PubMed Health⌕ Search

Biomedical subjects

M Olfson

Publications and source records attributed to M Olfson.

At least 91 records · Page 5Linked to original sources
PubMed1994

Outpatient psychotherapy in the United States, I: Volume, costs, and user characteristics.

OBJECTIVE: This article provides an overview of the volume, composition, and costs of outpatient psychotherapy in the United States. METHOD: Data were analyzed from the household section of the 1987 National Medical Expenditure Survey. The authors determined the volume and distribution of psychotherapy visits by provider specialty, setting, source of expenditure, and reason for visit. An examination was made of the demographic characteristics, health status, and mental health utilization profile of psychotherapy users. RESULTS: In 1987, Americans made 79.5 million outpatient psychotherapy visits at a total cost of $4.2 billion. Most of these visits were to mental health specialists (more than 80%) and were reported to be for the treatment of mental health conditions (63.5%). However, psychotherapy was not provided in a substantial proportion of the visits to mental health specialists (21.1%) or the visits to treat mental conditions (29.8%). Separated and divorced persons, females, whites persons aged 35 to 49 years, and those with more than 15 years of education had a greater likelihood of using psychotherapy. Psychotherapy use was also greater among persons in poor general health and those reporting health-related functional impairments. General medical costs of psychotherapy users exceeded those of nonusers. CONCLUSIONS: Psychotherapy accounts for approximately 8% of outpatient medical care costs. Users of psychotherapy appear to be more distressed than is commonly assumed: they report poorer general health, higher general medical costs, and more functional impairment than nonusers. Although mental health specialists commonly provide psychotherapy to treat mental disorders, all mental health care is not psychotherapy.

Adolescent↗
PubMed1994

Outpatient psychotherapy in the United States, II: Patterns of utilization.

OBJECTIVE: The purpose of this article is to characterize the use of psychotherapy based on episode duration. METHOD: Data were analyzed from the household section of the 1987 National Medical Expenditure Survey. The authors determined the demographic characteristics, provider and reason for visit distribution, mental and physical health status, and expenditures associated with very short-term (one to two sessions), short-term (three to 10 sessions), intermediate-term (11 to 20 sessions), and long-term (> 20 sessions) psychotherapy. RESULTS: Long-term psychotherapy accounted for 15.7% of psychotherapy users and 62.9% of total psychotherapy expenditures. Age above 65 years, black race, and less than 12 years of education decreased the likelihood of receiving long-term psychotherapy. Whereas long-term psychotherapy episodes tended to be provided by the specialty sector (65.7%) for specific mental conditions (53.8%), very short-term episodes were predominantly provided by the general medical sector (72.2%) for general medical or unspecified conditions (68.3%). Psychotropic medication use and, to less extent, psychiatric hospitalization tended to be more common among longer- as opposed to shorter-term users. CONCLUSIONS: Long-term and short-term psychotherapy tend to be provided by different health care professionals for the treatment of different types of health conditions. To help ensure the future of third-party payment for long-term psychotherapy, research is needed to better define the conditions under which long-term psychotherapy achieves benefits that equal or surpass those of other medical services or procedures of similar cost.

Adolescent↗
PubMed1994

Measuring outpatient mental health care in the United States.

A standard definition of outpatient mental health care does not now exist. Data from the 1987 National Medical Expenditure Survey are used to examine how varying the definition influences utilization estimates. A broad definition of mental health care, which requires purchase of a psychotropic medication or a psychotherapy visit or a visit for a mental health condition, captures nearly seven times as many persons as a definition that requires a visit to a mental health specialist for a mental health condition and either purchase of a psychotropic medication or psychotherapy. Because estimates of mental health service use are highly sensitive to how treatment is defined, caution should be exercised in evaluating mental health utilization data.

Ambulatory Care↗
PubMed1993

The array of psychiatric services in general hospitals.

This paper examines the frequency with which general hospitals with inpatient psychiatric units provide psychiatric emergency, outpatient, and partial hospital care. An analysis is presented of data from the 1988 American Hospital Association Annual Survey of Hospitals focusing on the number and proportion of general hospitals with psychiatric units that offer psychiatric emergency, outpatient, and partial hospital services. The vast majority (82.6%) of general hospitals with psychiatric units provided psychiatric emergency room services, approximately half (50.3%) provided psychiatric outpatient services, and slightly over a third (37.9%) offered partial hospitalization services. General hospitals with psychiatric units were more likely to provide outpatient psychiatric services if they were under private nonprofit or nonfederal governmental control than if they were under private for-profit control. General hospitals with inpatient substance abuse treatment services were more likely to provide complementary outpatient services than were general hospitals with inpatient psychiatric services (70.8% vs 50.3%). The results indicate that at half of the hospitals with psychiatric units, discharge planning necessarily involves referring patients outside of the hospital for continuing care.

