This document summarizes a study that interviewed 39 consumers receiving integrated primary care and mental health services at a community mental health center. The consumers described how they manage both physical and mental health conditions, viewing them as interconnected. They also provided positive feedback on the integrated care model, noting the convenience of having services co-located, friendly knowledgeable providers, and collaboration between provider types. The study aimed to understand consumer perspectives on managing co-occurring conditions and views of integrated care services.
Engines of Success for U.S. Health Reform?
Eric B. Larson, MD, MPHVice President for Research, Group Health Executive Director, Group Health Research Institute
Background: The numbers of caregivers burdened by dementia is increasing. Depression is also found more in this group and
causes higher morbidity. The aim of this study was to investigate the predictors of depression among Thai family caregivers in order to develop effective interventions in primary care Methods: A total of 177 participants were recruited in primary care setting. They were assessed for sociodemographic data, health status, caregiver burden and depressive symptoms measured by Charlsons Comorbidities (CCI), Zarit Burden Interview (ZBI) and Patient Health Questionnaire (PHQ-9), respectively. The data for dementia patients included severity and functional status. Depression was defi ned as PHQ-9 ≥ 9. Multivariate linear regression model was applied to assess the independent relationship between possible risk factors and risk of depression.
Sudhir mishra guide for proposal development sudhirMishra75
This document presents a health research project proposal on assessing self-medication practices among rural people in Rolpa District, Nepal. The proposal outlines the high rates of self-medication in Asia and developing countries. The study aims to estimate the proportion of self-medication and analyze associations between characteristics, perceptions, access to healthcare, social support, and self-medication practices. It proposes examining these relationships through a survey of rural residents assessing demographics, perceptions of benefits and barriers, access factors, and social support systems. The study intends to provide insights into self-medication behaviors and their drivers to ultimately help design interventions.
Rural Physician Recruitment: Results from the 2019 Rural Physician and Admini...Jackson Physician Search
This whitepaper reviews the results of our recent rural physician and administrators survey and provides a summary of action items administrators should consider when recruiting physicians to their community.
This document provides an overview of disease management for depression. It defines disease management and explains why depression is a suitable condition for a disease management program. Depression is common, underdiagnosed and undertreated despite available effective therapies. Disease management could help improve diagnosis and treatment of depression through strategies like educating healthcare providers, increasing screening of patients, and ensuring adherence to treatment guidelines. This could help reduce the personal and economic burden of depression.
Relationship Between Drugs and Health Workers - Sample Essaya1customwritings
A1CustomWritings.com are experienced in all academic levels of assignments and in any academic fields, the team of experts of our custom essay writing service have the ability to help you with any requirements of your essay. Our team takes pride in the quality of work provided to our customers and we pledge to do whatever it takes to ensure you receive a paper of only the highest quality.
Rx16 federal tues_1115_1_fretwell_2gabbert-wilkebrownOPUNITE
This document summarizes a presentation on state and community-level programs for preventing prescription drug misuse and expanding treatment options like medication-assisted treatment. Speakers from Georgia and Iowa discussed their strategies for engaging stakeholders, implementing prevention initiatives in targeted communities, leveraging funding sources, and addressing challenges in data and addressing disparities. Iowa described their efforts to expand access to medication-assisted treatment for opioid use disorders through a new grant, including challenges implementing changes quickly.
The document provides an overview of the history and development of nursing as a profession. It discusses Florence Nightingale's pioneering work in nursing in the 1800s and the establishment of formal nursing education. It also outlines the various roles and settings in which nurses practice today, including differences between practical/vocational nursing and registered nursing. Finally, it briefly describes the current healthcare system and managed care environment in which nurses work.
Engines of Success for U.S. Health Reform?
Eric B. Larson, MD, MPHVice President for Research, Group Health Executive Director, Group Health Research Institute
Background: The numbers of caregivers burdened by dementia is increasing. Depression is also found more in this group and
causes higher morbidity. The aim of this study was to investigate the predictors of depression among Thai family caregivers in order to develop effective interventions in primary care Methods: A total of 177 participants were recruited in primary care setting. They were assessed for sociodemographic data, health status, caregiver burden and depressive symptoms measured by Charlsons Comorbidities (CCI), Zarit Burden Interview (ZBI) and Patient Health Questionnaire (PHQ-9), respectively. The data for dementia patients included severity and functional status. Depression was defi ned as PHQ-9 ≥ 9. Multivariate linear regression model was applied to assess the independent relationship between possible risk factors and risk of depression.
Sudhir mishra guide for proposal development sudhirMishra75
This document presents a health research project proposal on assessing self-medication practices among rural people in Rolpa District, Nepal. The proposal outlines the high rates of self-medication in Asia and developing countries. The study aims to estimate the proportion of self-medication and analyze associations between characteristics, perceptions, access to healthcare, social support, and self-medication practices. It proposes examining these relationships through a survey of rural residents assessing demographics, perceptions of benefits and barriers, access factors, and social support systems. The study intends to provide insights into self-medication behaviors and their drivers to ultimately help design interventions.
Rural Physician Recruitment: Results from the 2019 Rural Physician and Admini...Jackson Physician Search
This whitepaper reviews the results of our recent rural physician and administrators survey and provides a summary of action items administrators should consider when recruiting physicians to their community.
This document provides an overview of disease management for depression. It defines disease management and explains why depression is a suitable condition for a disease management program. Depression is common, underdiagnosed and undertreated despite available effective therapies. Disease management could help improve diagnosis and treatment of depression through strategies like educating healthcare providers, increasing screening of patients, and ensuring adherence to treatment guidelines. This could help reduce the personal and economic burden of depression.
Relationship Between Drugs and Health Workers - Sample Essaya1customwritings
A1CustomWritings.com are experienced in all academic levels of assignments and in any academic fields, the team of experts of our custom essay writing service have the ability to help you with any requirements of your essay. Our team takes pride in the quality of work provided to our customers and we pledge to do whatever it takes to ensure you receive a paper of only the highest quality.
Rx16 federal tues_1115_1_fretwell_2gabbert-wilkebrownOPUNITE
This document summarizes a presentation on state and community-level programs for preventing prescription drug misuse and expanding treatment options like medication-assisted treatment. Speakers from Georgia and Iowa discussed their strategies for engaging stakeholders, implementing prevention initiatives in targeted communities, leveraging funding sources, and addressing challenges in data and addressing disparities. Iowa described their efforts to expand access to medication-assisted treatment for opioid use disorders through a new grant, including challenges implementing changes quickly.
The document provides an overview of the history and development of nursing as a profession. It discusses Florence Nightingale's pioneering work in nursing in the 1800s and the establishment of formal nursing education. It also outlines the various roles and settings in which nurses practice today, including differences between practical/vocational nursing and registered nursing. Finally, it briefly describes the current healthcare system and managed care environment in which nurses work.
This document summarizes a presentation on advances in treating chronic pain and addiction. It includes:
- Presenters from PRIUM, American Airlines, and the Treatment Research Institute
- Learning objectives around chronic pain, psychosocial issues, Medicaid requirements for the ASAM Criteria, and implementing the criteria
- Disclosures from presenters about relevant relationships
- Overview of topics like the bidirectional relationship between physical and mental health, impacts of adverse childhood experiences, and the influence of stigma on substance use treatment
- American Airlines' workers compensation program which saw a 40% reduction in claims and lower pharmacy costs and disability after redesigning their approach to focus on early intervention and additional resources for employees with chronic
Community hlth planning_project_final 2Casey Burritt
The document summarizes a community health project conducted by Old Dominion University nursing students in partnership with Miles Memorial United Methodist Church and Sentara Health Prevention. The students assessed the health of the church congregation through surveys and interviews. Their assessment found that high blood pressure was a major health concern, along with allergies, obesity, and depression. The students developed a health plan to address these issues through education and screenings. The congregation is made up of mostly older adults and Caucasians. Literature reviews found that high blood pressure increases with age and is more prevalent in Europe and associated with risk factors like smoking. The project aimed to promote health and prevent illness in the congregation.
Gender Difference in Response to Preventative Health Careiowafoodandfitness
Luther College Students prepared the following community assessments as part of their Psychology of Health and Illness class in the Fall Semester 2008.
This document summarizes a presentation on managing morphine equivalent dose (MED) and identifying high-risk opioid use through "red flagging." It discusses how calculating MED at the point of sale can help identify unsafe dosages and decrease opioid prescriptions. It also evaluates different methods to screen for overdose risk, finding that simple opioid use thresholds to flag patients may not accurately target those most likely to experience preventable overdoses. The presentation aims to explain MED management, describe payer solutions that reduced opioid use, and identify more precise ways to intervene with highest-risk patients.
The document discusses rural health care and innovation. It talks about self-destructive behaviors, non-adherence to treatment, and health promotion. It provides data on leading causes of death in the US and discusses challenges of accessibility in rural areas. It suggests bringing basic health services to people in more accessible community locations.
Bridging Gaps in MH Service Delivery - Community LevelPaul Brown
A presentation defining the problems associated with local communities absorbing deinstitutionalized mental health patients. EBP's are introduced along with an example local community advocacy project and results of a demonstration project, linking emerging offenders leaving custody with MI to wraparound case management services.
