Biomedical subjects

Jeffrey M Pyne

Publications and source records attributed to Jeffrey M Pyne.

16 recordsLinked to original sources

PubMed2006

Correlates of health-related quality of well-being in older patients with schizophrenia.

Research on correlates of health-related quality of life (HRQOL) among older patients with schizophrenia has been very limited. This study evaluated the relative impact of positive, negative, and depressive symptoms, movement disorders, and cognitive impairment on HRQOL among middle-aged and older patients with schizophrenia or schizoaffective disorder. Participants were 199 patients aged 45 to 85 years. The study was cross-sectional. The primary outcome measure was the Quality of Well-Being scale, and correlates were measures of positive and negative symptoms, depression, abnormal movements, and cognitive performance. Severity of depressive symptoms and of cognitive impairment correlated significantly with HRQOL and independently affected HRQOL scores. The initiation/perseveration subscale of the Dementia Rating Scale had the largest impact. These findings suggest that depressive symptoms and cognitive functioning should be part of the routine assessment of older people with schizophrenia and may be targets for psychopharmacological and psychosocial interventions to improve HRQOL.

Age Factors↗

PubMed2006

Quality-adjusted health status in veterans with posttraumatic stress disorder.

This study evaluated the quality-adjusted health status in veterans with posttraumatic stress disorder (PTSD). In a cross-sectional study veterans diagnosed with PTSD completed a quality-adjusted health status measure (Quality of Well-Being Self-Administered [QWB-SA] scale), PTSD symptom severity measures (Mississippi Scale for Combat-Related PTSD and Clinician-Administered PTSD Scale), and a depression severity measure (Beck Depression Inventory). Significant inverse relationships were identified between the QWB-SA and PTSD severity measures as well as between the QWB-SA and depression severity measures in this sample. Demonstration of these relationships suggests that greater symptom severity is associated with lower quality-adjusted health status in veterans with PTSD. More importantly, the QWB-SA was designed for use in cost-effectiveness analyses and may be useful in assessing the relative value of PTSD interventions compared with other mental and physical health interventions.

Combat Disorders↗

PubMed2006

Impact of comorbid anxiety disorders on health-related quality of life among patients with major depressive disorder.

OBJECTIVE: This study examined the impact of comorbid anxiety disorders-posttraumatic stress disorder (PTSD), generalized anxiety disorder, and panic disorder-on health-related quality of life among primary care patients enrolled in a collaborative care depression intervention study for the Department of Veterans Affairs (VA). METHODS: Baseline data were used from 324 participants in the Telemedicine Enhanced Antidepressant Management (TEAM) Study, a multisite randomized effectiveness trial targeting VA primary care patients with depression. Health-related quality of life was measured by using the Quality of Well-Being Scale, self-administered version (QWB-SA) and the mental component summary (MCS-12V) and physical component summary (PCS-12V) of the 12-item Short Form Health Survey for Veterans (SF-12V). RESULTS: A majority of participants (69 percent) had at least one anxiety disorder. Generalized anxiety disorder and PTSD predicted scores on the QWB-SA. PTSD predicted scores on the PCS-12V, but none of the comorbid anxiety disorders predicted scores on the MCS-12V. In addition, social support, depression severity, and the number of chronic medical conditions significantly predicted QWB-SA scores; the number of self-reported chronic physical health conditions and the number of depression episodes significantly predicted PCS-12V scores; and social support and depression severity significantly predicted MCS-12V scores. CONCLUSIONS: According to scores on the QWB-SA, generalized anxiety disorder and PTSD comorbid with major depressive disorder impair health-related quality of life above and beyond major depressive disorder alone.

Anxiety Disorders↗

PubMed2006

Agreement between patients with schizophrenia and providers on factors of antipsychotic medication adherence.

