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Biomedical subjects

Elizabeth Lin

Publications and source records attributed to Elizabeth Lin.

At least 19 recordsLinked to original sources
PubMed2007

Impact of a managed-Medicare physical activity benefit on health care utilization and costs in older adults with diabetes.

OBJECTIVE: The purpose of this article was to determine the effects of a managed-Medicare physical activity benefit on health care utilization and costs among older adults with diabetes. RESEARCH DESIGN AND METHODS: This retrospective cohort study used administrative and claims data for 527 patients from a diabetes registry of a staff model HMO. Participants (n = 163) were enrolled in the HMO for at least 1 year before joining the Enhanced Fitness Program (EFP), a community-based physical activity program for which the HMO pays for each EFP class attended. Control subjects were matched to participants according to the index date of EFP enrollment (n = 364). Multivariate regression models were used to determine 12-month postindex differences in health care use and costs between participants and control subjects while adjusting for age, sex, chronic disease burden, EFP attendance, prevention score, heart registry, and respective baseline use and costs. RESULTS: Participants and control subjects were similar at baseline with respect to age (75 +/- 5.5 years), A1C levels (7.4 +/- 1.4%), chronic disease burden, prevention score, and health care use and costs. After exposure to the program, there was a trend toward lower hospital admissions in EFP participants compared with control subjects (13.5 vs. 20.9%, P = 0.08), whereas total health care costs were not different (P = 0.39). EFP participants who attended > or = 1 exercise session/week on average had approximately 41% less total health care costs compared with those attending <1 session/week (P = 0.03) and with control subjects (P = 0.02). CONCLUSIONS: Although elective participation in a community-based physical activity benefit at any level was not associated with lower inpatient or total health care costs, greater participation in the program may lower health care costs. These findings warrant additional investigations to determine whether policies to offer and promote a community-based physical activity benefit in older adults with diabetes can reduce health care costs.

Aged↗
PubMed2006

Depression and activity limitations: examining gender differences in the general population.

BACKGROUND: This study examines the relationship between major depression, subclinical depressive symptomatology and activity limitation in a representative sample of Canadian men and women, with a particular emphasis on examining gender differences. METHODS: Over a 4-year period, the three waves of data were collected from a representative sample of Canadian adults aged 18-60 beginning in 1994. A brief diagnostic interview for major depression, current limitations in home, work, and other activities (e.g., leisure), presence of each of 13 chronic medical conditions, and other sociodemographic information were gathered. Regression analyses adjusted for potential confounding of time-dependent and time-invariant covariates. These analyses were performed separately for men and women. RESULTS: Major depression had a significant adverse impact on all types of activities for the entire community sample, and this impact was generally robust when controlling for potential confounders. Gender differences were observed for leisure activities with depressed men showing a higher likelihood of limitation in these activities than depressed women. CONCLUSIONS: The findings provide further evidence that major depression leads to impairments in a range of daily activities. Gender differences in the impact of depression on leisure activities may be important to consider in depression treatment.

Adolescent↗
PubMed2006

Inequity in mental health care under Canadian universal health coverage.

OBJECTIVE: Previous research has produced conflicting evidence about socioeconomic disparities in mental health care under universal health coverage in Canada. This study sought to determine equity in the delivery of ambulatory services from psychiatrists and family physicians for mental health problems in this setting. METHODS: Outpatient billing claims and neighborhood socioeconomic status were examined with cross-sectional analysis. The study area consisted of the central southern portion of the city of Toronto, Ontario, including the city's downtown core. This urban setting is an economically and culturally diverse area. A total of 1,221 homogeneous enumeration areas (local neighborhoods) were surveyed, and data were examined for the 746,141 residents of these areas who had had a health visit in 2000. Rates of mental health visits to family physicians and psychiatrists were compared across socioeconomic quintiles. Socioeconomic status was determined according to educational attainment in the enumeration area. RESULTS: Claimants from neighborhoods with the highest socioeconomic status were 1.6 times as likely as those from neighborhoods with the lowest socioeconomic status to use psychiatric care. Among persons who received care from a psychiatrist, claimants from neighborhoods with the highest socioeconomic status had significantly more psychiatric claims than those from neighborhoods with the lowest socioeconomic status. No significant gradients were found for either sex for any use of mental health care provided by family physicians. Among females, service users from the highest socioeconomic areas had more mental health visits to family physicians than those from the lowest socioeconomic areas. CONCLUSIONS: Marked socioeconomic disparities were found in the use of care from a psychiatrist. Unlimited coverage of physician-provided mental health care is insufficient to fairly distribute services to those most in need.