Ethical And Legal Aspects Of Health CareLajpat Rai
This document outlines several key ethical issues in telemedicine practice including maintaining patient confidentiality and avoiding harm, obtaining informed consent, establishing fees, maintaining accurate records, and ensuring access to healthcare. It also discusses privacy concerns regarding personal information disclosure and storage as well as technological risks associated with telemedicine like equipment quality and inadequate guidelines.
The presentation by Professor David Peters was given at the First Complex Adaptive Systems Training Workshop for CNHDRC, which was held in Beijing, China, from 18-19 July. It explains the basic elements of health systems and how they relate to a complex adaptive systems approach.
First model of one stop service for drug users in drug dependent centers in s...Alexander Decker
This study developed and evaluated a "one stop service" model providing integrated care for drug users at a drug dependence treatment center in southern Thailand. Fifty-six intravenous and other drug users received services including methadone maintenance, HIV/AIDS testing and counseling, health education, tuberculosis screening, antiretroviral therapy, and harm reduction. Most participants were satisfied with the integrated services. The model helped address barriers to care by providing comprehensive services in a single location and establishing a self-help support group. The study concluded the one stop service model should be expanded to improve care for drug users and reduce HIV transmission in Thailand.
The document discusses the ethical dilemma around using prescription drugs as the standard of care for treating patients. While the Hippocratic Oath states that doctors should first do no harm, prescription drugs can cause harmful side effects and even death for some patients. Studies have found that adverse drug reactions and medical errors kill over 100,000 patients annually in the US. Some doctors have also been found to unethically prescribe unnecessary treatments, like yearly flu shots that introduce viruses and bacteria, just to generate revenue from prescribing antibiotics. The current healthcare system prioritizes treating illnesses with drugs over preventing them, but changing to a preventative model and using telemedicine could help solve the healthcare crisis and better uphold medical ethics of first doing no harm.
The document proposes a new health plan focused on incentivizing healthy behaviors and reducing unnecessary healthcare costs. It notes that 50% of healthcare costs are due to preventable conditions and 35% of spending is wasteful. The plan would provide financial incentives for activities like health assessments, enrolling in coaching programs, and completing health education modules in order to encourage participation and healthy choices. The goals are to help people better understand and manage their health while saving on healthcare expenses over time.
The document summarizes a health consumerism survey conducted in North Texas. The survey aimed to understand patient preferences and experiences accessing healthcare. It collected both qualitative and quantitative data through an online and paper-based questionnaire distributed across Tarrant County. Key findings included high levels of patient satisfaction overall with provider communication and care coordination. However, some areas for improvement were identified such as encouraging patients to ask questions and using visual aids. The survey also found that the majority of respondents were not willing to have someone monitor their medications due to privacy concerns. Education levels did not impact understanding of provider explanations. The results provide insights into patient behaviors and opportunities to further engage consumers in their healthcare.
Population Health Management Telehealth Intervention Medical Research Treatin...CrimsonpublishersMedical
Population Health Management Telehealth Intervention Medical Research Treating Comorbid Clinical Obesity and Depression in Geriatric Patients Part One: Review of Tele-Medicine Scientific Research by Robelyn A Garcia in International Journal of Medical Sciences
Overview and history of home health careSUNITA SINGH
The document provides an overview of home health care in the United States, including its history and the Medicare home health care program. It discusses how care shifted from the home to hospitals in the early 20th century due to advances in medicine and technology. It also summarizes how the Medicare home health care benefit expanded in the 1980s-1990s but was curtailed by the Balanced Budget Act of 1997 which focused the program on post-acute care and set limits on spending. The document outlines the eligibility requirements and covered services under Medicare home health care.
This document provides an introduction to medical ethics, including key concepts and principles. It discusses how ethics guides moral decision making in medicine. Medical ethics refers to the values and standards that govern relationships between physicians and patients, colleagues, and society. Some core principles of medical ethics include beneficence, non-maleficence, autonomy, justice, and confidentiality. Throughout history, various codes of conduct have been developed to articulate ethical guidelines for physicians.
1) Health services research uses observational studies and administrative data to evaluate how policies, financing systems, and healthcare delivery impact access, quality, and costs of healthcare.
2) Studies of Medicaid administrative data have provided lessons on improving mental healthcare, finding underuse of effective treatments for schizophrenia and poor but improving quality of care overall.
3) Key findings include evidence that quality of care and racial/ethnic disparities vary significantly between states and within states, and that disparities in effective care like clozapine use are larger for minority groups.
This document provides information about Medicare coverage of home health care services. It outlines who is eligible for home health care benefits, what services are covered including skilled nursing care, physical therapy, occupational therapy and more. It also discusses how Medicare pays for home health care through 60-day episodes of care. The document notes some services that are not covered like 24-hour care, delivered meals or personal care services.
Compliance, concordance and empowerment in patients with type two diabetes me...NiyotiKhilare
This presentation compares the traditional model that focuses on compliance of the patient, with the new model which focuses on empowering the patient. The presentation will also focus elaborately on empowerment as an intervention for improved medical adherence in diabetic patients.
Explore and analyse concordance as a concept and empowerment as a strategic intervention to improve patient outcomes in diabetes.
Key Stakeholders in Public Health Issue.docx4934bk
Key stakeholders in a public health issue include those affected by the issue as well as those who can influence or make decisions related to the issue. It is important to identify stakeholders to understand their interests and perspectives which informs policy analysis. Primary care physicians, specialists, and other healthcare providers have an interest in public health issues that impact patient care. Government agencies also have an interest as they are responsible for funding programs and creating regulations and policies. Identifying stakeholders is crucial for conducting a thorough policy analysis.
Identify and summarize determinants of a public health problemMalikPinckney86
Identify and summarize determinants of a public health problem:
individual/ biological, interpersonal/
Intrapersonal Factors: involve an individual's beliefs, attitudes, and knowledge about a health condition.
Lifestyle Causal Beliefs about Obesity
when categorized as ‘some'/‘a lot', 94% of participants held not exercising causal beliefs, 95% held overeating causal beliefs, 90% held eating certain types of food causal beliefs, 70% held chemicals in food causal beliefs, and 41% held smoking causal beliefs about obesity, compared to the 69% who held genetic causal beliefs about obesity. There were few associations between lifestyle causal beliefs about obesity and any of the sociodemographic or health-related characteristics assessed.
Genetic Causal Beliefs about Obesity-Related Diseases
Overall, 82% of participants held genetic causal beliefs about type 2 diabetes (fig. 2), 79% about heart disease (fig. 3) and 75% about cancer (fig. 4), when categorized as ‘some/a lot.' table 3 shows that there were very few associations with participant sociodemographic or health-related characteristics.(all threse from https://www.karger.com/Article/Fulltext/343793)
This study is based on the Ecological Systems Theory and Family and Community Systems perspectives, which emphasize the need to consider the effects of individual, family, community, and societal factors on health and social outcomes (Bronfenbrenner & Morris, 1988; Campbell, Hesketh, & Davison, 2010; Elder et al., 2007; Fulkerson et al., 2015; Novilla, Barnes, De La Cruz, Williams, & Rogers, 2006; Valente, 2012).
This study contributes to the literature in several ways and emphasizes that peers and families are important sources of influence when it comes to healthy eating and choices of activities in young adolescents. Specifically, adolescents who reported a stronger connection with their family also engaged more frequently in physical activity than adolescents who reported lower familism. The benefits of targeting the family as part of lifestyle interventions are well established (Epstein, Paluch, Roemmich, & Beecher, 2007; Skelton, Buehler, Irby, & Grzywacz, 2012; St Jeor, Perumean-Chaney, Sigman-Grant, Williams, & Foreyt, 2002). The rationale underlying family-centered approaches is that modification of the youth’s environment is necessary to change and maintain children’s healthy habits. As a primary source of socialization, parents not only influence youths’ healthy lifestyle in providing access to resources and in modeling and reinforcing healthy habits, but they also provide the basis for the development of healthy peer relationships. Conceivably, stronger family connections may operate directly on young adolescents’ physical activity, but also indirectly in establishing the foundations for healthy peer relationships, which in turn promote healthier diet and a less sedentary lifestyle.
Furthermore, adolescents who reported higher PSF had a healthier diet and spent less time engagi ...
Behavioral Health Integration PowerPointT L Dunlop
The document discusses behavioral health integration and its benefits. It defines behavioral health integration as the systematic coordination of mental health, substance abuse, and primary care services through a team approach using evidence-based practices. Integrating behavioral health services into primary care settings provides a one-stop shop for patients, benefits patients and providers by improving quality of care, and lowers overall healthcare costs by 20-40%. The document recommends integrating behavioral health practitioners into primary care clinics to assist patients with lifestyle changes, medication compliance, and management of chronic conditions, mental health issues, and substance abuse.