Community Mental Health Services↗
PubMed1993

Trends in the prescription of antidepressants by office-based psychiatrists.

OBJECTIVE: This study was done in an effort to determine whether there was a change over the past decade in the number and proportion of patients prescribed antidepressants by psychiatrists in private practice. METHOD: The authors analyzed data from the National Ambulatory Medical Care Survey for the years 1980, 1985, and 1989, focusing on visits by adults over the age of 18 years to physicians specializing in psychiatry and psychiatric subspecialties. RESULTS: The number of visits that included prescribing an antidepressant medication grew from approximately 2.5 million in 1980 to 4.7 million in 1989, or from 17.9% to 30.4% of all office-based psychiatric visits. Fluoxetine, which first became available in 1988, accounted for 29.6% of the prescriptions for antidepressants in 1989. Increases in prescriptions for antidepressants were particularly evident for male patients, young adult patients, and patients with neurotic disorders. CONCLUSIONS: There was an increase in the 1980s in the use of antidepressants in office-based psychiatric practice. The advent of new agents and the broadening of the clinical usefulness of existing agents may have contributed to this increase.

Adult↗
PubMed1993

The roles of psychiatrists in organized outpatient mental health settings.

OBJECTIVE: This paper describes the clinical roles of psychiatrists in U.S. organized outpatient mental health settings. METHOD: Data were analyzed from the 1986 National Institute of Mental Health Client/Patient Sample Survey. The authors determined the range, volume, and content of services provided to established outpatients treated by psychiatrists at six types of mental health organizations: state and county mental hospital clinics, general hospital mental health clinics, private psychiatric hospital clinics, U.S. Department of Veterans Affairs medical center mental health clinics, free-standing mental health clinics, and multiservice mental health organizations. RESULTS: The psychiatrists treated nearly one-half (48.2%) of the established outpatients in organized settings, more than any other discipline. Most of the psychiatrists' patients (68.3%) were also treated by other mental health professionals. Psychiatrists treated a greater proportion of the patients at hospital-based clinics (60.7%) than at clinics without hospital affiliations (43.6%). They also treated larger proportions of the patients with schizophrenia (77.9%), affective disorders (50.6%), or anxiety disorders (59.2%) than those with adjustment disorders (23.7%), substance use disorders (34.3%), or childhood mental disorders (29.5%). The patients treated by psychiatrists commonly received psychotropic medications (77.3%) and individual therapy (66.3%) but less commonly received group (20.7%), skills (11.9%), or family (5.9%) therapy. CONCLUSIONS: In organized outpatient settings, psychiatrists typically work with other mental health professionals to treat a select group of severely ill patients. However, there is considerable variation in the extent to which different types of mental health organizations rely on psychiatrists to provide clinical care.

Adolescent↗
PubMed1993

Inpatient treatment of schizophrenia in general hospitals.

OBJECTIVE: To improve treatment of schizophrenic patients in short-term inpatient units, the authors review studies of interventions that have been implemented with schizophrenic patients during brief hospitalizations and suggest areas for future research. METHODS: The review is organized around seven general treatment domains, including the therapeutic alliance, continuity of care, family involvement, procurement of community services, psychosocial rehabilitation, medication compliance, and substance abuse treatment. RESULTS AND CONCLUSIONS: Because schizophrenic patients have traditionally been treated in long-term settings, little literature exists to inform interventions on short-term units. The authors suggest that general hospital staff strengthen the treatment alliance between patients and outpatient clinicians, aggressively pursue community supports, work to ensure patients' follow-up with outpatient care, and consider depot medications and patient education to promote medication compliance.

Combined Modality Therapy↗
PubMed1992

Depressive symptoms and mental health service utilization in a community sample.

This study examines the utilization of health visits for mental health purposes by community respondents with depressive symptoms. Data are drawn from first wave interviews of the Epidemiologic Catchment Area (ECA) project at the Baltimore, Durham, and Los Angeles sites. The results indicate that persons with depressive symptoms, even in the absence of a recent DIS/DSM-III disorder, are at increased risk for making mental health related visits. The risk of visiting a general medical provider or mental health specialist for mental health treatment tends to increase as the number of depressive symptoms increase. Sociodemographic factors including age, racial background, and employment status also influence the risk of making a mental health related visit.