Adult↗
PubMed2005

Clinical and functional outcomes of depression treatment in patients with and without chronic medical illness.

BACKGROUND: In patients with chronic medical conditions, depression can be viewed as an expected reaction to illness or an independent condition requiring active treatment. We examine how clinical and functional outcomes of depression treatment compare in primary-care patients with and without chronic medical illness. METHOD: Health plan administrative data were used to identify primary-care patients initiating antidepressant treatment, including a general sample (n=204) and cohorts with ischemic heart disease (n=68), diabetes (n=93), or obstructive lung disease (n=74). Telephone interviews at baseline, 2 months, and 6 months assessed depression (Structured Clinical Interview for DSM-IV, Hopkins Symptom Checklist depression scale), functional status (SF-36) and days of disability because of to illness. RESULTS: At baseline, depression severity in patients with diabetes and obstructive lung disease was similar to those without medical co-morbidity, but significantly lower in those with ischemic heart disease. Social and emotional functioning were similar across all groups, but those with chronic medical illness reported greater physical impairment. All groups showed significant improvement in depression over six months, but the rate of improvement was significantly slower in those with heart disease. All groups showed significant and similar improvement in social and emotional functioning, but physical functioning showed little change. Days of disability and restricted activity improved significantly in all groups. Improvement in depression during treatment was strongly related to change in disability. CONCLUSIONS: Patients with chronic medical illness and co-morbid depression show significant improvements in mood, social and emotional functioning, and disability following initiation of depression treatment. Depression may be a stronger determinant of disability than is stable chronic medical illness.

Adult↗
PubMed2005

Measuring the effect of a large reduction in welfare payments on mental health service use in welfare-dependent neighborhoods.

BACKGROUND: Major social policy changes were implemented in Canada in the last decade with few efforts to examine their potential health effects. OBJECTIVES: We sought to determine the impact of a large reduction in welfare benefits on use of ambulatory physician mental health services in areas with high levels of welfare dependency relative to areas with low levels of welfare dependency. METHODS: The setting was Toronto, Canada. Data sources included census, provincial health insurance, and municipal welfare data. We used generalized estimating equations to compare ambulatory mental health service rates by neighborhood level of welfare dependency before and after a 21.6% reduction in welfare payments. RESULTS: There were no long-term relative differences by welfare dependency in mental health service use before compared with after the policy change. There was a very small short-term increase in mental health visits to generalists in the 6 months after the policy change. We demonstrated a marked gradient in psychiatric service use with low welfare dependency areas having significantly higher rates of use than high welfare dependency areas. CONCLUSIONS: We demonstrated a mismatch between known levels of need for care and levels of psychiatric use. We conclude that where use of services is not tightly linked to need for services, utilization data may be unsuitable for evaluating programs or policies. Social policy changes with potential health effects should have integrated evaluations planned at the time of policy implementation.

Community Mental Health Services↗
PubMed2004

Using administrative data to measure ambulatory mental health service provision in primary care.

OBJECTIVE: We sought to determine the accuracy of administrative data for identifying mental health service provision in primary care. STUDY DESIGN: This was a chart abstraction study measuring agreement between billing data and clinical data on the binary variable "mental health visit." Data were collected from the charts and billing records of 5 academic family practice clinics in Toronto, Ontario (1999 to 2000). Billing claims (n = 952) were selected from the billings for all visits by a stratified random sampling technique. A blinded data abstractor reviewed the clinical charts and assigned diagnostic codes for each patient visit associated with the selected claims. Any visit with at least 1 abstracted mental health diagnostic code was defined as a mental health visit. The test characteristics of 4 administrative measures of mental health service provision, based on different combinations of billing codes, were calculated. RESULTS: The accuracy of the administrative data was 86.8% when compared with clinical data. The sensitivity of the 4 administrative measures ranged from 22.3% to 80.7%. The specificity ranged from 97.0% to 99.5%. CONCLUSIONS: This is the first study to establish the performance of administrative data in measuring mental health service provision in a primary care setting. In our setting, broadly defined administrative measures of mental health have excellent specificity and adequate sensitivity for exploring and understanding mental health service utilization.