This document summarizes a presentation on advances in treating chronic pain and addiction. It includes:
- Presenters from PRIUM, American Airlines, and the Treatment Research Institute
- Learning objectives around chronic pain, psychosocial issues, Medicaid requirements for the ASAM Criteria, and implementing the criteria
- Disclosures from presenters about relevant relationships
- Overview of topics like the bidirectional relationship between physical and mental health, impacts of adverse childhood experiences, and the influence of stigma on substance use treatment
- American Airlines' workers compensation program which saw a 40% reduction in claims and lower pharmacy costs and disability after redesigning their approach to focus on early intervention and additional resources for employees with chronic
Community hlth planning_project_final 2Casey Burritt
The document summarizes a community health project conducted by Old Dominion University nursing students in partnership with Miles Memorial United Methodist Church and Sentara Health Prevention. The students assessed the health of the church congregation through surveys and interviews. Their assessment found that high blood pressure was a major health concern, along with allergies, obesity, and depression. The students developed a health plan to address these issues through education and screenings. The congregation is made up of mostly older adults and Caucasians. Literature reviews found that high blood pressure increases with age and is more prevalent in Europe and associated with risk factors like smoking. The project aimed to promote health and prevent illness in the congregation.
Gender Difference in Response to Preventative Health Careiowafoodandfitness
Luther College Students prepared the following community assessments as part of their Psychology of Health and Illness class in the Fall Semester 2008.
This document summarizes a presentation on managing morphine equivalent dose (MED) and identifying high-risk opioid use through "red flagging." It discusses how calculating MED at the point of sale can help identify unsafe dosages and decrease opioid prescriptions. It also evaluates different methods to screen for overdose risk, finding that simple opioid use thresholds to flag patients may not accurately target those most likely to experience preventable overdoses. The presentation aims to explain MED management, describe payer solutions that reduced opioid use, and identify more precise ways to intervene with highest-risk patients.
The document discusses rural health care and innovation. It talks about self-destructive behaviors, non-adherence to treatment, and health promotion. It provides data on leading causes of death in the US and discusses challenges of accessibility in rural areas. It suggests bringing basic health services to people in more accessible community locations.
Bridging Gaps in MH Service Delivery - Community LevelPaul Brown
A presentation defining the problems associated with local communities absorbing deinstitutionalized mental health patients. EBP's are introduced along with an example local community advocacy project and results of a demonstration project, linking emerging offenders leaving custody with MI to wraparound case management services.
Ethical And Legal Aspects Of Health CareLajpat Rai
This document outlines several key ethical issues in telemedicine practice including maintaining patient confidentiality and avoiding harm, obtaining informed consent, establishing fees, maintaining accurate records, and ensuring access to healthcare. It also discusses privacy concerns regarding personal information disclosure and storage as well as technological risks associated with telemedicine like equipment quality and inadequate guidelines.
The presentation by Professor David Peters was given at the First Complex Adaptive Systems Training Workshop for CNHDRC, which was held in Beijing, China, from 18-19 July. It explains the basic elements of health systems and how they relate to a complex adaptive systems approach.
First model of one stop service for drug users in drug dependent centers in s...Alexander Decker
This study developed and evaluated a "one stop service" model providing integrated care for drug users at a drug dependence treatment center in southern Thailand. Fifty-six intravenous and other drug users received services including methadone maintenance, HIV/AIDS testing and counseling, health education, tuberculosis screening, antiretroviral therapy, and harm reduction. Most participants were satisfied with the integrated services. The model helped address barriers to care by providing comprehensive services in a single location and establishing a self-help support group. The study concluded the one stop service model should be expanded to improve care for drug users and reduce HIV transmission in Thailand.
The document discusses the ethical dilemma around using prescription drugs as the standard of care for treating patients. While the Hippocratic Oath states that doctors should first do no harm, prescription drugs can cause harmful side effects and even death for some patients. Studies have found that adverse drug reactions and medical errors kill over 100,000 patients annually in the US. Some doctors have also been found to unethically prescribe unnecessary treatments, like yearly flu shots that introduce viruses and bacteria, just to generate revenue from prescribing antibiotics. The current healthcare system prioritizes treating illnesses with drugs over preventing them, but changing to a preventative model and using telemedicine could help solve the healthcare crisis and better uphold medical ethics of first doing no harm.
The document proposes a new health plan focused on incentivizing healthy behaviors and reducing unnecessary healthcare costs. It notes that 50% of healthcare costs are due to preventable conditions and 35% of spending is wasteful. The plan would provide financial incentives for activities like health assessments, enrolling in coaching programs, and completing health education modules in order to encourage participation and healthy choices. The goals are to help people better understand and manage their health while saving on healthcare expenses over time.
The document summarizes a health consumerism survey conducted in North Texas. The survey aimed to understand patient preferences and experiences accessing healthcare. It collected both qualitative and quantitative data through an online and paper-based questionnaire distributed across Tarrant County. Key findings included high levels of patient satisfaction overall with provider communication and care coordination. However, some areas for improvement were identified such as encouraging patients to ask questions and using visual aids. The survey also found that the majority of respondents were not willing to have someone monitor their medications due to privacy concerns. Education levels did not impact understanding of provider explanations. The results provide insights into patient behaviors and opportunities to further engage consumers in their healthcare.
Population Health Management Telehealth Intervention Medical Research Treatin...CrimsonpublishersMedical
Population Health Management Telehealth Intervention Medical Research Treating Comorbid Clinical Obesity and Depression in Geriatric Patients Part One: Review of Tele-Medicine Scientific Research by Robelyn A Garcia in International Journal of Medical Sciences
Overview and history of home health careSUNITA SINGH
The document provides an overview of home health care in the United States, including its history and the Medicare home health care program. It discusses how care shifted from the home to hospitals in the early 20th century due to advances in medicine and technology. It also summarizes how the Medicare home health care benefit expanded in the 1980s-1990s but was curtailed by the Balanced Budget Act of 1997 which focused the program on post-acute care and set limits on spending. The document outlines the eligibility requirements and covered services under Medicare home health care.
This document provides an introduction to medical ethics, including key concepts and principles. It discusses how ethics guides moral decision making in medicine. Medical ethics refers to the values and standards that govern relationships between physicians and patients, colleagues, and society. Some core principles of medical ethics include beneficence, non-maleficence, autonomy, justice, and confidentiality. Throughout history, various codes of conduct have been developed to articulate ethical guidelines for physicians.
1) Health services research uses observational studies and administrative data to evaluate how policies, financing systems, and healthcare delivery impact access, quality, and costs of healthcare.
2) Studies of Medicaid administrative data have provided lessons on improving mental healthcare, finding underuse of effective treatments for schizophrenia and poor but improving quality of care overall.
3) Key findings include evidence that quality of care and racial/ethnic disparities vary significantly between states and within states, and that disparities in effective care like clozapine use are larger for minority groups.
This document provides information about Medicare coverage of home health care services. It outlines who is eligible for home health care benefits, what services are covered including skilled nursing care, physical therapy, occupational therapy and more. It also discusses how Medicare pays for home health care through 60-day episodes of care. The document notes some services that are not covered like 24-hour care, delivered meals or personal care services.
Compliance, concordance and empowerment in patients with type two diabetes me...NiyotiKhilare
This presentation compares the traditional model that focuses on compliance of the patient, with the new model which focuses on empowering the patient. The presentation will also focus elaborately on empowerment as an intervention for improved medical adherence in diabetic patients.
Explore and analyse concordance as a concept and empowerment as a strategic intervention to improve patient outcomes in diabetes.
Key Stakeholders in Public Health Issue.docx4934bk
Key stakeholders in a public health issue include those affected by the issue as well as those who can influence or make decisions related to the issue. It is important to identify stakeholders to understand their interests and perspectives which informs policy analysis. Primary care physicians, specialists, and other healthcare providers have an interest in public health issues that impact patient care. Government agencies also have an interest as they are responsible for funding programs and creating regulations and policies. Identifying stakeholders is crucial for conducting a thorough policy analysis.
Identify and summarize determinants of a public health problemMalikPinckney86
Identify and summarize determinants of a public health problem:
individual/ biological, interpersonal/
Intrapersonal Factors: involve an individual's beliefs, attitudes, and knowledge about a health condition.
Lifestyle Causal Beliefs about Obesity
when categorized as ‘some'/‘a lot', 94% of participants held not exercising causal beliefs, 95% held overeating causal beliefs, 90% held eating certain types of food causal beliefs, 70% held chemicals in food causal beliefs, and 41% held smoking causal beliefs about obesity, compared to the 69% who held genetic causal beliefs about obesity. There were few associations between lifestyle causal beliefs about obesity and any of the sociodemographic or health-related characteristics assessed.
Genetic Causal Beliefs about Obesity-Related Diseases
Overall, 82% of participants held genetic causal beliefs about type 2 diabetes (fig. 2), 79% about heart disease (fig. 3) and 75% about cancer (fig. 4), when categorized as ‘some/a lot.' table 3 shows that there were very few associations with participant sociodemographic or health-related characteristics.(all threse from https://www.karger.com/Article/Fulltext/343793)
This study is based on the Ecological Systems Theory and Family and Community Systems perspectives, which emphasize the need to consider the effects of individual, family, community, and societal factors on health and social outcomes (Bronfenbrenner & Morris, 1988; Campbell, Hesketh, & Davison, 2010; Elder et al., 2007; Fulkerson et al., 2015; Novilla, Barnes, De La Cruz, Williams, & Rogers, 2006; Valente, 2012).
