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Biomedical subjects

Julie A Pavlin

Publications and source records attributed to Julie A Pavlin.

9 recordsLinked to original sources
PubMed2004

Conducting population behavioral health surveillance by using automated diagnostic and pharmacy data systems.

INTRODUCTION: The Walter Reed Army Institute of Research used the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) to conduct population-based behavioral health surveillance among military-health-system beneficiaries. The study analyzed the effectiveness of using prescribing patterns of psychotropic medications to monitor changes in a community's behavioral health status. OBJECTIVES: The objectives of this study were to 1) determine the feasibility of tracking psychiatric illnesses by monitoring prescriptions for psychiatric medications; 2) assess how often psychiatric medications are prescribed for patients with no record of psychiatric illness; 3) determine at what types of clinics these medications are prescribed most often and what other diagnoses are attributed to these patients; and 4) analyze data for potential changes in the population's mental health after high-stress events. METHODS: Correlation analysis and calculations of sensitivity and specificity were used to determine how well prescription medications correlate with outpatient diagnoses and how well they serve as proxies for outpatient diagnoses. A descriptive analysis was conducted of the types of clinics (e.g., primary care, behavioral health, or other specialty clinics) treating patients and the associated percentage of concurrence between prescriptions and diagnostic codes. RESULTS: In military treatment facilities, a diagnosis of depression or anxiety correlated significantly (r = 0.82) with antidepressant or anxiolytic prescriptions. Sensitivity of prescriptions when compared with outpatient visits was 0.76, and specificity was 0.94. Among those patients who visited a primary care clinic either the day before or the same day as an antidepressant or anxiolytic prescription was filled, 60.1% did not receive a diagnosis of any mental health disorder. Behavioral health clinics had the highest correlation between diagnoses and prescriptions; specialty clinics had the lowest. CONCLUSIONS: Behavioral health trends in a population can be monitored by automated analysis of prescribing patterns alone. This method might be a rapid indicator of needed mental health interventions after acute stress-inducing events and be more sensitive than tracking diagnoses alone.

Disease Outbreaks↗
PubMed2003

Implementing syndromic surveillance: a practical guide informed by the early experience.

Syndromic surveillance refers to methods relying on detection of individual and population health indicators that are discernible before confirmed diagnoses are made. In particular, prior to the laboratory confirmation of an infectious disease, ill persons may exhibit behavioral patterns, symptoms, signs, or laboratory findings that can be tracked through a variety of data sources. Syndromic surveillance systems are being developed locally, regionally, and nationally. The efforts have been largely directed at facilitating the early detection of a covert bioterrorist attack, but the technology may also be useful for general public health, clinical medicine, quality improvement, patient safety, and research. This report, authored by developers and methodologists involved in the design and deployment of the first wave of syndromic surveillance systems, is intended to serve as a guide for informaticians, public health managers, and practitioners who are currently planning deployment of such systems in their regions.

Bioterrorism↗
PubMed2003

Investigation of disease outbreaks detected by "syndromic" surveillance systems.

Syndromic surveillance systems can detect potential disease outbreaks quickly and can provide useful tools to assist in outbreak investigation. The steps used to investigate diseases detected through these newer methods are not that different from traditional investigative measures, but the differences and limitations of the systems must be understood. With syndromic surveillance systems, there is often readily available electronic demographic information that can help define the epidemic and direct disease control measures. The diagnosis needs to be confirmed as quickly as possible, however, as specific diagnostic information will be missing with early detection from nonspecific data. It is also important not to disregard smaller, nonsevere rises in disease incidence as they might be a harbinger of a worsening outbreak. The rapidity of most syndromic surveillance systems also requires an equally rapid response, and planning must be done to prioritize alert categories and the response sequence to best utilize the information available in these new systems.

Bioterrorism↗
PubMed2003

Innovative surveillance methods for rapid detection of disease outbreaks and bioterrorism: results of an interagency workshop on health indicator surveillance.

A system designed to rapidly identify an infectious disease outbreak or bioterrorism attack and provide important demographic and geographic information is lacking in most health departments nationwide. The Department of Defense Global Emerging Infections System sponsored a meeting and workshop in May 2000 in which participants discussed prototype systems and developed recommendations for new surveillance systems. The authors provide a summary of the group's findings, including expectations and recommendations for new surveillance systems. The consensus of the group was that a nationally led effort in developing health indicator surveillance methods is needed to promote effective, innovative systems.

Bioterrorism↗
PubMed2002

Diagnostic analyses of biological agent-caused syndromes: laboratory and technical assistance.

The impact of a bioterrorism attack can be greatly reduced by collaboration among primary healthcare providers, laboratories, the veterinary community, public health officials, and emergency response personnel. Improved communication and coordination are essential to make this happen. As a first-line provider, the emergency physician must keep in mind the possibility of bioterrorism and alert the laboratory so that samples can be processed in the correct fashion. New and exciting developments in laboratory organization, communication, and diagnostic capabilities will ensure that all patients receive the best possible care.

Animal Diseases↗
PubMed2002

Disease outbreak detection system using syndromic data in the greater Washington DC area.

BACKGROUND: Many infectious disease outbreaks, including those caused by intentional attacks, may first present insidiously as ill-defined syndromes or unexplained deaths. While there is no substitute for the astute healthcare provider or laboratorian alerting the health department of unusual patient presentations, suspicious patterns may be apparent at the community level well before patient-level data raise an alarm. METHODS: Through centralized Department of Defense medical information systems, diagnoses based on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes are obtained daily from 99 military emergency rooms and primary care clinics across the Washington, DC, region. Similar codes are grouped together in seven diagnostic clusters that represent related presenting signs, symptoms, and diagnoses. Daily monitoring of the data is conducted and evaluated for variation from comparable historic patterns for all seven syndrome groups. Geospatial mapping and trend analysis are performed using geographic information systems software. Data were received on a daily basis beginning in December 1999 and collection continues. The data cut-off date for this manuscript was January 2002. RESULTS: Demographic breakdown of military beneficiaries covered by the surveillance area reveals a broad age, gender, and geographic distribution that is generalizable to the Washington DC region. Ongoing surveillance for the previous 2 years demonstrates expected fluctuations for day-of-the-week and seasonal variations. Detection of several natural disease outbreaks are discussed as well as an analysis of retrospective data from the Centers for Disease Control and Prevention's sentinel physicians-surveillance network during the influenza season that revealed a significantly similar curve to the percentage of patients coded with a respiratory illness in this new surveillance system. DISCUSSION: We believe that this surveillance system can provide early detection of disease outbreaks such as influenza and possibly intentional acts. Early detection should enable officials to quickly focus limited public health resources, decrease subsequent mortality, and improve risk communication. The system is simple, flexible, and, perhaps most critical, acceptable to providers in that it puts no additional requirements on them.

Ambulatory Care↗