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The Minnesota Senior Health Options program: an early effort at integrating care for the dually eligible.

BACKGROUND: Duplication of funding and resultant inefficiencies have prompted active consideration of pooling the funding for persons covered by both Medicare and Medicaid into a single managed care program. This study reports the initial results of the first such program. METHODS: A sample of enrollees in Minnesota Senior Health Options (MSHO) and two sets of controls (within the same catchment area and outside it) as well as their families were interviewed to assess their functional status and satisfaction with their medical care. Respondents included those living in the community and those living in nursing homes. RESULTS: The MSHO and control samples were generally alike in terms of demographics and illness patterns. The differences that were found reflected those attributable to geographic location more than program. The groups were also similar with regard to functional status. There were few satisfaction differences among the community-dwelling samples, but the MSHO nursing residents and especially their families expressed more satisfaction with several aspects of care. CONCLUSIONS: Whereas no causal conclusions about outcomes can be drawn from a cross-sectional sample, there is no indication that managed care for the dually eligible population has profound impacts on care. However, the system of care provided to nursing home residents is appreciated over traditional care.

Aged↗

Treatment program for mental hospitals.

Many thousands of patients in the "chronic" wards of mental hospitals have been considered unsuitable subjects for active treatment, on the assumption that little could be accomplished. However, a well integrated therapeutic program under skilled psychiatric direction and involving all personnel who will come in contact with the patient gives promise of returning a substantial number of patients to their homes. The program suggested in this paper also retards personality disorganization and refutes the current nihilistic attitude concerning the patient whose mental condition has been deemed to be chronic.

Counseling↗

Selling health promotion programs: recommendations for occupational health nurses.

1. Although some suggest that health promotion programs should not be conducted in the workplace, there is generally strong support for workplace programs by both the public and private sectors. 2. Many published reports of cost savings attributed to health promotion programs are available. The calculations of cost savings contain many flaws and generally do not reflect a comprehensive analysis of all costs associated with programs, especially those associated with changes in death rates and longevity. 3. Specific recommendations for occupational health nurses include: analysis of the corporate situation; integration of programs with occupational health and safety activities; involvement of all levels of workers in planning and promoting the programs; evaluation through employee participation and satisfaction, not by cost benefit analysis; and consideration of offering programs to family members. 4. Nursing as a whole should provide leadership for implementing programs to promote health and prevent disease. The worksite offers unique opportunities for occupational health nurses to implement the Healthy People 2000 objectives to enhance the health of working adults.

Cost Savings↗

Transferring health and family planning service innovations to the public sector: an experiment in organization development in Bangladesh.

The International Centre for Diarrhoeal Disease Research, Bangladesh, has launched a field experiment in two rural thanas of Bangladesh to test the transferability of its successful health and family planning experiment in Matlab to the Ministry of Health and Population Control service system. This paper reviews the Matlab experiment with particular attention to its organization and identifies elements for transfer. The intervention strategy and operations research design of the new experiment are discussed. The proposed design follows an organization development strategy in which collaborative diagnostic research is used to foster institutional change.

Bangladesh↗

Prevalence, patterns, and correlates of spit tobacco use in a college athlete population.

We surveyed varsity athletes (N = 1,328) in 16 California colleges about their patterns of spit (smokeless) tobacco (ST) use, related habits, reasons for use, and preferred methods for quitting. Prevalence of use was analyzed by sport and demographic characteristics, and patterns of use in players using snuff exclusively, using chewing tobacco exclusively, and those using both were compared. Odds ratios and 95% confidence intervals were calculated, adjusting for ethnic group. Prevalence was highest in Whites (44%) and Native Americans (48%) and lowest in African Americans (11%), and higher in varsity baseball (52%) than varsity football players (26%), in players attending rural colleges, and among those who ever smoked cigarettes or used alcohol. Forty-one percent of ST users initiated regular use during their high school years. Athletes who used snuff exclusively used it more intensively and for more years than those who used chewing tobacco exclusively. Snuff users indicated a greater perceived need for ST, but also were more ready to quit. These data suggest ST programs with prevention and cessation components are appropriate for high school as well as college athletes. Such interventions should focus on baseball players, distinguish snuff from chewing tobacco users in planning quit strategies, integrate intervention programs for cigarette smoking and alcohol consumption, provide training in refusal skills, and attempt to change social norms in support of ST use by integrating popular peers and significant others (e.g., wives/girlfriends) to endorse nonuse of ST.