This study contributes to the literature in several ways and emphasizes that peers and families are important sources of influence when it comes to healthy eating and choices of activities in young adolescents. Specifically, adolescents who reported a stronger connection with their family also engaged more frequently in physical activity than adolescents who reported lower familism. The benefits of targeting the family as part of lifestyle interventions are well established (Epstein, Paluch, Roemmich, & Beecher, 2007; Skelton, Buehler, Irby, & Grzywacz, 2012; St Jeor, Perumean-Chaney, Sigman-Grant, Williams, & Foreyt, 2002). The rationale underlying family-centered approaches is that modification of the youth’s environment is necessary to change and maintain children’s healthy habits. As a primary source of socialization, parents not only influence youths’ healthy lifestyle in providing access to resources and in modeling and reinforcing healthy habits, but they also provide the basis for the development of healthy peer relationships. Conceivably, stronger family connections may operate directly on young adolescents’ physical activity, but also indirectly in establishing the foundations for healthy peer relationships, which in turn promote healthier diet and a less sedentary lifestyle.
Furthermore, adolescents who reported higher PSF had a healthier diet and spent less time engagi ...
Behavioral Health Integration PowerPointT L Dunlop
The document discusses behavioral health integration and its benefits. It defines behavioral health integration as the systematic coordination of mental health, substance abuse, and primary care services through a team approach using evidence-based practices. Integrating behavioral health services into primary care settings provides a one-stop shop for patients, benefits patients and providers by improving quality of care, and lowers overall healthcare costs by 20-40%. The document recommends integrating behavioral health practitioners into primary care clinics to assist patients with lifestyle changes, medication compliance, and management of chronic conditions, mental health issues, and substance abuse.
Recovery from Addictions in Healthcare workers - by Ann Sparks (research synt...Ann Hinnen Sparks
This document provides background information for a proposed qualitative study examining the experiences and perceptions of healthcare practitioners in long-term recovery from addiction. The study aims to understand how perceptions of stigma, social support, and spirituality change throughout the recovery process. 18 participants who entered non-punitive recovery programs at least 5 years prior will be interviewed. Modeling and Role Modeling theory guides the study by taking a holistic, client-centered approach. Key concepts of stigma, social support, and spirituality are defined. The proposed method is a phenomenological analysis of interviews to identify themes in practitioners' recovery journeys and how their views have changed over time.
Quantitative/Mixed-Methods
American InterContinental University
March 27, 2018
Running head: QUANTITATIVE/MIXED-METHODS
1
QUANTITATIVE/MIXED-METHODS
2
Quantitative/Mixed-Methods
Abstract
Case studies which are done in the field of medicine work towards improving the health of the population. There are some of the parts contained in case studies which are abstract, results, limitations of results, conclusions, and applications. The common statistical methods used in research are descriptive numerical and qualitative thematic analyses. The results of the studies show that equal participation of individuals in the health sector will help boost public health. Limitations of results are that although some strategies may work towards improving health sector, not all of them are effective.
Public health is an important sector in any country for it directly affects the economy of the nation. There need to be certain ways which should be employed with the aim of supporting and improving public health. In this paper, I am going to examine 4 contemporary peer-reviewed articles which employ quantitative or mixed-methods concerning ways on how to improve the health of the public. The interest of the paper is to aid in achieving the best impact in public health sector via using programs which will improve health outcomes drastically. Enhancement of public health will in return help to improve the well-being of populations across the world. Public health awareness on how to avoid unhealthy lifestyles should be created.
In the articles, samples and populations used were appropriate for it showed the real representative of the population at hand. All the samples used in the 4-contemporary peer-reviewed articles fulfilled the rule of thumb hence making them appropriate. The samples used were suitable for they were used to estimate the population parameters for it stood for the entire inhabitants. The samples used were larger but not too large to consume more resources of money and time. The larger sample has helped to produce accurate results making the samples valid and appropriate. The appropriateness of the samples used in these articles, it has been proved via usage of target variance. In using target variance an estimate to be derived from the model eventually attained.
Each article which has been used includes having results, limitations of results, conclusions, and applications. The first contemporary peer-reviewed article is entitled, Refugee women’s involvements of maternity-care facilities in Canada: a methodical review using a description synthesis written by Gina MA Higginbottom, Myfanwy Morgan, Miranda Alexandre, Yvonne Chiu, Joan Forgeron, Deb Kocay and Rubina Barolia. The article was published 11 February 2015. The results show that there needs to have a healthier understanding of the aspects that produce discrepancies in availability, adequacy, and outcomes during parenthood care (Higginbottom, Morgan, Alexandre, Chiu, Forg ...
The job is just to read each individual peer post that I put there.docxarmitageclaire49
The job is just to read each individual peer post that I put there and respond to them with a response of 3-4 sentences long
Peer #1
For the Research Assignment, I have chosen to focus on an area of Healthcare that rarely gets the
attention it deserves Mental health. I
chose this topic because I am personally effected by it and so are many millions of Americans. Mental illness is also one of the leading causes of
death in our nation and one life is lost as a result of suicide, abuse or incarceration every 17mins in the United States. Mental illness has been my
area of focus throughout this program and the advocacy and participatory philosophy will be useful for the final project because it suggests that “
that research inquiry needs to be intertwined with politics and a political agenda” (Creswell, p.9). I do believe that mental health has a specific
agenda for a study and that there has been constant aim for reform in healthcare and mental health. This social issue is definitely pertinent right
now and topics that address it such as “empowerment, inequality, oppression, domination, suppression, and alienation” (Creswell, p.9), and are
really the focus of the study. The goal of this project for me, is to provide a voice to participants and give them the ability address the concerns that
will lead to reform.
According to Kemmis and Wilkinson (1998) this philosophy offers four key features of the advocacy/participatory framework of inquiry:
1. Participatory actions are focused on bringing about change, and at the end of this type of study, researchers create an action agenda for change.
2. It is focused on freeing individuals from societal constraints, which is why the study begins with an important issue currently in society.
3. It aims to create a political debate so that change will occur.
4. Since advocacy/participatory researchers engage participants as active contributors to the research, it is a collaborative experience.
Research Problem Statement
My Vision is to Provide members of the community with the opportunities and education needed to prevent death due to suicide, acts of self-harm
and the traumatic impact of mental illness. By promoting resilience, the enhancement of community resources, conflict resolution and support for
individuals, families and the communities of those who suffer with mental disorders, illness or have a sudden mental health crisis. The target
population includes all individuals within Chatham County, with unmet mental health needs. These individuals are currently not being served by
traditional methods due to financial, structural, and personal barriers including access and stigma. Untreated mental health issues of these
individuals put them at risk for exacerbation of physical health problems, suicide attempts, premature moves to long-term care se.
This document summarizes a study examining factors that affect access to mental health care. The study focuses on environment (rural vs. urban), socioeconomic status, financial barriers, and awareness of stigma. Literature is reviewed finding rural residents have less access to care than urban residents. Lower socioeconomic status and lack of insurance also reduce access. Stigma and negativity towards mental illness can deter people from seeking treatment. The study aims to determine if these factors influence access to mental health care using GSS survey data from 2006. Hypotheses predict less access to care for rural residents, those with lower socioeconomic status, activity limitations, and awareness of stigma.
Read and respond to each peer initial post with 3-4 sentence long re.docxniraj57
Read and respond to each peer initial post with 3-4 sentence long response
Peer #1
For the Research Assignment, I have chosen to focus on an area of Healthcare that rarely gets the
attention it deserves.
Mental health.
I
chose this topic because I am personally effected by it and so are many millions of Americans. Mental illness is also one of the leading causes of
death in our nation and one life is lost as a result of suicide, abuse or incarceration every 17mins in the United States. Mental illness has been my
area of focus throughout this program and the advocacy and participatory philosophy will be useful for the final project because it suggests that
“
that research inquiry needs to be intertwined with politics and a political agenda” (Creswell, p.9). I do believe that mental health has a specific
agenda for a study and that there has been constant aim for reform in healthcare and mental health. This social issue is definitely pertinent right
now and topics that address it such as “empowerment, inequality, oppression, domination, suppression, and alienation” (Creswell, p.9), and are
really the focus of the study. The goal of this project for me, is to provide a voice to participants and give them the ability address the concerns that
will lead to reform.
According to Kemmis and Wilkinson (1998) this philosophy offers four key features of the advocacy/participatory framework of inquiry:
1. Participatory actions are focused on bringing about change, and at the end of this type of study, researchers create an action agenda for change.
2. It is focused on freeing individuals from societal constraints, which is why the study begins with an important issue currently in society.
3. It aims to create a political debate so that change will occur.
4. Since advocacy/participatory researchers engage participants as active contributors to the research, it is a collaborative experience.
Research Problem Statement
My Vision is to Provide members of the community with the opportunities and education needed to prevent death due to suicide, acts of self-harm
and the traumatic impact of mental illness. By promoting resilience, the enhancement of community resources, conflict resolution and support for
individuals, families and the communities of those who suffer with mental disorders, illness or have a sudden mental health crisis. The target
population includes all individuals within Chatham County, with unmet mental health needs.
