) is osteoarthritis of the knee joint. The goals of this study were to assess the trend in rate of TKR in Wisconsin and to describe the economic impact of these surgical procedures on the health care system. METHOD: A population-based cross-sectional study of TKR surgeries was conducted among Wisconsin residents aged > or = 45 years. The Wisconsin inpatient hospital discharge data from 1990 through 2000 were used. Rates were age-adjusted to the 2000 U.S. population, and charges for TKR were adjusted for inflation. RESULTS: From 1990 through 2000, the age-adjusted rate for TKR increased by 81.5% (from 162 to 294 per 100,000; p<0.001). The rate increased the most among the youngest age group (45-49 years), rate ratio 5.1 for men, 4.2 for women. The total charges for TKR increased from 69.4 million dollars to 148 million dollars (109.2% inflation-adjusted increase). Medicare received the highest proportion of charges for TKR procedures, but throughout the study period, the proportion of charges covered by private insurance increased by 39%. CONCLUSIONS: The rate and costs of TKR procedures among Wisconsin residents increased substantially from 1990 through 2000, especially among younger age groups. Changes in medical practices probably accounted for some of this increase, but these trends also may reflect an increased prevalence of osteoarthritis, which in turn may be related to dramatic increases in the number of individuals who are overweight.

Age Distribution↗