Adolescent↗

Integration of Health Systems Management Bachelors Program graduates into the Israeli healthcare market.

Ben-Gurion University (BGU) in Beer-Sheva, opened a special program (B.A. degree) for training junior academic administrative personnel who can improve the quality of service in health care organizations through suitable and high-quality administration. The program the first of its kind in Israel, has been in operation since 1994, providing 50 candidates for administrative positions within the health system per year. The research goals of the project described in this paper were to examine integration of 224 graduates of the undergraduate program in Health Systems Management (HSM) within the private and public health system in Israel, including employment trends and evaluation of the program in retrospect. Questionnaires were sent to all graduates of the program. Participants were requested to answer questions regarding their present place of employment and their satisfaction with their academic degree. The findings showed that the graduates of the undergraduate program in HSM have integrated well into the health system, butnotas well as they could have. The graduates encountered difficulties in their absorption into management roles in the public health system and feel that the extent of their abilities has yet to be fully recognized and utilized by the system.

Education, Professional↗

Integrating services for injection drug users infected with hepatitis C virus with methadone maintenance treatment: challenges and opportunities.

Despite the high prevalence of hepatitis C virus (HCV) infection among drug users enrolled in methadone maintenance treatment programs, few drug users are being treated with combination therapy. The most significant barrier to treatment is lack of access to comprehensive HCV-related care. We describe a pilot program to integrate care for HCV infection with substance abuse treatment in a setting of maintenance treatment with methadone. This on-site, multidisciplinary model of care includes comprehensive screening and treatment for HCV infection, assessment of eligibility, counseling with regard to substance abuse, psychiatric services, HCV support groups, directly observed therapy, and enhanced linkages to a tertiary care system for diagnostic procedures. Our approach has led to high levels of adherence, with liver biopsy and substantial rates of initiation of antiviral therapy. Two cases illustrate the successful application of this model to patients with HCV infection complicated by active substance abuse and psychiatric comorbidity.

Adult↗

A cognitive-behavioral therapeutic community for substance dependent and homeless veterans: treatment outcome.

This paper presents data regarding a residential rehabilitation program that integrates cognitive-behavioral and therapeutic community techniques to treat homelessness and substance abuse. The study cohort was 110 military veterans admitted to a Domiciliary Care for Homeless Veterans program of the Department of Veterans Affairs. The cohort had multiple psychosocial problems at admission, and all had drug/alcohol abstinence as a treatment goal. Structured interviews conducted at 3, 6, 9, and 12 months postdischarge revealed that a substantial proportion had positive outcomes with respect to housing, substance abuse abstinence, employment, and self-rated psychological symptoms. This integrated cognitive-behavioral therapeutic community approach appears to be a viable treatment for this subset of homeless and also may be effective for other populations with similar clinical characteristics.

Adult↗

The Effect of Mindfulness-Based Psychoeducation Program on Mindfulness, Self-Compassion, and Forgiveness Tendencies of Patients with Bipolar Disorder: A Randomized Controlled Trial.

This study examined the effects of a mindfulness-based psychoeducation program on mindfulness, self-compassion, and forgiveness in patients with bipolar disorder using a pretest-posttest randomized controlled experimental design. The study sample comprised of 40 patients (experimental group, n&#x2009;=&#x2009;20; control group, n&#x2009;=&#x2009;20). A mindfulness-based psychoeducation program was administered to the experimental group, while no intervention was administered to the control group. Data were collected using a personal information form, the Mindfulness Scale, the Self-Compassion Scale Short Form, and the Heartland Forgiveness Scale. The study revealed that the experimental group's mean scores on the mindfulness, self-compassion, and forgiveness scales following the intervention were significantly higher than those of the control group (p&#x2009;<&#x2009;.05). This study found that a mindfulness-based psychoeducation program increased mindfulness, self-compassion, and forgiveness in patients with bipolar disorder. The findings are limited to a small outpatient sample from a single CMHC and may not be generalizable to hospitalized patients with more severe clinical presentations. Mindfulness-based educational programs may enhance mental health, improve illness insight, support symptom management, and strengthen social functioning in individuals with bipolar disorder. The results emphasize the importance of integrating these programs into treatment processes and reveal the necessity for psychiatric nurses to actively implement mindfulness-based interventions. Psychiatric nurses should consider incorporating mindfulness-based techniques into their practice to improve the mental health of individuals with bipolar disorder, better understand the disorder, control symptoms, and improve social interactions.

