Biomedical subjects

Craig S Rosen

Publications and source records attributed to Craig S Rosen.

10 recordsLinked to original sources

PubMed2006

Telephone monitoring and support for veterans with chronic posttraumatic stress disorder: a pilot study.

Dropout from outpatient mental health treatment may contribute to high rates of relapse and rehospitalization among veterans with chronic posttraumatic stress disorder (PTSD). In a quasi-experimental cohort study, 87 male and 17 female veterans discharging from residential PTSD treatment received either standard referral to outpatient care (N = 77) or standard referrals supplemented by biweekly telephone calls (N = 27). Telephone monitoring and support was feasible and acceptable to 85% of clients. Compared to prior patient cohorts, clients receiving telephone support were twice as likely (88% vs. 43%) to complete an outpatient visit within 1 month of discharge and reported higher satisfaction with care.

Adult↗

PubMed2005

Reliability and acceptability of automated telephone surveys among Spanish- and English-speaking mental health services recipients.

Interactive Voice Response (IVR), an automated system that administers surveys over the phone, is a potentially important technology for mental health services research. Although a number of studies have compared IVR to live interviews, few have looked at IVR in comparison to pencil-and-paper survey administration. Further, few studies have included subjects from those populations most likely to benefit from IVR technology, namely patients with lower education levels and non-English-speaking patients. This randomized clinical study, conducted at a community health center serving low-income English- and Spanish-speaking populations, assessed the reliability of an IVR-administered Brief Symptom Inventory (BSI) relative to a paper-and-pencil version. The study was adequately powered. Results showed that patients gave similar responses to the IVR and paper-and-pencil surveys; in addition, patients were generally equally satisfied with both experiences. We conclude that, while more large-scale research is needed, IVR can be a useful survey administration tool.

Automation↗

PubMed2005

A survey of PTSD screening and referral practices in VA addiction treatment programs.

Veterans with posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) demonstrate worse outcomes following treatment for SUDs than do veterans with SUDs only, and so PTSD treatment may enhance SUD outcomes for patients. A survey of current practice patterns in VA SUD treatment programs was undertaken to determine their concurrence with emerging practice guidelines for the assessment and treatment of SUD-PTSD comorbidity. Clinicians in outpatient SUD clinics and/or inpatient SUD programs were surveyed in six VA medical centers in 1999 and 2001 (respondents n = 57 and n = 39, respectively). Although one half to two thirds of clinicians working with SUD patients routinely screen for trauma exposure and PTSD, few assessments are systematically conducted using validated measures. Routine referrals to PTSD specialty and dual-diagnosis programs and to veterans' centers are made by between 35% and 60% of providers across inpatient and outpatient settings. Implications for improvement of clinical outcomes are discussed.

Humans↗

PubMed2005

Conversion and validation of the Teen-Addiction Severity Index (T-ASI) for Internet and automated-telephone self-report administration.

This study converted the Teen-Addiction Severity Index (T-ASI) into self-report formats using Internet (Net) and interactive voice response (IVR) automated-telephone technologies. Reliability and convergent validity were assessed among 95 inpatient adolescent participants. Current functioning scores obtained by clinician interview correlated well with self-report Net (mean r=.74, SD=.14) and IVR (mean r=.72, SD=.16). Lifetime history items obtained by clinicians were consistent with self-report Net (mean r=.60, SD=.32; mean kappa=.67, SD=.24) and IVR formats (mean r=.60, SD=.30; mean kappa=.64, SD=.26). Participants rated "ease of use" as being high for both Net and IVR formats. These findings suggest that automated T-ASI administration is a valid and potentially less expensive alternative to clinician-administered T-ASI interviews.

Adolescent↗

PubMed2004

Validation of the Addiction Severity Index (ASI) for internet and automated telephone self-report administration.

This study assesses the convergent validity of Internet (Net) and interactive voice response (IVR) automated telephone self-report versions of the Addiction Severity Index (ASI) relative to the established, clinician-administered (CA) ASI. Eighty-eight subjects were recruited from an addiction treatment program to complete three ASI assessments. The mean correlation between composite scores obtained by Net and IVR and those obtained via clinician interview was.91 (range.81-.95). For History items, the mean correlation was.77 (range.14-1.00) and the mean kappa coefficient was.75 (range.46-1.00). The results demonstrated the validity of these self-report Net and IVR versions of the ASI. Self-report Net and IVR were rated as "very satisfactory" or "extremely satisfactory" by a majority of respondents for ease of use. Automation can reduce the labor costs associated with ASI administration and may facilitate longitudinal tracking of subjects from home.

Adult↗

PubMed2004

VA practice patterns and practice guidelines for treating posttraumatic stress disorder.

Little is known about how recent ISTSS practice guidelines (E. B. Foa, T. M. Keane, & M. J. Friedman, 2000) compare with prevailing PTSD treatment practices for veterans. Prior to guideline dissemination, clinicians in 6 VA medical centers were surveyed in 1999 (n = 321) and in 2001 (n = 271) regarding their use of various assessment and treatment procedures. Practices most consistent with guideline recommendations included psychoeducation, coping skills training, attention to trust issues, depression and substance use screening, and prescribing of SSRIs, anticonvulsants, and trazodone. PTSD and trauma assessment, anger management, and sleep hygiene practices were provided less consistently. Exposure therapy was rarely used. Additional research is needed on training, clinical resources, and organizational factors that may influence VA implementation of guideline recommendations.

