Center for Health Equity Research and Promotion

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Leonard Davis Institute of Health Economics

Author: Judith Long

Health & Medicine

NOVEL PREDICTORS OF MEDICATION ADHERENCE AMONG VETERANS J.A. Long 1,2 ; S.E. Kimmel 2 ; W. Yang 2 ; A. Troxel 2 ; K. Volpp 1,2 . 1VA Center for Health Equity Research and Promotion, Philadelphia, PA; 2University of Pennsylvania, Philadelphia, PA. ,[object Object],[object Object],[object Object],Background Table 1: Sample Table ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Methods Results ,[object Object],[object Object],[object Object],Conclusions ,[object Object],Policy Implications ,[object Object],[object Object],[object Object]

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Available online at www.sciencedirect.com Cognitive and Behavioral Practice 18 (2011) 5–15 www.elsevier.com/locate/cabp Integrating Motivational Interviewing and Cognitive Behavioral Therapy in the Treatment of Eating Disorders: Tailoring Interventions to Patient Readiness for Change Josie Geller, St. Paul's Hospital, Vancouver, and University of British Columbia Erin C. Dunn, St. Paul's Hospital, Vancouver 1077 © 20 Publ This paper focuses on the integration of Motivational Interviewing (MI) and cognitive behavioral therapy (CBT) in the treatment of eating disorders. Although CBT is regarded as the treatment of choice in this population, it nevertheless has limitations: some patients fail to engage, drop out from treatment prematurely, or simply do not improve. These are common problems in a population characterized by high levels of ambivalence about change. MI strategies can assist clinicians in enhancing readiness for change, tailoring interventions to patient readiness status, and maintaining a therapeutic alliance throughout all stages of treatment. Preliminary research examining the efficacy of adaptations of MI in the treatment of individuals with eating disorders has been promising. This paper presents 4 patient scenarios involving individuals with varying degrees of readiness and in the context of different treatment settings. For each patient scenario, key issues are described and common roadblocks to developing or maintaining a therapeutic alliance are provided. Vignettes illustrate conversations between the patient and therapist for each scenario, highlighting how MI techniques can be integrated into CBT treatment and promote a working therapeutic relationship that enhances long-term treatment outcome. MILLIONS of individuals every year are affected byeating disorders: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Lifetime prevalence for AN is approximately 0.5% to 1% for females and .1% to .3% for males; lifetime prevalence for BN is approximately 1% to 3% for females and .5% to 2% for males; and lifetime prevalence for BED is approximately 2% to 5%, with no marked gender difference (Dingemans, Bruna, & van Furth, 2002; Hudson, Hiripi, Pope, & Kessler, 2007; Striegel-Moore, 2000; Woodside et al., 2001). An even larger number of individuals suffer from what is currently categorized as Eating Disorder Not Otherwise Specified (EDNOS), which is best described as a residual category for eating disorders of clinical severity that do not meet diagnostic criteria for AN or BN (Fairburn, 2008). Eating disorders are characterized by serious distur- bances in eating, such as binge eating, fasting, and purging (i.e., engaging in compensatory weight control behaviors), as well as subjective distress and excessive concern about body shape and weight. These behaviors are associated with a number of physical and psychological consequences. Physical consequences include amen- -7229/10/5–15$1.00/0 10 Associ.

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High psychiatric readmission rates continue while evidence suggests that care is not perceived by patients as “patient centered.” Research has focused on aftercare strategies with little attention to the inpatient treatment itself as an intervention to reduce readmission rates. Quality improvement strategies based on patient-centered care may offer an alternative. We evaluated outcomes and readmission rates using a benchmarking methodology with a naturalistic data set from an inpatient psychiatric facility (N 2,247) that used a quality-improvement strategy called systematic patient feedback. A systematic patient feedback system, the Partners for Change Outcome Management System (PCOMS), was used. Overall pre-post effect sizes were d 1.33 and d 1.38 for patients diagnosed with a mood disorder. These effect sizes were statistically equivalent to RCT benchmarks for feedback and depression. Readmission rates were 6.1% (30 days), 9.5% (60 days), and 16.4% (180 days), all lower than national benchmarks. We also found that patients who achieved clinically significant treatment outcomes were less likely to be readmitted. We tentatively suggest that a focus on real-time patient outcomes as well as care that is “patient centered” may provide lower readmission rates.

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1 PAGE 2 1. What is the question the authors are asking? They asked about a reduction in judgmental biases regarding the cost and probability associated with adverse social events as they are presumed as being mechanisms for the treatment of Social Anxiety Disorder (SAD). Also, the authors poised on the changes in judgmental biases as mechanisms to explain cognitive-behavioral therapy for social anxiety disorder. On top of that, they stated that methodological limitations extant studies highlight the possibility that rather than causing symptom relief, a significant reduction in judgmental biases tends to be consequences of it or correlate. Considerably, they expected cost bias at mid-treatment to be a predictor of the treatment outcome. 2. Why do the authors believe this question is important? According to the authors, this question was relevant as methodological limitations of present studies reflect on the possibility that instead of causing symptom belief, a significant reduction in judgmental biases can be consequences or correlated to it. Additionally, they ought to ascertain the judgment bias between treated and non-treated participants. Significantly, this was important as they had to determine the impact of pre and post changes in cost and probability of the treatment outcomes. But, probability bias at mid-treatment was a predictor of the treatment outcome contrary to the cost bias at mid-treatment that could not be identified as a significant predictor of the treatment outcome. 3. How do they try to answer this question? They conducted a study to evaluate the significant changes in judgmental bias as aspects of cognitive-behavioral therapy for social anxiety disorders. To do this, they conducted a study using information from two treatment studies; an uncontrolled trial observing amygdala activity as a response to VRE (Virtual Reality Exposure Therapy) with the use of functional magnetic resonance imaging and a randomized control trial that compared Virtual Reality Exposure Therapy with Exposure Group Therapy for SAD. A total of 86 individuals who met the DSM-IV-TR criteria for the diagnosis of non-generalized (n=46) and generalized (n=40) SAD participated. After completing eight weeks of the treatment protocol, the participants who identified public speaking as their most fearsome social situation were included. The SCID (Structured clinical interview for the DSM-IV) was used to ascertain diagnostic and eligibility status on Axis 1 conditions within substance abuse, mood and anxiety disorder modules. The social anxiety measures were measured with the use of BFNE (Brief Fear of Negative Evaluation), a self-reporting questioner that examined the degree to which persons fear to be assessed by other across different social settings. Additionally, the OPQ (Outcome Probability Questionnaire) self-reporting questionnaire was used to evaluate individual’s estimate on the probability that adverse, threatening events will occur at t ...

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