Adult↗
PubMed2004

Who benefits from more structured depression treatment?

OBJECTIVE: This article uses data from two studies that have demonstrated the overall effectiveness of Collaborative Care interventions to evaluate factors associated with poor outcomes overall (general prognostic factors) and factors associated with greater or lesser effects of treatment (differential treatment effects). METHODS: Adult primary care patients initiating antidepressant treatment for major depression were randomized to usual care or to Collaborative Care, a structured depression treatment program that included planned, proactive and coordinated care with a health care team and informed, activated patients (n = 156, mean age = 43, 85% white). Response to treatment was defined as a 50% or greater reduction in depression at four months. RESULTS: High neuroticism and a history of recurrent major depression (3+ episodes) or dysthymia predicted poor outcomes in general. While the magnitude of the intervention effects differed, frequently cited predictors of persistence of depression (age, gender, depression severity, medical and psychiatric comorbidity) were not significantly associated with greater or lesser benefit from Collaborative Care (no differential treatment effects). Results demonstrate the robustness of intervention effects across numerous groups at risk for persistence of depression. CONCLUSIONS: These findings suggest that at the time of diagnosis it is not possible to predict who is most likely to benefit from Collaborative Care. Instead, outcomes of treatment should be routinely monitored among depressed patients to ensure optimal response.

Adolescent↗
PubMed2004

Behavioral and clinical factors associated with depression among individuals with diabetes.

OBJECTIVE: The goal of this study was to determine the behavioral and clinical characteristics of diabetes that are associated with depression after controlling for potentially confounding variables. RESEARCH DESIGN AND METHODS: A population-based mail survey was sent to patients with diabetes from nine primary care clinics of a health maintenance organization. The Patient Health Questionnaire was used to diagnose depression, and automated diagnostic, pharmacy, and laboratory data were used to measure diabetes treatment intensity, HbA(1c) levels, and diabetes complications. RESULTS: Independent factors that were associated with a significantly higher likelihood of meeting criteria for major depression included younger age, female sex, less education, being unmarried, BMI > or = >30 kg/m(2), smoking, higher nondiabetic medical comorbidity, higher numbers of diabetes complications in men, treatment with insulin, and higher HbA(1c) levels in patients <65 years of age. Independent factors associated with a significantly higher likelihood of meeting criteria for minor depression included younger age, less education, non-Caucasian status, BMI > or = 30 kg/m(2), smoking, longer duration of diabetes, and a higher number of complications in older (> or = 65 years) patients. CONCLUSIONS: Smoking and obesity were associated with a higher likelihood of meeting criteria for major and minor depression. Diabetes complications and elevated HbA(1c) were associated with major depression among demographic subgroups: complications among men and HbA(1c) among individuals <65 years of age. Older patients with a higher number of complications had an increased likelihood of minor depression.

Age Factors↗
PubMed2003

Increased medical costs of a population-based sample of depressed elderly patients.

BACKGROUND: We examined whether older adults with depressive symptoms below the diagnostic threshold and those with DSM-IV major depression and/or dysthymia have higher medical costs than those without depression. METHODS: We mailed the PRIME-MD 2-item depression screen to the patients of 2 large primary care clinics of a staff-model health maintenance organization in Seattle, Wash. All 11 679 patients 60 years and older with primary care providers at the participating clinics were included, and 8894 (76.2%) were successfully enrolled. An additional 107 patients were referred to the study by their primary care physician. Nonrespondents were slightly younger and had higher inpatient medical costs in the previous 6 months. Patients with positive findings on at least 1 item or referred by their family physician were offered an interview with the Structured Clinical Interview for DSM-IV. The total cost of medical services for the 6 months before the study was obtained from the cost accounting system of the health maintenance organization. RESULTS: Total ambulatory costs were 43% to 52% higher and total ambulatory and inpatient costs were 47% to 51% higher in depressed compared with nondepressed elderly patients after adjustment for chronic medical illness. This increase was seen in every component of health care costs, with only a small percentage due to mental health treatment. In mean costs, depressed elderly patients averaged an increase of 763 US dollars to 979 US dollars in ambulatory costs and 1045 US dollars to 1700 US dollars in ambulatory and inpatient costs. No differences in costs were noted between patients with subthreshold depressive syndromes and those with DSM-IV depressive disorders. CONCLUSION: Depressive symptoms and DSM-IV depressive disorders in elderly patients are associated with significantly higher health care costs, even after adjustment for chronic medical illness.

