PubMed Health⌕ Search

Biomedical subjects

H A Pincus

Publications and source records attributed to H A Pincus.

At least 19 recordsLinked to original sources
PubMed2001

The societal costs of chronic major depression.

Major depression is a widespread, often chronic disorder affecting the individual, his or her family, and society as a whole. It incurs tremendous social and financial costs in the form of impaired relationships, lost productivity, and lost wages. Although chronic major depression is eminently treatable, it continues to be undertreated and underrecognized. This is particularly true in primary care settings, where physicians are usually the first to encounter chronic depression but are seldom trained to distinguish depression from other medical illnesses with similar symptoms. In addition, because of the stigma attached to depression, patients often characterize their symptoms as part of a physical illness or fail to report them to a clinician at all. This article discusses the epidemiology of depression, its impact and burden on society, and its special character (including diagnosis and treatment) as a chronic illness.

Chronic Disease↗
PubMed2000

Managed care and fee discounts in psychiatry: new evidence.

This article describes the extent of managed care and fee discounting in psychiatric practice using data on 970 randomly sampled American Psychiatric Association members from the 1996 National Survey of Psychiatric Practice. Seventy percent of psychiatrists were found to have some patients in managed behavioral health care programs. The survey data illustrate that psychiatrists' involvement in managed care spans primary practice settings and is fairly evenly distributed across regions of the United States. Nationally, psychiatrists discount fees for 35% of their patients, with significant variation by practice type and extent of involvement in managed behavioral health care. The average level of discount is 25% with little variation by practice type or extent of involvement in managed behavioral health care. There is little evidence that psychiatrists with patients in managed care have higher fee levels than psychiatrists with no patients in managed care.

Cost Sharing↗
PubMed2000

Recent patterns and predictors of antipsychotic medication regimens used to treat schizophrenia and other psychotic disorders.

Up-to-date data are needed on the types of treatments used by psychiatrists and the reasons for use of particular treatments. Using 1997 American Psychiatric Association (APA) Practice Research Network (PRN) Study data on patients with schizophrenia and other psychotic disorders, we identified the characteristics of antipsychotic medications (APMs) currently being prescribed and factors associated with the use of particular regimens. In this study population, use of the newer APMs, including risperidone, olanzapine, and clozapine, has increased rapidly and now accounts for over one-half of all APM use. Other intriguing findings include the fact that one-sixth of patients with schizophrenia and other psychotic disorders are concurrently treated with two or more APMs. Factors associated with being prescribed one of the newer APMs risperidone or olanzapine include being elderly, having more education, being white, having psychiatric comorbidity, and making fewer recent visits to a psychiatrist. The APA PRN Study data are an important new resource for mental health services researchers.

Adolescent↗
PubMed2000

Large medical databases, population-based research, and patient confidentiality.

OBJECTIVE: This article is a discussion of the use of large clinical databases in population-based research on psychiatric disorders. METHOD: The authors review uses of large clinical databases in research on the etiology, impact, and treatment of psychiatric disorders. They also describe existing privacy safeguards applicable to use of medical records data in research. RESULTS: The growth of large medical databases has prompted increasing concern about the confidentiality of patient records. Efforts to restrict access to computerized medical data, however, may preclude use of such data in important and legitimate research. Prior research using large medical databases has made important contributions across a broad range of topics, including epidemiology, genetics, treatment effectiveness, and health policy. Continued population-based research will be essential in order to preserve the accessibility and quality of treatment for people with psychiatric disorders. CONCLUSIONS: Public domain research should be distinguished from proprietary or commercial uses of health information, and existing privacy safeguards should be vigorously applied. In our efforts to protect patient privacy, however, we should take care not to endorse or reinforce prejudices against psychiatric treatment and people who suffer from psychiatric disorders. Neither should we ignore important opportunities to improve quality of care and influence public policy through population-based research.

Confidentiality↗
PubMed2000

Understanding disability in mental and general medical conditions.

OBJECTIVE: This study characterized the prevalence, characteristics, and impact of mental and general medical disabilities in the United States. METHOD: The 1994-1995 National Health Interview Survey of Disability was the largest disability survey ever conducted in the United States. A national sample was screened for disability, defined as limitation or inability to participate in a major life activity. Analyses compared cohorts who attributed their disability to physical, mental, or combined conditions. RESULTS: Of 106,573 adults, 1.1% reported functional disability from mental conditions, 4.8% from general medical conditions, and 1.2% from combined mental and general medical conditions. Disabilities attributed to a mental condition were predominantly associated with social and cognitive difficulties, those attributed to general medical conditions with physical limitations, and combined disabilities with deficits spanning multiple domains. In multivariate models, comorbid medical and mental conditions were associated with a twofold increase in odds of unemployment and a two-thirds increase in odds of support on disability payments compared to respondents with a single form of disability. More than half the nonworking disabled reported that economic, social, and job-based barriers contributed to their inability to work. One-fourth of working disabled people reported discrimination on the basis of their disability during the past 5 years. CONCLUSIONS: An estimated three million Americans (one-third of disabled people) reported that a mental condition contributes to their disability. Mental, general medical, and combined conditions are associated with unique patterns of functional impairment. Social and economic factors and job discrimination may exacerbate the functional impairments resulting from clinical syndromes.

Adolescent↗
PubMed2000

Alcohol abuse and dependence in a national sample of psychiatric patients.