These individuals are currently not being served by
traditional methods due to financial, structural, and personal barriers including access and stigma. Untreated mental health
issues of these
individuals put them at risk for exacerbation of physical health problems, suicide attempts, premature moves to long-term care settings, and
psychiatric hospitalization, incarceration, residential alcohol/drug treatment or homelessness. The target population is all individuals within
Chatham County, ...
1
Literature Review Assignment
STUDENT NAME
Class
Date
2
Part A: Annotated Bibliography
Article 1: Immigration as a Social Determinant of Health
Castañeda, H., Holmes, S. M., Madrigal, D. S., Young, M.-E. D., Beyeler, N., & Quesada, J.
(2015). Immigration as a Social Determinant of Health. Annual Review of Public
Health, 36(1), 375–392. doi: 10.1146/annurev-publhealth-032013-182419
Abstract
Although immigration and immigrant populations have become increasingly important foci in
public health research and practice, a social determinants of health approach has seldom been
applied in this area. Global patterns of morbidity and mortality follow inequities rooted in
societal, political, and economic conditions produced and reproduced by social structures,
policies, and institutions. The lack of dialogue between these two profoundly related
phenomena—social determinants of health and immigration—has resulted in missed
opportunities for public health research, practice, and policy work. In this article, we discuss
primary frameworks used in recent public health literature on the health of immigrant
populations, note gaps in this literature, and argue for a broader examination of immigration as
both socially determined and a social determinant of health. We discuss priorities for future
research and policy to understand more fully and respond appropriately to the health of the
populations affected by this global phenomenon.
Annotated Bibliography
The article reports on the importance of identifying social determinants and the effects of
socially determined structures among immigrant populations in the United States. The study
identifies ways in which immigrants health outcomes are based on biases due to using
3
information based on group behaviors instead of on an induvial case. The impact of migrant and
immigrant individuals, physical and mental health in these communities’ changes as social,
economic, and political policies take place. This article is helpful in that broadens the
immigration experience including more central factors than just language, income, or education
as the cause of all health related problems in this community. But to show factors of power
structures and the ability to put in place effective health interventions that respond to direct
causes of poor or declining health in these populations.
Article 2: Fear by Association: Perceptions of Anti-Immigrant Policy and Health Outcomes
Vargas, Edward & Sanchez, Gabriel & Juárez, Melina. (2017). Fear by Association: Perceptions
of Anti-Immigrant Policy and Health Outcomes. Journal of Health Politics, Policy and
Law. 42. 3802940. 10.1215/03616878-3802940.
Abstract
The United States is experiencing a renewed period of immigration and immigrant policy
activity as well as heightened enforcement of such policies. This intensified activity can affect
various aspects of im ...
Multiple Chemical Sensitivities - A Proposed Care Model v2zq
Multiple Chemical Sensitivities - A Proposed Care Model - Resources for Healthy Children www.scribd.com/doc/254613619 - For more information, Please see Organic Edible Schoolyards & Gardening with Children www.scribd.com/doc/254613963 - Gardening with Volcanic Rock Dust www.scribd.com/doc/254613846 - Double Food Production from your School Garden with Organic Tech www.scribd.com/doc/254613765 - Free School Gardening Art Posters www.scribd.com/doc/254613694 - Increase Food Production with Companion Planting in your School Garden www.scribd.com/doc/254609890 - Healthy Foods Dramatically Improves Student Academic Success www.scribd.com/doc/254613619 - City Chickens for your Organic School Garden www.scribd.com/doc/254613553 - Huerto Ecológico, Tecnologías Sostenibles, Agricultura Organica www.scribd.com/doc/254613494 - Simple Square Foot Gardening for Schools - Teacher Guide www.scribd.com/doc/254613410 - Free Organic Gardening Publications www.scribd.com/doc/254609890 ~
Evaluations of and Interventions for Non Adherence to Oral Medications as a P...NiyotiKhilare
The focus of this presentation will be medical non-adherence as a psychosocial issue in diabetes. The presentation will also focus elaborately on empowerment as an intervention amongst other interventions.
Four Strategies for Compassionate, Complete Behavioral HealthcareKarl Michelfelder
This document discusses strategies for improving behavioral healthcare. It advocates for integrating behavioral and physical healthcare to provide more holistic care for patients' overall needs. Barriers between primary and behavioral care need to be bridged to close gaps in patient care. An electronic health record can help providers treat all of a patient's needs by creating a single, integrated care record to improve information sharing between providers.
Ader et al (2015) The Medical Home and Integrated Behavioral Health Advancing...Ben Miller
This document discusses recommendations for advancing the integration of behavioral health and primary care. It recommends:
1. Building demonstration projects to test integrated care approaches and evaluate them using standardized measures.
2. Developing training programs for integrated care teams, which typically include the patient, primary care provider, behavioral health specialist, and care manager.
3. Implementing population-based strategies to improve behavioral health and strengthen relationships between practices and community resources.
Presentation of our curricular integration, Interprofessional approaches and Student Leader Training strategies in the second year of our 3 year SBIRT Training Grant.
Substance abuse has significant negative impacts on mental health. It can lead to the development of mental health conditions like depression and anxiety. People who abuse substances often have co-occurring mental illnesses. Treating both substance abuse and mental health issues simultaneously is challenging and integrated treatment approaches are needed. Substance abuse disorders are also linked to poorer psychosocial functioning and problems with relationships, work, and daily life. Women may be particularly vulnerable as substance abuse can stem from attempts to self-medicate physical or mental health conditions.
This document summarizes a workshop focused on opportunities for collaboration between health care and public health. It discusses four topics: payment reform, the Million Hearts initiative, the relationship between hospitals and public health, and collaboration for asthma care. Case studies on payment reform in Ohio and the Million Hearts initiative in New York are provided. The workshop highlighted the importance of communication and partnership across different levels (e.g. state, community) and sectors (e.g. health care, public health, social services) to improve population health outcomes.
Patients' satisfaction towards doctors treatmentmustafa farooqi
This document provides an introduction, literature review, and proposed framework for a study on patient satisfaction towards doctor treatment at state hospitals in Multan, Pakistan. The study aims to examine if patients are satisfied with the healthcare process, doctor treatment and behavior, and information/communication. The conceptual framework identifies background variables, independent variables related to doctor treatment, and dependent variables of patient satisfaction. The literature review discusses several prior studies that examined factors influencing patient satisfaction like doctor competence, communication, and attitudes. The theoretical framework discusses social identity theory and satisfaction theory in understanding patient attitudes and expectations.
Patients' satisfaction towards doctors treatmentmustafa farooqi
The mood of the care recipient to see if the impression (expectations) of service are met by the patient may be defined as patient satisfaction. The current perspective on service efficiency tends to be that patient treatment meets public standards and requirements in terms of interpersonal support as well as professional assistance. (Hardy et al. 1996).
For various reasons, customer satisfactions in the healthcare industry have been investigated. First it was important to decide on the extent and the degree to which patient care seekers, the meeting of drugs criteria and the continuous use of these services have effect, satisfaction as a quality of service metric, as well as allowing doctors and health services to better appreciate and use the input of the patient. (Ong et al. 2000).
Consumer satisfaction with healthcare services is a multi-panel term that refers to the core facets of treatment and suppliers, while PS medical services with the quality enhancement systems from the patient context, full control of quality and the intended outcomes of services are considered to be of primary importance (Janicijevic et al. 2013).
The Pakistani health system is being changed somewhat and there are wonderful scope for applying standard of services to health care. Patients in Pakistan now have access to increased quality health care. Obviously, the staff and staff are the most important winners of a successful health care environment of every community sector framework (Bakari et al. 2019).
The medical clinic of today's study is the product of a long and complicated war of civilization to quantify produce and study and to give thought to the thoughtful (Fullman et al. 2017).
Behavioral Health Staff in Integrated Care Settings | The Vital Role of Colla...CHC Connecticut
NCA Clinical Workforce Development, Team-Based Care 2019 Webinar Series
Webinar broadcast on: May 06, 2019 | 3 p.m. EST
Experts in psychology, psychiatry and nursing will share ways in which they effectively utilize their roles at the top of their license to monitor and support high-risk patients. By examining these various roles, experts will address how you can effectively support integration at your health center to improve outcomes.
Behavioral Health Staff in Integrated Care Settings | The Vital Role of Colla...
Rollins et al. 2016
1. Full Terms & Conditions of access and use can be found at
http://www.tandfonline.com/action/journalInformation?journalCode=wsmh20
Download by: [Jennifer Wright-Berryman] Date: 15 April 2016, At: 11:18
Social Work in Mental Health
ISSN: 1533-2985 (Print) 1533-2993 (Online) Journal homepage: http://www.tandfonline.com/loi/wsmh20
Managing Physical and Mental Health Conditions:
Consumer Perspectives on Integrated Care
Angela L. Rollins PhD, Jennifer Wright-Berryman PhD, Nancy H. Henry BA,
Alicia M. Quash, Kyle Benbow, Kelsey A. Bonfils MS, Heidi Hedrick MA, Alex P.