OBJECTIVE: Medication adherence continues to be a challenge for patients with schizophrenia. Many interventions have been tested but not widely adopted. To fill this gap, this qualitative study examined patient and provider perspectives on barriers, facilitators, and motivators related to adherence. METHODS: Twenty-six patients (15 veterans and 11 nonveterans) diagnosed as having schizophrenia or schizoaffective disorder completed in-depth qualitative interviews. Each patient's mental health provider completed an open-ended paper-and-pencil questionnaire that followed the format of the patient qualitative interview. Patients and their providers were asked about seven domains of an explanatory model for schizophrenia and about barriers to, facilitators for, and motivators to taking antipsychotic medication. Patients and providers responded from the perspective of the patient. Patient interviews were audiotaped and transcribed. The data were analyzed with content analysis and constant comparison methods. RESULTS: Explanatory model agreement between patients and their providers ranged from 40 to 100 percent, depending on the explanatory model domain. Patients identified 214 unique barriers, facilitators, and motivators, and agreement between patients and their providers ranged from 54 to 65 percent. Sample patient quotes are provided. CONCLUSIONS: Substantial disagreement arose between patients and their providers with regard to their explanatory models for schizophrenia and the barriers, facilitators, and motivators thought to affect patients' medication adherence decisions. These findings will be used to develop and test a patient-centered strategy to enhance medication adherence.

Adult↗

PubMed2006

Preference-weighted health status associated with substance use-disorders treatment.

OBJECTIVE: Cost-effectiveness analyses using preference-weighted health status as the measure of effectiveness allow for the direct comparison of cost-effectiveness ratios for physical and mental health interventions. However, these analyses are not commonly used for substance use-disorders interventions. We conducted a methodological evaluation of the relationship between preference-weighted health status and 6-month substance use-disorders treatment outcomes. METHOD: The design was an observational study of clients receiving substance use-disorders treatment. Fifteen high-volume treatment centers within a regional managed behavioral health care organization participated. There were 165 subjects (117 men, 48 women) diagnosed with current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, substance dependence in the analysis. Baseline and 6-month data included substance-use quantity, frequency, and diagnostic criteria and preference-weighted Medical Outcomes Study Short Form-36 scores based on visual analog scale (VAS) and standard gamble (SG) conversion formulas. RESULTS: Controlling for sociodemographic variables, VAS change for early remission at 6 months was 0.107 (p = .0002) (reference category continued dependence). SG change for early remission at 6 months was 0.041 (p < .0004). Using heavy drinkers as the reference category, VAS preference-weighted change was 0.062 (p = .10) for abstinent and 0.112 (p = .01) for moderate drinkers. SG preference-weighted change was 0.027 (p = .08) for abstinent and 0.046 (p = .01) for moderate drinkers. CONCLUSIONS: These findings support the construct validity of preference-weighted health status in substance use-disorders treatment. Direct comparisons of the cost-effectiveness of substance use-disorders treatment with other mental or physical health interventions are critical during times of limited health care resources.

Adult↗

PubMed2005

Health state preference scores of children with spina bifida and their caregivers.

Cost-effectiveness evaluations of interventions to prevent or treat spina bifida require quality of life information measured as preference scores. Preference scores of caregivers also may be relevant. This study tested whether the preference scores of children with spina bifida and their caregivers would decrease as disability in the child increased. Families of children aged 0-17 with spina bifida (N = 98) were identified using a birth defect surveillance system in the state of Arkansas. Primary caregivers of children with spina bifida identified other families with an unaffected child (N = 49). Preference scores for child health states were determined using the Health Utilities Index--Mark 2 (HUI2). Caregiver preference scores were determined using the Quality of Well-Being (QWB) scale. Children with spina bifida were categorized into three disability levels according to the location of the child's lesion. Mean preference scores declined for both affected children and the primary caregiver as disability in the child increased. In multivariate analysis, the preference score of the child was a significant and positive predictor of the primary caregiver's preference score. A more modest association was found for caregiver health preference scores by lesion location. The findings can inform cost-effectiveness evaluations of interventions to treat or prevent spina bifida.

Adolescent↗

PubMed2005

One size fits some: the impact of patient treatment attitudes on the cost-effectiveness of a depression primary-care intervention.