Age Factors↗
PubMed2003

Use of antidepressants among Canadian workers receiving depression-related short-term disability benefits.

OBJECTIVES: Little is known about how antidepressants are being used, but rising antidepressant expenditures and the accompanying impulse to control costs make this a critical issue to be addressed. The authors studied patterns of antidepressant use in a population of workers receiving depression-related short-term disability benefits to determine whether populations likely to benefit from antidepressants are using them and, if so, whether they are using them in a way that the benefits from their use are maximized. METHODS: The analyses were based on 1996-1998 administrative data from short-term disability and prescription drug benefit claims and occupational health department records for employees of three Canadian companies. RESULTS: Approximately 58 percent of employees who were receiving depression-related short-term disability benefits had made at least one antidepressant claim. Employees who did not use antidepressants typically reported significantly fewer symptoms at baseline on average than those who did. About 91 percent of the employees who used antidepressants filled at least one prescription for a guideline-recommended first-line agent. Approximately 79 percent of antidepressant dosages reflected those suggested by the Canadian Network for Mood and Anxiety Treatment, and three timeframe indicators suggested that most patients used antidepressants within the recommended timeframes. CONCLUSIONS: The results of this study represent an important first step in exploring the question of how antidepressants are used among workers with depression-related disability. For the most part, these workers and those whose depression was more severe were more likely to obtain antidepressants.

Adult↗
PubMed2003

Willingness to pay for depression treatment in primary care.

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

Adult↗
PubMed2003

The Canadian Psychiatric Association practice profile survey: I. Methods and general sample characteristics.

OBJECTIVE: To describe the rationale, methodology, and general sample characteristics of the Canadian Psychiatric Association (CPA) practice profile survey, a national survey of psychiatrists and psychiatric practice. METHOD: Mail-in interviews were sent to all Canadian psychiatrists listed in their provincial registers and to all active CPA members (total = 3628). Respondents provided general information about their professional activities for one 24-hour day and detailed information for 1 randomly selected hour. Patient information--including sociodemographics, diagnostic profiles, functioning levels, risk of harm to self or others, and disposition--was elicited for 1 patient seen during the random hour as well as for the most seriously ill patient receiving clinical services that day. RESULTS: There was a 45.5% response rate. Questionnaires completed by nonpsychiatrists or with a large percentage of missing or incorrect data were eliminated (107 surveys), resulting in a final sample size of 1570. CPA members and those from Western Canada responded at a higher rate to the survey. The results suggest some cause for concern about future manpower shortages. Most psychiatrists practise eclectically, seeing patients across the life-span, and working in both community and institutional settings. The old and the young appear to be underserviced, compared with adults. CONCLUSIONS: This study represents an important step forward in evaluating the profile and activities of the profession.

Adult↗
PubMed2003

The Canadian Psychiatric Association practice profile survey: II. General description of results.

OBJECTIVE: To provide an overview of the results of the Canadian Psychiatric Association (CPA) practice profile survey (PPS), a national survey of psychiatrists and psychiatric practice. METHOD: Mail-in interviews were sent to all Canadian psychiatrists listed in their provincial registers and to all active CPA members (total = 3628). Respondents provided general information about their professional activities for one 24-hour day and detailed information for 1 randomly selected hour. Patient information--including sociodemographics, diagnostic profiles, functioning levels, risk of harm to self or others, and disposition--was elicited for 1 patient seen during the random hour as well as for the most seriously ill patient receiving clinical services that day. RESULTS: Psychiatrists work 10 hours daily on average and take calls for 5 hours. Sixty percent of the overall work time is in the provision of direct patient care, and fee-for-service payments account for 55% of hours worked. Forty percent of the clinical work is provided in a hospital setting, and 34% is in a private office. Agency work accounted for only 6% of clinical hours worked. Relatively few practitioners provide services to children, older, or forensic patients. The average patient seen is female, aged 40 years, unmarried or with a marital disruption, significantly impaired in multiple areas of functioning, and likely to suffer from depression (21%), schizophrenia (14%), an anxiety disorder (13%), or bipolar disorder (12%). Comorbid Axis I and Axis II disorders are common (each over 30%) and fairly high rates of suicidal (15% to 30%) and homicidal (10% to 20%) risk are present. CONCLUSIONS: This paper suggests a wide diversity of practice in psychiatry in Canada, with services being provided to a wide range of individuals with many different conditions.