Miller BS, Ruthie Firmin MS & Michelle P. Salyers PhD
To cite this article: Angela L. Rollins PhD, Jennifer Wright-Berryman PhD, Nancy H. Henry
BA, Alicia M. Quash, Kyle Benbow, Kelsey A. Bonfils MS, Heidi Hedrick MA, Alex P. Miller BS,
Ruthie Firmin MS & Michelle P. Salyers PhD (2016): Managing Physical and Mental Health
Conditions: Consumer Perspectives on Integrated Care, Social Work in Mental Health, DOI:
10.1080/15332985.2016.1173160
To link to this article: http://dx.doi.org/10.1080/15332985.2016.1173160
Accepted author version posted online: 15
Apr 2016.
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Managing physical and mental health conditions:
Consumer perspectives on integrated care
Angela L. Rollins, PhD
Richard L. Roudebush VAMC Center for Health Information and Communication,
ACT Center of Indiana, Indiana University Purdue University Indianapolis, Psychology
Department, Indianapolis, Indiana, USA
Jennifer Wright-Berryman, PhD
School of Social Work, University of Cincinnati, Cincinnati, Ohio, USA
Nancy H. Henry, B.A., Alicia M. Quash, Kyle Benbow, Kelsey A. Bonfils, M.S., Heidi
Hedrick, M.A., Alex P.Miller, B.S., Ruthie Firmin, M.S., Michelle P. Salyers, Ph.D.
ACT Center of Indiana, Indiana University Purdue University Indianapolis, Psychology
Department, Indianapolis, Indiana, USA
Corresponding address: Jennifer Wright-Berryman, PhD, University of Cincinnati, School of
Social Work, PO Box 210108, French Hall West, 1616, Cincinnati, OH 45221-0108,
wrigh2jb@ucmail.uc.edu
Authors disclose no conflicts of interest related to this research.
All authors wrote or contributed significant editing for the manuscript.
Key words: Severe mental illness, integrated care, mental health services, primary care services
Abstract
Background: Despite the growing trend of integrating primary care and mental health
services, little research has documented how consumers with severe mental illnesses manage
comorbid conditions or view integrated services.
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Objectives: We sought to better understand how consumers perceive and manage both mental
and physical health conditions and their views of integrated services.
Methods: We conducted semi-structured interviews with consumers receiving primary care
services integrated in a community mental health setting.
Results: Consumers described a range of strategies to deal with physical health conditions and
generally viewed mental and physical health conditions as impacting one another. Consumers
viewed integration of primary care and mental health services favorably, specifically its
convenience, friendliness and knowledge of providers, and collaboration between providers.
Conclusions: Although integration was viewed positively, consumers with SMI may need a
myriad of strategies and supports to both initiate and sustain lifestyle changes that address
common physical health problems.
Introduction
People with a severe mental illness (SMI), such as schizophrenia, bipolar disorder, and major
depression, experience shortened lifespans compared to their peers without major mental
illnesses. Recent reviews document that people with SMI die 15-25 years earlier than the general
population, and the trend towards early mortality has accelerated in recent years (Jones et al.,
2004; Morden, Mistler, Weeks, & Bartels, 2009; Saha, Chant, & McGrath, 2007). The causes of
this unfortunate phenomenon are complex. Some research attributes excess mortality to the high
rates of physical comorbidities: 75% of adults with SMI have one or more comorbid physical
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health conditions and 50% have at least two such conditions (Jones et al., 2004; Morden et al.,
2009). Other research suggests risky health behaviors, such as smoking, poor diet, and sedentary
lifestyles, contribute to a wide range of these comorbid conditions, like cardiovascular disease,
diabetes, cancer, and chronic pulmonary illness. Prevalence rates for cardiovascular disease, for
instance, are 22% for people with SMI (Jones et al., 2004), compared to 11.5% for the US
general population adults (Centers for Disease Control and Prevention, 2012). Many of these
factors can be attributed to a metabolic syndrome associated with extended use of atypical
antipsychotic medications. Metabolic syndrome is described as a group of risk factors (such as
weight gain, hypertension and insulin resistance) that occur together to increase the risk for
cardiovascular disease, type II diabetes, and stroke (Deakin et al., 2010). For example, Casey et
al. (2004) reported that people with schizophrenia using antipsychotics such as olanzapine and
clozapine were six times as likely to have insulin resistance compared to the group using
conventional antipsychotics. Although metabolic syndrome has been associated with weight gain
and subsequent insulin resistance, the exact causes of the syndrome are not fully understood (De
Hert, Schreurs, Vancampfort, & Van Winkel, 2009).
The mental health field has focused on the integration of primary care and behavioral health
services as one method of addressing the early mortality and physical comorbidity challenges for
people with SMI. A recent initiative by the Substance Abuse and Mental Health Services
Administration (SAMHSA) of the US Department of Health and Human Services funded 100
demonstration projects for integrated primary care and behavioral health. However, published
data from these demonstrations have not included how consumers experience comorbid mental
and physical health conditions, or the integration of their physical and mental healthcare
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services. The majority of studies in this area focus on the benefits and challenges of providing
mental health services within traditional primary care settings (e.g., (Bailey, 1997; Bindman et
al., 1997; Lester, Tritter, & Sorohan, 2005; Rogers, 2001)). For example, Lester and colleagues
(2005) asked consumers with SMI about their experience of traditional primary care services. In
this study, consumers reported that quick access to primary care services, provider optimism,
continuity of care, and listening skills were more important than specific mental health
knowledge from their primary care provider (Lester et al., 2005). In the same study, primary care
providers reported less comfort with the specialized mental health care needs of persons with
SMI and recognized struggles in communicating with this patient population (Lester et al.,
2005). To our knowledge, there has been only one study focused on consumers’ perspectives of
integrated primary care services within specialty mental health contexts. In this study, consumers
endorsed their preference for consumer providers (over traditional clinician-delivered services)
and hands-on guidance on healthy lifestyle management (Cabassa et al., 2013). We sought to
better understand how consumers experience both mental health and physical health conditions,
how they attempt to manage these conditions, and how they perceive integrated care in the
context of a particular demonstration project focused on integrating primary care services within
a specialty mental health clinic. This information can contribute to the limited but growing
knowledge base on consumer perceptions and experiences of integrated care, and can be used to
create more consumer-centered services.
Methods
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The community and academic partners involved in this study received a SAMHSA integration
grant in 2010 to implement a primary care clinic within a community mental health center
(CMHC) in a Midwestern city. The primary care clinic staff were employed by a federally-
qualified heath care center with whom the CMHC had a long-standing partnership. The primary
care provider (a nurse practitioner) and nurses met weekly with CMHC staff (primarily nurses)
to coordinate care and review clients’ charts. A nurse care manager, employed by the CMHC,
was also assigned full-time to the primary care clinic to serve as another conduit for coordination
of care. At the time of this particular study, the program had enrolled over 300 individuals with
SMI to receive their primary care services within the new clinic.
We conducted semi-structured interviews with 39 consumers who were participating in a larger
study of physical health decision-making autonomy preferences in integrated care settings.
Participants were all diagnosed with a major mental disorder, including schizophrenia (n=19),
major affective disorders (n=16), or other mental health disorders (n=4). Using convenience
sampling, research staff approached consumers and invited them to participate as they arrived for
their primary care appointment at the integrated health clinic. Consumers who agreed to
participate were asked to provide written informed consent and were compensated $20 for their
time. Most interviews took 30 minutes to complete. Of the 47 consumers approached, 39 agreed
to participate in the interview. Interviewers were bachelor’s and master’s level research
assistants who had received training in qualitative interviewing techniques. None of the
interviewers had clinical responsibilities for research participants. Interview questions were
designed to answer 4 key research questions: 1) What health conditions do participants have and
how do they manage them? 2) Are there differences in how consumers manage their physical
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health versus their mental health? 3) What do consumers think about relationship of mental and
physical health? 4) What are consumer perceptions of integrated care? Research protocol probes
then included: What are your thoughts about having your primary care clinic at the mental health
center? What do you like about getting your primary care services at your mental health center?
Is there anything that you would change about it? What condition(s) cause you to seek services
here? How are you managing those conditions? How do you think your mental health and your
physical health affect one another? Are there differences in what you do to take care of your
mental health versus your physical health? All study procedures were reviewed and approved by
the Indiana University Purdue University Indianapolis Institutional Review Board.
Interviews were recorded, transcribed, and coded using a combination of content analysis and an
iterative, consensus-based approach to identify emergent themes (Charmaz, 2006). Pairs of raters
(eight total) divided the transcripts for coding. Two raters read each transcript and independently
extracted quotes that reflected answers to each of the four questions. The two raters then
compared notes and came to consensus on which quotes reflected the particular domains. Then
each team developed a summary for a particular question, reading the quotes across participants
within a domain and linking responses together, looking for similarities and differences across
participant responses. One person took primary responsibility for the summary, and the second
rater re-read the quotes and edited the summary.
Results
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What health conditions do participants have and how do they
manage them?