BACKGROUND: Despite their impact on outcomes, the effect of patient treatment attitudes on the cost-effectiveness of health-care interventions is not widely studied. This study estimated the impact of patient receptivity to antidepressant medication on the cost-effectiveness of an evidence-based primary-care depression intervention. METHOD: Twelve community primary-care practices were stratified and then randomized to enhanced (intervention) or usual care. Subjects included 211 patients beginning a new treatment episode for major depression. At baseline, 111 (52.6%) and 145 (68.7%) reported receptivity to antidepressant medication and counseling respectively. The intervention trained the primary-care teams to assess, educate, and monitor depressed patients. Twelve-month incremental (enhanced minus usual care) total costs and quality-adjusted life years (QALYs) were calculated. RESULTS: Among patients receptive to antidepressants, the mean incremental cost-effectiveness ratio was dollar 5,864 per QALY (sensitivity analyses up to dollar 14,689 per QALY). For patients not receptive to antidepressants, the mean incremental QALY score was negative (for both main and sensitivity analyses), or the intervention was at least no more effective than usual care. CONCLUSIONS: These findings suggest a re-thinking of the 'one size fits all' depression intervention, given that half of depressed primary-care patients may be non-receptive to antidepressant medication treatment. A brief assessment of treatment receptivity should occur early in the treatment process to identify patients most likely to benefit from primary-care quality improvement efforts for depression treatment. Patient treatment preferences are also important for the development, design, and analysis of depression interventions.

Adult↗

PubMed2005

Functional impact and health utility of anxiety disorders in primary care outpatients.

OBJECTIVE: The objective of this study was to examine the relative impact of anxiety disorders and major depression on functional status and health-related quality of life of primary care outpatients. METHOD: Four hundred eighty adult outpatients at an index visit to their primary care provider were classified by structured diagnostic interview as having anxiety disorders (panic disorder with or without agoraphobia, social phobia, and posttraumatic stress disorder; generalized anxiety disorder was also assessed in a subset) with or without major depression. Functional status, sick days from work, and health-related quality of life (including a preference-based measure) were assessed using standardized measures adjusting for the impact of comorbid medical illnesses. Relative impact of the various anxiety disorders and major depression on these indices was evaluated. RESULTS: In multivariate regression analyses simultaneously adjusting for age, sex, number of chronic medical conditions, education, and/or poverty status, each of major depression, panic disorder, posttraumatic stress disorder, and social phobia contributed independently and relatively equally to the prediction of disability and functional outcomes. Generalized anxiety disorder had relatively little impact on these indices when the effects of comorbid major depression were considered. Overall, anxiety disorders were associated with substantial decrements in preference-based health states. CONCLUSIONS: These observations demonstrate that the presence of each of 3 common anxiety disorders (ie, panic disorder, posttraumatic stress disorder, and social phobia)-over and above the impact of chronic physical illness, major depression, and other socioeconomic factors-contributes in an approximately additive fashion to the prediction of poor functioning, reduced health-related quality of life, and more sick days from work. Greater awareness of the deleterious impact of anxiety disorders in primary care is warranted.

Absenteeism↗

PubMed2004

Relationship between perceived stigma and depression severity.

The purpose of this study was to explore the relationship between perceived stigma and being in treatment for depression and current depression severity. Face-to-face interviews were conducted with a convenience sample of depressed subjects from a Veterans Administration outpatient mental health clinic (N = 54) and never-depressed subjects from a Veterans Administration primary care clinic (N = 50). Depression severity was measured using the 9-item Primary Care Evaluation of Mental Disorders depression measure. Stigma was measured using the 5-item Stigma Scale for Receiving Psychological Help modified for depression treatment. Statistical analyses included Spearman correlation and multivariate regression. In the correlation analysis, being in treatment for depression compared with never experiencing depression was associated with significantly higher levels of perceived stigma (p <.001). In separate multivariate models controlling for significant univariate correlates, greater depression severity (p <.001) and meeting criteria for current major depression (p <.001) were significant predictors of perceived stigma. Greater depression severity appears to be a strong predictor of perceived stigma.

Cross-Sectional Studies↗

PubMed2004

A pilot study of barriers to medication adherence in schizophrenia.