Canada↗
PubMed2003

Anxiety-related visits to Ontario physicians following September 11, 2001.

OBJECTIVE: To determine whether the climate of increased anxiety following the terrorist attacks of September 11, 2001, and the subsequent anthrax cases led to increased anxiety-related physician visits. METHOD: We undertook a retrospective, population-based study of all Ontario residents. We identified physician visits using Ontario's universal health care insurance program. Interventional autoregressive integrated moving average (ARIMA) time series models were used to examine the impact of the terrorist attacks and anthrax infections on the rate of anxiety-related physician visits. RESULTS: Neither the terrorist attacks of September 11 (P > or = 0.40) nor the anthrax infections in October and November (P > or = 0.14) had a statistically significant impact on the rate of anxiety-related visits to physicians. CONCLUSIONS: The climate of heightened anxiety did not result in increased demand for mental health services.

Anxiety Disorders↗
PubMed2003

Pattern of antidepressant use and duration of depression-related absence from work.

BACKGROUND: Few studies have examined the relationship between antidepressant prescription and receipt of depression-related disability benefits. AIMS: To address two questions: first, is prescription of antidepressants in accordance with published clinical guides associated with better disability outcomes, and second, what is the relationship between guideline-concordant antidepressant prescription and length of disability? METHOD: An observational study was conducted using administrative data from three major Canadian financial and insurance sector companies. Short-term disability and prescription drug claims records for 1996-1998 were linked for workers receiving depression-related short-term disability benefits during that time. RESULTS: Recommended first-line agents and recommended doses were significantly associated with return to work (chi(2)=6.64, P<0.036). In addition, among those who returned to work, early intervention was significantly associated with a shortened disability episode (beta=-24.1; 95% CI -34.4 to -13.8). CONCLUSIONS: Depression-related workplace disability is a problem for which there is no simple solution. These results provide an additional piece to the puzzle of helping workers disabled by depression to return to work.

Absenteeism↗
PubMed2002

Quantitative and structural determination of pseudoephedrine sulfate and its related compounds in pharmaceutical preparations using high-performance liquid chromatography.

A simple isocratic reversed-phase high performance liquid chromatograghic method for the separation of pseudoephedrine and its related compounds in pharmaceutical formulations is described. The separation is achieved in less than 35 min on a C-18 column (4.6 mm I.D. x 25 cm length, 5-micrometer particle size) using a mobile phase consisting of a mixture of ammonium acetate and methanol. The results described in this report demonstrate that the method is sensitive and selective. Structural elucidation of two new pseudoephedrine degradation products is described. On the basis of structural analysis by liquid chromatography-mass spectrometry (LC-MS) and liquid chromatography-nuclear magnetic resonance spectroscopy (LC-NMR), the two newly elucidated degradation products were identified to be 2-(carboxyamino)propiophenone (molecular ion of m/z=194) and 2-formyl-2-(methylamino)-acetophenone (molecular ion of m/z=178).

Chromatography, High Pressure Liquid↗
PubMed2002

Self-reported use of mental health services versus administrative records: should we care?

Studies of mental health services have emphasized that people in need are not receiving treatment. However, these studies, based on self-reported use, may not be consistent with administrative records. This study compared self-reports of mental health service use with administrative records in a large representative sample. Respondent reports within the Ontario portion of the 1994/95 Household Component of the National Population Health Survey (NPHS) were individually linked to the provincial mental-health physician reimbursement claims. A total of 5187 Ontarians, aged 12 years or more, reported on their use of mental healthcare within the NPHS and 4621 (89%) consented and were successfully linked to administrative records. Comparisons between the two sources identified that the agreement for any use and volume of use was moderate to low and varied according to select respondent characteristics. These differences affected estimates of the associations with use and volume of use. People who reported high levels of distress reported more visits than those who did not and this effect was stronger in the self-reported data. These results suggest that recall bias may be present. Regardless of the definition of care, access for those in need remains a concern despite universal medical insurance coverage.

Adolescent↗