OBJECTIVE: To examine clinical characteristics and services being provided to Alcohol Abuse/Dependent (AAD) patients in current psychiatric practice. METHOD: In a national sample of psychiatrists (N = 417), each provided data on three preselected patients (N = 1,245; 51.8% women) that included demographics, DSM-IV diagnoses, treatment setting and health-plan measures. Logistic regression was used to compare patients with and without an AAD diagnosis. RESULTS: Only 12% of patients (n = 151) had an AAD diagnosis. AAD patient care was more frequently subject to utilization review and restriction or specification of medications to be prescribed (formulary). Psychiatrists also perceived greater restrictions on AAD patient care (e.g., requirements to use specific practice guidelines or treatment algorithms). CONCLUSIONS: Findings suggest that health care systems are subjecting treatment patients with AAD to greater scrutiny and may be limiting the extent and nature of care provided to these patients. The low prevalence of AAD among patients being seen by psychiatrists also warrants further attention. Study findings highlight the utility of practice-based research in addiction psychiatry.

Adult↗
PubMed2000

Psychiatric care of patients with depression and comorbid substance use disorders.

BACKGROUND: The goal of this study was to describe the sociodemographic and clinical characteristics and routine psychiatric care of depressed patients with or without substance use disorders (SUDs) and to assess the association between the presence of comorbid SUD and the psychiatric management of patients with depression. METHOD: Each of a sample of 531 psychiatrists participating in the Practice Research Network (PRN) of the American Psychiatric Institute for Research and Education was asked to provide information about 3 randomly chosen patients. Data were collected using a self-administered questionnaire, which generated detailed diagnostic and clinical data on 1228 psychiatric patients. Weighted data were analyzed using the SUDAAN software package. Multivariate logistic regression was used to compare depressed patients with and without SUD. RESULTS: A total of 595 patients (48.4%) were diagnosed with depression (DSM-IV criteria). The prevalence of SUD (excluding nicotine dependence) in this group was 18.1%. The group with SUD had a significantly larger proportion of males, young adults, patients seen in public general hospitals, and non-managed care public plans. No significant group differences were found for primary payer, locus of care, length of treatment, type of current or past treatment, and prescription of medications. Only 2.2% of SUD patients were prescribed with an anti-SUD medication (i.e., disulfiram and naltrexone). CONCLUSION: Concomitant SUDs have little effect on the routine psychiatric care of depressed patients. Efforts should be made to improve the identification and management of depressed patients with SUD.

Adolescent↗
PubMed1999

Psychiatric patients and treatments in 1997: findings from the American Psychiatric Practice Research Network.

Despite extensive studies on the epidemiology of mental disorders and advances in the treatment of these conditions, there is a paucity of detailed information concerning the characteristics of psychiatric patients and how treatments are administered in routine psychiatric practice. This 1997 observational study collected detailed information from 417 psychiatrists on the demographic, diagnostic, clinical, and treatment characteristics of a systematic sample of 1228 patients. Six hundred thirty-seven patients (51.9%) were women and the mean patient age was 41.9 years. The most common diagnostic category (53.7%) was mood disorders, followed by schizophrenia/psychotic disorders (14.6%), anxiety disorders (9.3%), and disorders of childhood (7.7%). Six hundred seventy-one patients (54.6%) had at least one comorbid Axis I condition and almost half (49.8%) had a history of psychiatric hospitalization. Patients received a mean of 2.0 psychotherapeutic medications, most commonly antidepressants (62.3%). Findings demonstrate that psychiatrists in routine practice treat a patient population with severe, complex conditions.

Adolescent↗
PubMed1999

Practice patterns of international and U.S. medical graduate psychiatrists.

OBJECTIVE: The practice patterns of international medical graduate (IMG) and U.S. medical graduate (USMG) psychiatrists were compared. METHOD: Using data from the 1996 National Survey of Psychiatric Practice, the authors compared IMGs and USMGs in terms of demographic characteristics, practice settings, patients' clinical characteristics, and sources of reimbursement. RESULTS: The IMGs surveyed tended to be older than USMGs, included a higher proportion of women, and were more racially heterogeneous. They worked longer hours, worked more frequently in the public sector, and treated a higher proportion of patients with psychotic disorders. The IMGs also received a higher percentage of their income than USMGs from Medicaid and Medicare, whereas the reverse was true of self-payment. Most of these differences remained significant after psychiatrist's age, gender, race, board certification, and work setting were controlled for. CONCLUSIONS: IMG and USMG psychiatrists have different practice patterns. Policies that substantially decrease the number of IMG psychiatrists may adversely affect the availability of psychiatrists to treat minorities and other underserved populations.

Adult↗
PubMed1999

Trends in office-based psychiatric practice.

OBJECTIVE: The authors examine trends in the composition and duration of visits to psychiatrists in office-based psychiatric practice. METHOD: An analysis was performed of physician-reported data from the 1985 and 1995 National Ambulatory Medical Care Surveys focusing on visits to physicians specializing in psychiatry. Secular changes in visit characteristics were assessed, and mean visit durations were determined for selected sociodemographic and clinical groups. RESULTS: In the decade between 1985 and 1995, visits in office-based psychiatry became shorter, less often included psychotherapy, and more often included a medication prescription. The proportion of visits that were 10 minutes or less in length increased. A shortening in visit duration was most evident for younger patients, privately insured patients, and patients who were not prescribed a psychotropic medication. In the 1995 survey, 6.8% of the psychiatric visits included patient contact with another health care professional. CONCLUSIONS: Changing financial arrangements and new pharmacologic treatments may have contributed to these changes in practice style.

Adolescent↗