BACKGROUND: Interventions to improve adherence to antipsychotic medication are needed. The aims of the current study were to identify the most common barriers to medication adherence in a cohort of patients receiving outpatient and inpatient treatment for an acute exacerbation of schizophrenia, compare clinical and demographic characteristics of patients with lower versus higher numbers of barriers, and characterize patients most likely to be nonadherent to antipsychotic medication. METHOD: The present study analyzed data collected during the Schizophrenia Guidelines Project (SGP), a multisite study of strategies to implement practice guidelines that was funded by the U.S. Department of Veterans Affairs and conducted from March 1999 to October 2000. Nurse coordinators had conducted clinical assessments and performed an intervention designed to improve medication adherence by addressing barriers to adherence. Data on patient symptoms, functioning, and side effects had been obtained using the Positive and Negative Syndrome Scale (PANSS), the Schizophrenia Outcomes Module, the Medical Outcomes Study 36-item Short-Form Health Survey, and the Barnes Akathisia Scale (BAS). Administrative data were used to identify patients with an ICD-9 code for schizophrenia. A total of 153 patients who met this criterion and participated in the intervention arm of the SGP had complete data available for analysis in the current study. RESULTS: The most common patient-reported barriers were related to the stigma of taking medications, adverse drug reactions, forgetfulness, and lack of social support. Bivariate analysis showed that patients with high barriers were significantly more likely to be nonadherent (p < or =.02), to have problems with alcohol or drug use (p =.02), to have higher PANSS total scores (p =.03), and to have higher mean BAS scores (p =.02). Logistic regression showed that lower patient education level (odds ratio [OR] = 3.95, p =.02), substance abuse (OR = 3.24, p =.01), high PANSS total scores (OR = 1.02, p =.05), and high barriers (OR = 2.3, p =.05) were significantly associated with the probability of nonadherence. CONCLUSIONS: It may be possible to identify patients most likely to benefit from adherence intervention. The data presented here will help to inform future research of clinical interventions to improve medication adherence in schizophrenia and help to stimulate further work in this area.

Adult↗

PubMed2003

Cost-effectiveness of a primary care intervention for depressed females.

BACKGROUND: To date, there is little information about the differential impact of primary care interventions by gender. We conducted an exploratory cost-effectiveness analysis by gender of an intervention to improve recognition and guideline-concordant treatment of depression in primary care. METHODS: Primary care practices that did not employ an onsite mental healthcare specialist were randomized to enhanced (intervention) versus usual care. All subjects met study criteria for current major depression. Medical Outcomes Study SF-36 scores were converted into quality-adjusted life years (QALYs) to compare the 1-year effectiveness of enhanced versus usual care by gender. Based on results of previous studies, antidepressant acceptors beginning a new depression treatment episode were the focus of the analysis. Statistical analyses included multivariate regression models controlling for sociodemographic and clinical covariates. RESULTS: In the main analysis, enhanced care for females was more expensive and more effective than usual care, at an additional cost of $5244 per QALY. For males, enhanced care was essentially cost and outcome neutral compared to usual care. The cost-effectiveness ratio estimates were robust to sensitivity analyses. Psychological side effects to the intervention may partially explain the limited effect of the intervention on outcomes for males. LIMITATIONS: We consider these results exploratory because the SF-36 to quality-adjusted life year conversion formula is preliminary and because of the relatively small sample size. CONCLUSIONS: The estimated cost-effectiveness ratio of this depression intervention is within the acceptable range for females, but not males. If replicated, these exploratory findings suggest that interventions to improve primary care depression treatment may need to be modified to improve their effectiveness in males while maintaining their effectiveness in females.

Adult↗

PubMed2003

Use of the quality of well-being self-administered version (QWB-SA) in assessing health-related quality of life in depressed patients.