Humans↗

Immediate outcomes of substance use treatment within a state psychiatric hospital.

Outcomes of an integrated inpatient treatment program for persons with serious mental illness and substance use disorders are examined in relationship to five stages of treatment--stabilization, engagement, persuasion/awareness, active treatment, and relapse prevention. The study used a randomized design with participants assigned to an integrated mental health and substance abuse treatment program or standard psychiatric hospital treatment. At discharge, participants in the integrated treatment program indicated more active engagement in treatment and greater awareness of mental health issues, substance use issues, and the 12-step program than those who received standard hospital treatment. Participants in the integrated treatment program also saw their treatment as being more effective and had more motivation to stay healthy and sober. The integrated treatment program was not equally effective at each treatment stage with all participants. The implications of the program's success overall and at each treatment stage are discussed.

Adult↗

Sex therapy for the penile prosthesis recipient.

In conclusion, the evidence for technical success of the penile prosthesis is clear, but more detailed follow-up studies suggest that a large minority of patients and partners fail to achieve sexual satisfaction. If the goal of surgery is to restore sexual frequency, variety, and pleasure to optimal levels, an integrated treatment program that incorporates sex therapy may be more successful than implantation alone. The type of sex therapy required depends on the risk factors present for postsurgery sexual dissatisfaction. A majority of patients can benefit from several sessions of brief sexual counseling preoperatively, with routine follow-up at 3 and 6 months after surgery to identify problems in resuming sex successfully. I also would point out that an integrated treatment approach is just as applicable to home intracavernosal injection programs. Including sex therapy in the package might reduce the large drop-out rates currently being seen and might decrease the risk of misuse of these medications.

Consumer Behavior↗

[Dengue control in an urban area of Brazil: impact of the Family Health Program on traditional control].

A study was performed in different areas of São José do Rio Preto which include the Family Health Program (FHP) and the Dengue Control Program, and the results of integration between the two programs were evaluated. In addition to other responsibilities, community health agents instructed residents on dengue control measures, encouraging the population to adopt the practices in areas with the FHP. Vector control agents were responsible for breeding site control and instructed local residents on the Dengue Control Program. From 2001 to 2003, surveys were conducted to measure residents' dengue control knowledge and practices. The proportions of residents in the FHP area that reported health services as a source of information increased significantly as compared to the other area. There were significant changes concerning the increase in information about the disease and reduction in vector breeding sites. The results show that integration between the programs is possible and could help optimize resources, avoiding duplicity of procedures and fostering greater community involvement in dengue control.

Aedes↗

Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders.

OBJECTIVE: Comorbidity of substance abuse disorders with schizophrenia is associated with a greater risk for serious illness complications and poorer outcome. Methodologically sound studies investigating treatment approaches for patients with these disorders are rare, although recommendations for integrated and comprehensive treatment programs abound. This study investigates the relative benefit of adding an integrated psychological and psychosocial treatment program to routine psychiatric care for patients with schizophrenia and substance use disorders. METHOD: The authors conducted a randomized, single-blind controlled comparison of routine care with a program of routine care integrated with motivational interviewing, cognitive behavior therapy, and family or caregiver intervention. RESULTS: The integrated treatment program resulted in significantly greater improvement in patients' general functioning than routine care alone at the end of treatment and 12 months after the beginning of the study. Other benefits of the program included a reduction in positive symptoms and in symptom exacerbations and an increase in the percent of days of abstinence from drugs or alcohol over the 12-month period from baseline to follow-up. CONCLUSIONS: These findings demonstrate the effectiveness of a program of routine care integrated with motivational interviewing, cognitive behavior therapy, and family intervention over routine psychiatric care alone for patients with comorbid schizophrenia and alcohol or drug abuse or dependence.

Adolescent↗

Gross anatomy of the head and neck and neuroscience in an integrated first-year medical school curriculum.

The curriculum for first year medical students at the University of Cincinnati has changed. Beginning in the fall of 1998, material in the first year was presented in an Integrated Educational Program. The goal of this program was to provide students with an understanding of the normal structure, function, and development of the human body. The purpose of this report is to discuss the unique integration that occurs in a block offered during the Spring Quarter. The two components of this block are Gross Anatomy of the Head and Neck and Brain and Behavior I. Brain and Behavior I is a new offering combining neuroanatomy, neurophysiology, neurology, and a psychiatry/behavioral component. The unique combinations offered in this block are logical, educationally sound, and have been enthusiastically received by both the students and faculty.

Anatomy↗