Participants were asked to indicate if they have any of a list of specific health conditions
(diabetes, hypertension, COPD, heart disease, and cancer) or other health issue(s), and if so,
participants were asked how they manage that condition. Table 1 lists the frequency of
conditions disclosed by participants and methods of managing these conditions. Of the 39
participants interviewed, 37 (94%) reported having at least one chronic physical health condition.
Most (68%) of participants reported having hypertension. Participants reported managing their
hypertension by taking medications as prescribed, getting exercise, and being conscientious of
what they consume. Participant 1009 stated, “I take medicine, so I'm okay every day as long as I
take my medicine… And, I walk a lot. I’ve got a dog, so I walk at least three times a day... And
the apartment I live in has an indoor pool…It's relaxing for me and it kind of relieves stress for
me”. Participant 1009 also addressed the importance of a healthy diet saying, “I do eat fruits. I
just need to work on the vegetables….and cut back on my [soft drinks]”.
Chronic obstructive pulmonary disease (COPD) was the second most prevalent health condition
reported amongst our participants (28%). Several others also mentioned difficulty breathing at
times. Using oxygen, inhalers or nebulizers, and/or quitting smoking were the most commonly
reported strategies for managing this condition. Participant 3001 reported that attending support
groups along with using the nicotine patch helped to reduce smoking: “I'm trying real hard to
quit smoking and that'll help it a lot…I do pretty well. I tried several methods to quit smoking.
The patch works real well for me, and nicotine gum works well for me and I, over the past year,
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I've probably not smoked more than I smoke [now], which does affect COPD a lot. [It would
help] to have the smoking cessation class come back. There was, like, a get together group for
people to support each [sic] and not smoke.” While it is ideal to stop smoking, several continued
to struggle with cessation, as participant 1011 shared: "It managed me... I smoked for 40 years. I
didn't manage it for 40 years."
Diabetes was another commonly endorsed condition (16%). Monitoring blood sugar, taking
insulin, and being cautious about eating habits are a few ways participants reported dealing with
this physical health condition. Participant 2002 stated, “I test my blood at least once a day. I take
my insulin shots. I changed my diet once I knew I was diabetic. I cut out a lot of sugar and
sodium.”
Three participants reported having heart disease while four more reported a heart condition
including irregular heart rate and heart valve issues. These individuals reported managing heart
disease or related conditions in a variety of ways such as: taking medication, exercising, quitting
smoking, and having a healthy diet. Participant 2003 also discussed getting support to lose
weight and eat healthy, saying, “I've had people inspire me to do that, and it's given me that little
bit of a push, [more] than I had before where I just had to make up my own mind. It's kind of
hard to do that. And if you have somebody kind of give you a little bit more inspiration and [sic]
willing to do it with you or give you that 'go for it' kind of attitude…That's what makes me
motivated to make it better.”
While some participants are succeeding in managing their particular health condition, there is
still room for improvement in obtaining resources and learning how to properly manage these
problems. As seen in Table 1, although many reported taking prescribed medication, getting
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adequate exercise, and constructing healthy eating habits to maintain good health, others were
still struggling to manage their conditions. For example, several participants (n=7) reported
relying on medication alone. However, the majority of participants (n=26) used two or more
methods to manage their health, with diet and exercise being the most frequently reported
behavioral strategies.
Are there differences in how consumers manage their physical
health versus their mental health?
Yes, there are differences. Of the 39 people who participated in the interviews, 21 people (54%)
responded that they do, in fact, approach the management of their physical health and mental
health differently. For some, there appeared to be different levels of perceived control. For
example, Participant 1007 indicated that she had more control over mental than physical health,
without mention of medication as an intervention. “I try to coax myself out of a mental slump if
I’m in one. A physical slump—not—I can call a doctor or do something about it, but basically
I’m not too much in control of that. But, mentally, I try to work on it and, and get in a better
state of mind.” Similarly, Participant 1008 shared:
With mental health, I try, I sit and study, thinking about things that might help…do self-help
things, and sometimes it does help for the time being. As far as my physical health, I mean I do
the best I can. When my foot – I got this gout – and when my foot hurts I stay off of it. Like,
I've been in bed for about five days here.
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Conversely, one participant (Participant 1021) offered an alternate perspective, believing he had
more control over physical health through exercise and weight loss, for example. When asked
about mental health management strategies, however, he simply replied, “I pray” without much
additional elaboration.
In addition to the theme of control, some participants explicitly described different management
strategies for mental vs. physical health. For example, Participant 1020 seemed to equate mental
health management strictly with pharmacologic intervention, but thought physical health could
be managed with general wellness strategies. “Mental is medication…Physical, I eat more
properly and exercise and stuff like that.” Another participant (1017) reported that she takes
preventative measures for physical health and relies on social support for her mental well-being.
“Well, my physical health—I just need to make sure that I drink plenty of water because when I
went into [health center] the first time I was dehydrated.” She added in reference to her mental
health, “I’m down here [the CMHC] and I have my brother and sister-in-law to check up on me.”
Participant 2005 also differentiated helpful activities for mental vs. physical health, stating “I
read a lot, which keeps your mind occupied...Well, cooking relaxes me mentally; but physically,
it ain't going to do a dang thing.”
It should be noted that three participants initially answered “No” when asked if there were
differences in the management of their mental and physical health needs, but went on in their
interviews to describe distinctly different ways in which they manage each area. As such, these
three responses were considered to manage their physical and mental health differently.
There are no differences. Twelve participants (31%) reported no appreciable differences in how
they managed mental vs. physical health problems. Of those 12 people, half of them specifically
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mentioned medication (either alone or along with other strategies) as an intervention they use to
manage both physical and mental health issues. For example, when asked if there was a
difference, P1014 said, “No. They both— pretty much I just take the pills.” P1029 elaborated a
little more, “Well, I take medicine for both of them. So, I try to relax. I can’t think, I try to just
rest and try to relax. That’s basically what I do for both of them, even if they’re independent or
separate.” Some participants had multiple strategies for both conditions. For example, P1002
reported, “See the doctor on a regular visit, take my medicine, exercise, music and go to movies,
entertain, have friends.” Interestingly, this same participant also reported that he partakes in
boxing as a health management technique. When queried about whether boxing was for mental
or physical health, he indicated that this activity was effective in managing both areas: “Yeah,
because you get your aggression out, too.”
What do consumers think about the relationship between mental
and physical health?
While one person indicated he found no relationship between mental and physical health and
others provided responses indicated uncertainty, 32 participants (82%) reported that they believe
there is some relationship between the two areas of health. Multiple themes emerged in this area
and are discussed below.
Mental health affects physical health. Thirteen participants (33%) indicated that their mental
health has an effect on their physical health. For example, Participant 1023 simply stated: “if
you’re depressed, you’re probably not going to feel good.” Several clients reported that a decline
in their mental health often resulted in lethargy. “Sometimes with my mental health,” said
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Participant 1014, “I want to sit and sleep.” Participant 1026 made a similar observation stating
that feeling “lonely” leads to inactivity: “I get lazy, and I don’t want to do nothing.” Participant
3000 had similar feelings about the link between depression and activity level: “You’ll be
depressed and don’t want to get out of bed.”
Only one participant (2001) discussed a link between the use of psychotropic medication and
physical health side effects from those medications. “I take [medication] and it makes me a little
dizzy and stuff.” When further queried by the researcher, this participant added: “Like, you
could be tired too much. You could be dizzy…. you could get a stomachache. Your muscles
could tense up.”
Physical health affects mental health. Of the 39 participants, 10 people (26%) endorsed the
belief that physical health has a unidirectional, mostly negative, effect on mental health. As
Participant 1007 stated, “… mostly if I don’t feel physically well, sometimes it could drag me
down.” Another participant had a similar response, stating “whenever I’m physically ill or
having symptoms more than usual, it affects my depression and my anxiety.” (P1019).
A few participants cited physical injuries or conditions as triggers for mental health problems.
For instance, Participant 1024 reported that a back injury necessitated a job change, which
negatively impacted his income and thereby his mood: “my income was way lower than what I
was used to making. That was a big reason why I think depression kind of set in.” Similarly,
Participant 1025 reported that a knee injury limited physical activity, which contributed to the
onset of depressive symptoms: “And I know that the fact that I’m less physically active is a
concern for me and leads to depression.” Participant 1017 noted specifically that menstruation
took a toll on her mentally: “I was crying at the drop of a hat.”
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One participant expressed a more positive outlook, that taking preventative measures for
physical health such as exercise and proper diet can positively influence mental health as well.
“Yeah, it does affect the mental health also,” said Participant 3001. “It strengthens your ability
to, um, feel better.”
Mental health and physical health affect each other.. Nine participants (23%) reported the
effects of each health dimension reciprocally influence the other. As Participant 1003 said, “If
one is bad, the other one’s bad.” Participant 1002 concurred: “If, you know, one’s out of whack,
it’s going to cause the other to be.” Participant 3003 spoke eloquently on this issue:
Well, if your mental is not working right, your physical's not going to be right. They work
together. You know, you've got to have one to have the other. But, mental affects your physical
as well as the physical affects the mental, so you got to have them working together. That's why
it's so important, like I said, you got to be able to exercise and sleep, and that way your physical
is working for the mental. You know, so it all goes together.
What are consumer perceptions of integrated care?