BACKGROUND: This study evaluated the cross-sectional and longitudinal relationship between depression severity and the Quality of Well-Being scale self-administered version (QWB-SA) in subjects diagnosed with current major depression. METHODS: The research design was prospective and observational. Data were collected on a convenience sample of 58 subjects. Additional measures included the Quality of Well-Being scale interviewer-version (interviewer-QWB), Hamilton Rating Scale for Depression (HRSD-17), Beck Depression Inventory, and each were collected at baseline, 4 weeks, and 4 months postmedication treatment. RESULTS: Cross-sectional and longitudinal QWB-SA scores were significantly correlated with depression severity and the interviewer-QWB. Treatment response, defined as 50% improvement in HRSD-17, was associated with 0.10 and 0.16 unit changes in the QWB-SA at 4 weeks and 4 months, respectively. The QWB-SA was significantly and negatively correlated with cross-sectional and longitudinal depression severity. LIMITATIONS: The study design was observational and used a convenience sample of subjects. CONCLUSIONS: The QWB-SA is less expensive to administer than the interviewer-QWB and is a useful alternative for determining the effectiveness and cost-effectiveness of treatments for depression relative to other physical and mental illness treatments.

Adult↗

PubMed2003

Cost-effectiveness of a primary care depression intervention.

OBJECTIVE: To determine the incremental cost-effectiveness of a quality improvement depression intervention (enhanced care) in primary care settings relative to usual care. DESIGN: Following stratification, we randomized 12 primary care practices to enhanced or usual care conditions and followed patients for 12 months. SETTING: Primary care practices located in 10 states across the United States. PATIENTS/PARTICIPANTS: Two hundred eleven patients beginning a new treatment episode for major depression. INTERVENTIONS: Training the primary care team to assess, educate, and monitor depressed patients during the acute and continuation stages of their depression treatment episode over 1 year. MEASUREMENTS AND MAIN RESULTS: Cost-effectiveness was measured by calculating incremental (enhanced minus usual care) costs and quality-adjusted life years (QALYs) derived from SF-36 data. The mean incremental cost-effectiveness ratio in the main analysis was US dollars 15463 per QALY. The mean incremental cost-effectiveness ratios for the sensitivity analyses ranged from US dollars 11341 (using geographic block variables to control for pre-intervention service utilization) to US dollars 19976 (increasing the cost estimates by 50%) per QALY. CONCLUSIONS: This quality improvement depression intervention was cost-effective relative to usual care compared to cost-effectiveness ratios for common primary care interventions and commonly cited cost-effectiveness ratio thresholds for intervention implementation.

Cost-Benefit Analysis↗

PubMed2003

Comparing the sensitivity of generic effectiveness measures with symptom improvement in persons with schizophrenia.

OBJECTIVE: The purpose of this study was to compare the sensitivity of four generic effectiveness measures with clinically meaningful symptom improvement in persons with schizophrenia. METHOD: Baseline and 6-month interviews were conducted with 134 subjects diagnosed with schizophrenia or schizoaffective disorder. The design was observational. The four generic effectiveness measures included the Quality of Well-Being scale (QWB), a quality-adjusted index score based on the SF-36 VAS, Veterans SF-36 mental health component summary score (MCS), and the World Health Organization Disablement Assessment Schedule (WHO-DAS). Symptom measures included the Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale (CDS). The side effect measure was the Extrapyramidal Symptom Rating Scale (ESRS). Data analysis included correlations between symptom, side effect, and generic effectiveness change scores; and an effect size calculation to detect a clinically significant improvement in the total PANSS. RESULTS: All four effectiveness measures were correlated with changes in side effects. All but the SG-36 VAS were correlated with changes in depression. Only the QWB was correlated with changes in PANSS scores. The QWB required at least three times fewer subjects (n = 61) to detect a clinically significant improvement in total PANSS compared with the other effectiveness measures (n = 201-324). CONCLUSIONS: It is recommended that clinicians and researchers use the QWB to demonstrate the effectiveness and cost-effectiveness of schizophrenia interventions. The QWB allows for direct comparison of the effectiveness and cost-effectiveness of schizophrenia interventions with other mental and physical health interventions and may contribute to a greater recognition of the value of mental health interventions.

Depressive Disorder↗

PubMed2002

Impact of primary care depression intervention on employment and workplace conflict outcomes: is value added?