Depression↗

PubMed2003

Causes of death among male veterans who received residential treatment for PTSD.

Previous studies have shown elevated mortality among psychiatric and substance abusing patients, including veterans with PTSD. Although early studies showed elevated deaths from external causes among Vietnam veterans in the early postwar years, more recent studies have also shown increased health problems among veterans with PTSD. This study compared mortality due to behavioral causes versus other diseases among 1,866 male veterans treated for PTSD. Death certificates obtained for 110 veterans indicated behavioral causes accounted for 62.4% of deaths, standardized mortality ratio = 3.4-5.5, including accidents (29.4%), chronic substance abuse (14.7%), and intentional death by suicide, homicide, or police (13.8%). Results suggest possible opportunities to improve outcomes of this at-risk patient population through harm reduction interventions and improved continuity of care.

Adult↗

PubMed2002

Physical and sexual abuse history and addiction treatment outcomes.

OBJECTIVE: Prior research on patients with substance use disorders has shown that lifetime physical or sexual abuse is associated with more impaired functioning at treatment intake. The present study sought to determine whether physical or sexual abuse also predicted treatment response (posttreatment outcomes) of individuals with substance use disorders. METHOD: Male (n = 19,989) and female (n = 622) veterans with substance use disorders were assessed with the Addiction Severity Index (ASI) early in treatment and reassessed an average of 12 months later. Treatment outcomes were compared for patients who did and did not report prior physical or sexual abuse in the initial ASI interview. RESULTS: Lifetime physical or sexual abuse predicted worse outcomes in six of seven domains of functioning, after controlling for baseline functioning, psychiatric diagnoses and demographic variables. Although women were more likely than men to report being abused, the effect of abuse on treatment outcomes was similar for both genders. Psychiatric problems at baseline mediated the effect of abuse history on outcomes. Abuse history moderated the effect of treatment intensity (contacts per month) on outcomes: More frequent treatment contacts were more beneficial for abused patients than for nonabused patients. CONCLUSIONS: Individuals with substance use disorders who have a history of physical or sexual abuse may have higher risk for problematic treatment outcomes as a result of greater psychiatric problems, deficits in social support and possible difficulties in establishing treatment alliance. Clinicians may consider increasing the duration and intensity of treatment to temper the negative effects of abuse on later functioning.

Domestic Violence↗

PubMedDate not supplied

Disparities in diabetes care: impact of mental illness.

BACKGROUND: Emerging evidence indicates that patients with mental health conditions (MHCs) may receive less intensive medical care. Diabetes serves as a useful condition in which to test for MHC-related disparities in care. We examined whether quality measures for diabetes care are worse for patients with or without MHCs. METHODS: This national, cross-sectional study included 313 586 noninstitutionalized Veterans Health Administration patients with diabetes (identified from diagnostic codes and prescriptions) whose Veterans Health Administration facility transmitted laboratory data to a central database; 76 799 (25%) had MHCs (based on diagnostic codes for depressed mood, anxiety, psychosis, manic symptoms, substance use disorders, personality disorders, and other categories). National data from Veterans Health Administration records, Medicare claims, and a national survey were linked to characterize 1999 diabetes care. RESULTS: Failure to meet diabetes performance measures was more common in patients with MHCs: unadjusted odds ratio (95% confidence interval) was 1.24 (1.22-1.27) for no hemoglobin A(1c) testing, 1.25 (1.23-1.28) for no low-density lipoprotein cholesterol testing, 1.05 (1.03-1.07) for no eye examination, 1.32 (1.30-1.35) for poor glycemic control, and 1.17 (1.15-1.20) for poor lipemic control. Disparities persisted after case mix adjustment and were more pronounced with specific MHCs (psychotic, manic, substance use, and personality disorders). The percentage not meeting diabetes care standards increased with increasing number of MHCs. CONCLUSION: Patients with mental illness merit special attention in national diabetes quality improvement efforts.

Age Factors↗

PubMedDate not supplied

How well are clinicians following dementia practice guidelines?

Although there are numerous clinical guidelines regarding the management of dementia, there have been few studies on their implementation in practice. Clinicians in six United States Department of Veterans Affairs medical centers (n = 200, 85% response rate) were surveyed regarding their use of practices recommended in the California Workgroup Guidelines for Alzheimer's Disease Management. The majority of providers (89% to 73%) reported that they routinely conducted neurological examinations, obtained histories from caregivers, discussed the diagnosis with the patient's family, discussed durable power of attorney, and made legally-required reports of drivers with dementia. Roughly two-thirds of providers said they routinely conducted cognitive screening examinations, screened for depression, reported elder abuse, and discussed care needs and decision-making issues with patients' families. Only half of all outpatient providers implemented caregiver support practices for at least half of their patients. Clinicians' choices of medications for cognition, mood, and behavior problems were broadly consistent with current practice guidelines. These results suggest possible priorities for quality improvement efforts. Further research is needed to clarify reasons for particular gaps between guidelines and practice and to identify specific targets for intervention.

Advance Directives↗