Convenience. The most common response when asked about the positives of integrated care was
convenience. Many participants liked that they could make only one trip for all their physical and
mental health needs. Participant 1015 stated, "I like that it's easier to interact with both doctors."
Another key point included location and travel, with many citing how close the clinic was from
where they were living. Many people also stated the convenience of not having multiple
appointments at multiple locations. Participant 1030 highlighted this saying, “you don't have to
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worry about having to rush from place to place and missing appointments or being late, so I think
that's really cool.”
Friendly and knowledgeable staff. The on-site staff members were also frequently cited as
positive aspects of integrated care. Many referred to staff as “really, really nice,” “friendly,” and
“personable.” Staff (including the front office workers, nurses, and doctors) also helped
participants feel comfortable. Participant 1003 spoke to this point saying, “I appreciate [staff
names] and I get along with them. I trust them and I just enjoy coming here.” Similarly
Participant 1009 said, “I like it here. I mean they treat me good…I don’t have to wait long. And,
if I do, they, they come and let me know. And, they take care of me. I like my doctor and I like
my therapist. ... I like the people here, everybody here.” Participant 1013 said “[Staff name]
always has something funny to say to lighten people up… The doctor is nice as well as his
nursing staff. Everybody's nice. They respect me, that kind of thing.”
In addition to being personable, staff were considered knowledgeable. For example, Participant
1016 stated, "I really like my doctor. I really think he knows his stuff. I like, too, that they're
really also concerned about you psychologically. I like how it is holistic…” Similarly,
Participant 1022 spoke about this knowledge saying, “if I have a question they'll answer it...I
haven't gotten an ‘I don’t know’.”
The overall environment of the setting was also considered a positive aspect of integrated care.
Participant 4010 praised the staff for making the environment more comfortable than his
previous experiences: “The feeling that it doesn't feel like a mental health center. It doesn't feel
like I'm in an institution. I know there are people here with more severe situations than myself,
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but I think it feels very right at home.” The highest praise came from participant 1011 who said
the staff was professional, well-managed, and welcoming every time they visited:
They’ve been very accommodating here...I can tell you those persons along with the persons that
work behind the counter out here make you feel mighty welcome when you come here...And,
they're so good about keeping appointments, calling you a day ahead of time, uh, you know, it's
just well managed here. And, the people are professional...It's – I mean, they're very
professional. I've come to rely on them...I think highly of everyone here. I just really do.
Shared information and communication. Many consumers appreciated that mental and physical
health doctors could easily communicate and collaborate. Participant 1025 spoke to this point,
saying, "I think it's a good idea because then they can relate my physical symptoms to my mental
treatment and they're there to know if it ties”. Participant 1027 was more specific in explaining
how the coordination between doctors can ensure that they are taking the correct medication:
“Because I'm not getting medicine from this doctor and that doctor and then having to confer.
They know exactly what I'm taking, when I'm taking it, and how it's supposed to be taken." One
participant (1028) had a very detailed response, highlighting how the coordination and
communication specifically helped her:
I think it's a wonderful thing because not only can they communicate with each other, they can
communicate with me…One time when I was having a test and it came out positive, my therapist
that I was talking to went to see the doctor and [could coordinate when to see her]. When they're
all working together, there's not such a big assumption that, ‘oh, it's all in her head’.... So, if
we're all communicating, we kind of can try to stay on the same page at least...And, also, if I do
get some of the diagnosis [and] I don't know exactly how to react, or if they worry me, then I can
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talk to my therapist [there] and say, you know, “I feel a little worried,” that kind of thing. And,
and, I don't have to sign a release for another place. I've already signed all that. And, it's all
coordinated. I like it.
Needed improvements. When asked about improvements to integrated care, 31 participants
(79%) responded that they would not recommend any changes. Those who thought
improvements were needed pointed to a few minor changes. Two participants spoke about
missing equipment that was necessary for their treatment, including an X-ray machine and
materials needed for blood testing. Another consumer wanted more prompt return on phone
calls, while two participants mentioned that having more doctors would help their treatment. For
example, Participant 2003 suggested, “There should be more, maybe more doctors or
psychiatrists and stuff like that, to be available to maybe even give you a choice of your own, to
pick out somebody. Maybe more counselors besides psychiatrists or doctors [for] maybe some
kind of access for different information.”
Discussion
Consumers of this integrated health clinic had numerous and varied physical health
conditions. Although they cited many different strategies to manage physical health conditions,
the most commonly endorsed health management strategy was medication. For those who did
identify a desire to make important behavioral modifications for physical health conditions (e.g.,
smoking cessation, increasing exercise, eating healthier diets), they reported struggling with
these lifestyle changes. Some consumers indicated a need for multiple strategies (i.e., nicotine
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patches, gum, and smoking cessation support classes) as well as needing extra “inspiration” to
make tough changes. Consumers with SMI may need a combination of strategies and supports to
initiate and sustain lifestyle changes that address common physical health problems, in addition
to medications. These notions are consistent with literature indicating the need for multi-
pronged, sustained approaches targeted toward consumers with SMI, above and beyond
interventions targeting the general population, to address smoking cessation (Cook et al., 2014;
Evins et al., 2014; Schroeder & Morris, 2010) and weight reduction (S. Bartels & Desilets, 2012;
Daumit et al., 2013).
Consumers’ perceptions of relationships between mental and physical health
overwhelmingly indicated they feel a link between the two, whether one-directional or mutually
influencing one another. Contrasting these findings were distinctions between how consumers
reported managing their physical and mental health conditions. While some participants
perceived less control over physical health conditions than mental health conditions, others
described managing both conditions using medications or other strategies. The emphasis on
medications was noteworthy in that, as a field, we may need to do more to activate consumers to
take steps to manage physical and mental symptoms with behavioral lifestyle choices. Though
medications may be underutilized for some conditions, such as nicotine replacement and
smoking cessation medications for people with SMI who smoke (Schroeder & Morris, 2010),
there seems to be a tendency to rely solely on medications for at least a subsample of the SMI
population.
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When asked about their perceptions of integrated care, most participants endorsed the
convenience of co-located healthcare services, as well as more general characteristics of being
served by knowledgeable, friendly staff who are concerned with their whole health, rather than
just mental or physical health. Consumers also were pleased with the level of collaboration and
communication between providers overseeing primary care and mental health needs.
Respondents even alluded that primary care services in isolation of mental health integration feel
more stigmatizing (“oh, it’s all in her head”). Participants highlighted how colocation facilitates
collaboration: the ease of communication when a mental health provider can simply walk down
the hall to communicate something important to primary care providers. This finding is
consistent with past research indicating better treatment engagement in co-located services (S. J.
Bartels et al., 2004) and the use of warm hand-offs often seen in well executed collaborative care
models. Participants generated few recommendations for improvement, other than the need to
broaden the array of services and procedures available at the integrated clinic (e.g., X-rays, wider
range of blood work). This particular program is relatively small in scale, compared to some
larger mental health programs. Larger programs may be able to justify the addition of these sorts
of equipment or available procedures. Likewise, the relatively small caseloads of consumers in
integrated care programs embedded in community mental health centers make it difficult to
justify the employment of multiple primary care providers that would allow consumers a choice
in which doctor provides their care.
Conclusion
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Overall, responses from consumers indicated a favorable view of the integration of primary care
services within a specialty mental health clinic, indicating some distinct advantages from the
consumers’ perspectives on this integration approach. There are notable implications for
practice. First, persons with SMI attending an integrated clinic may need practitioners to weigh
a variety of physical health management options. Secondly, the use of medication should be
emphasized in tandem with other behavioral and supportive techniques for healing and wellness.
Lastly, practitioners should continue to facilitate the collaboration between integrated primary
and behavioral healthcare, through communication and team planning, keeping the consumer at
the helm of the team.
Acknowledgements:
This study was supported by the following grants: National Institute of Mental Health (R24
MH074670; PI: Salyers), and Substance Abuse and Mental Health Services Administration
(5H79SM059751; PD: McKasson). The content is solely the responsibility of the authors and
does not necessarily represent the official views of the National Institutes of Health.
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Table 1. Common physical health conditions and management approaches
Physical Health Condition
# reporting
condition
Hypertension 25
Chronic Obstructive Pulmonary Disease 11
Heart Condition/Heart Disease (other than hypertension) 7
Diabetes 6
Thyroid conditions (e.g., hyperthyroid or hypothyroid) 5
Arthritis and other joint pain 5
Asthma 3
Epilepsy/seizures 3
Cancer 2
Gout 2
Back pain 2
Acid reflux 2
Hyperlipidemia 2
Other (e.g., HIV, brain tumor, Alzheimer’s disease,
dysmenorrhea) 11
Ways to manage health conditions
Medication 26
Other prescribed intervention (ex: Using Oxygen, Surgery) 5
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Frequent Monitoring of condition (ex: testing blood sugar) 5
Diet or healthy eating 17
Exercise 12
Smoking Cessation 7
Relaxation or stress reduction 6
Avoid triggers 2
Get support 2
Number of strategies used (N=37)
Reported 0 2
Reported 1 12
Reported 2 9
Reported 3 8
Reported more than 3 6
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