BACKGROUND: Depression causes significant functional impairment in sufferers and often leads to adverse employment outcomes for working individuals. Recovery from depression has been associated with better employment outcomes at one year. AIMS OF THE STUDY: The study s goals were to assess a primary care depression intervention s impact on subsequent employment and workplace conflict outcomes in employed patients with depression. METHODS: In 1996-1997, the study enrolled 262 employed patients with depression from twelve primary care practices located across ten U.S. states; 219 (84%) of the patients were followed at one year. Intent-to-treat analyses assessing intervention effects on subsequent employment and workplace conflict were conducted using logistic regression models controlling for individual clinical and sociodemographic characteristics, job classification and local employment conditions. To meet criteria for subsequent employment, persons working full-time at baseline had to report they were working full-time at follow-up and persons working part-time at baseline had to report working part-/full-time at follow-up. Workplace conflict was measured by asking patients employed at follow-up whether, in the past year, they had arguments or other difficulties with people at work . RESULTS: Findings showed that 92.1% of intervention patients met criteria for subsequent employment at one year, versus 82.0% of usual care patients (c2=4.42, p=.04). Intervention patients were less likely than usual care patients to report workplace conflict in the year following baseline (8.1% vs. 18.9%, respectively; c2=4.11; p=.04). The intervention s effect on subsequent employment was not mediated by its effect on workplace conflict. DISCUSSION: The intervention significantly improved employment outcomes and reduced workplace conflict in depressed, employed persons at one year. Economic implications for employers related to reduced turnover costs, for workers related to retained earnings, and for governments related to reduced unemployment expenditures and increased tax receipts may be considerable. LIMITATIONS: Although similar primary care depression interventions have been shown to produce comparable effects on subsequent employment at one year, replications in larger samples of depressed, employed patients in different economic climates may be necessary to increase the generalizability and precision of estimates. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Primary care interventions that enhance depression treatment and improve clinical outcomes can contribute meaningful added value to society by improving employment and workplace outcomes. IMPLICATIONS FOR HEALTH POLICIES: Federal/state governments may realize economic benefits from reduced unemployment expenditures and increased tax receipts should primary care depression interventions that improve employment outcomes be broadly disseminated. Policy initiatives to increase the dissemination of such interventions may be an innovative approach for improving labor force participation by depressed individuals. IMPLICATIONS FOR FURTHER RESEARCH: Formal cost-benefit analyses are needed to explore whether economic benefits to societal stakeholders from these and other labor outcomes equal or exceed the incremental costs of disseminating similar primary care interventions nationally. Researchers in other nations may wish to consider investigating the impact primary care depression interventions might have on employment and workplace outcomes in their countries.

Adult↗

PubMedDate not supplied

Cost-effectiveness of enhancing primary care depression management on an ongoing basis.

PURPOSE: Although potentially costly, enhancing primary care depression management on an ongoing basis results in substantial long-term treatment effectiveness. The purpose of this article is to compare the cost-effectiveness of this approach with that of usual care. METHODS: The study was conducted in 12 community primary care practices randomized to enhanced or usual care after stratification by baseline practice patterns. Practices assigned to enhanced care encouraged depressed patients to engage in active treatment, using practice nurses to provide regularly scheduled care management during the course of 24 months. We analyze outcomes for 211 adults (73.4% of potential eligible patients) beginning a new treatment episode for major depression determined by previsit screening. Outcomes included blinded estimates of days free of depression impairment as well as health care costs for 2 years. RESULTS: Enhanced care significantly increased the number of days free of depression impairment for 2 years when compared with usual care (647.6 days vs 588.2 days, P <.01). The incremental cost-effectiveness ratio for enhanced care ranged from 9,592 dollars to 14,306 dollars per quality-adjusted life-year (QALY). The number of incremental days free of depression impairment increased between the first year and the second year (23.0 vs 36.4, respectively, P <.001) while incremental health plan costs decreased significantly (568 dollars vs -12 dollars, P <.001). CONCLUSIONS: Enhancing primary care depression management on an ongoing basis should be considered for adoption by policy and health plan leaders.

Adult↗