Adolescent↗
PubMed1992

The detection of alcohol problems in a primary care clinic.

The CAGE is a four item questionnaire which is used to help clinicians identify alcohol problems. Charts of 433 primary care patients who were given a medical health form containing the CAGE questions (experimental patients) were compared with charts of 451 patients given a similar form that did not contain the CAGE questions (control patients). Alcohol problems were detected more frequently in the experimental patients (10.6%) than in the control patients (6.7%) (p < 0.05). This difference in detection tended to be most evident for persons with milder alcohol problems (problem drinking) as opposed to more well developed alcohol abuse. Experimental patients (3.7%) also tended to be more likely than control patients (2.9%) to receive active alcohol treatment during their initial medical visit. Medical health screening forms which include the CAGE questions may promote the identification of alcohol problems in primary care.

Alcoholism↗
PubMed1992

Psychiatric outpatient practice: patterns and policies.

OBJECTIVE: The purpose of this paper is to explore possible consequences of recent changes in the Medicare payment schedule for office-based psychiatric services. METHOD: Psychiatric office visits from the 1985 National Ambulatory Medical Care Survey were categorized in a manner that approximates commonly used codes of the Physicians' Current Procedural Terminology. An analysis was conducted of the frequency and clinical characteristics of various types of services, focusing particularly on visits of under 20 minutes in length that included a medication prescription (medication visits) and other visits of 35 minutes or less in duration (brief visits). RESULTS: Medication visits and brief visits together accounted for more than one-quarter (27.3%) of all U.S. psychiatric office visits. The relative risk of receiving these short visits was greater for patients who paid with public resources, were over 65 years of age, were nonwhite in race (brief visits only), received a prescription for an antipsychotic medication, or were diagnosed as having a psychotic disorder. CONCLUSIONS: Short office visits are provided to a particularly vulnerable patient population. The reduction in Medicare copayments for medication management services should increase the patient demand for these short visits. However, where the new Medicare schedule has lowered physician fees for these services, the financial incentive to provide short visits will decrease and patient access may become limited.

Adolescent↗
PubMed1992

Utilization of neuropsychiatric diagnostic tests for general hospital patients with mental disorders.

OBJECTIVE: The author's goal was to determine the frequency and distribution of neuropsychiatric diagnostic tests provided to general hospital patients with mental disorders. METHOD: Data from the 1989 National Hospital Discharge Survey were analyzed to determine the number, proportion, and general characteristics of 11,628 discharged patients with primary diagnoses of mental disorders who underwent computerized tomography (CT) scanning of the head, EEG, and magnetic resonance imaging (MRI) of the brain. RESULTS: Of the discharged patients with mental disorders, 5.1% had received CT scans, 2.8% had received EEGs, and 0.7% had received MRI. These rates were below the rates for patients discharged with primary diagnoses of neurological disorders but above the rates for patients discharged with primary diagnoses of other medical disorders. Among the patients discharged with mental disorder diagnoses, the likelihood of receiving a CT scan or an EEG was greater if the primary diagnosis was an organic disorder or if the secondary diagnosis was a medical disorder. Patients over age 65 were also more likely to have received a CT scan. Hospital size and location had a modest influence on the likelihood of receiving a CT scan or EEG, but the ownership of the hospital and the patient's source of payment were not significant influences. CONCLUSIONS: Neuropsychiatric diagnostic testing is selectively utilized in the routine treatment of general hospital psychiatric inpatients. Clinical variables rather than institutional or financial variables appear to be the most powerful predictors of which patients are selected to receive these tests.

Adolescent↗
PubMed1992

The treatment of depression: prescribing practices of primary care physicians and psychiatrists.

BACKGROUND: Depression is one of the most common mental disorders treated by primary care physicians. Concern has been expressed that primary care physicians underutilize antidepressants and overutilize anxiolytics in their management of depressive disorders. METHODS: Data from the 1980, 1985, and 1989 National Ambulatory Medical Care Surveys were used to examine the pharmacologic treatment provided by primary care physicians and psychiatrists during office visits with patients diagnosed as depressed. The number and proportion of these visits that included an antidepressant prescription or an anxiolytic prescription were determined. RESULTS: Primary care physicians and psychiatrists both prescribed antidepressants more commonly than other classes of psychotropic medications during visits that included a depression diagnosis. Compared with psychiatrists, primary care physicians more commonly prescribed antidepressants for depressive disorders (1980, 55% vs 33%; 1985, 59% vs 41%; 1989, 57% vs 45%). In 1989, benzodiazepines were prescribed in 16% of the primary care visits for depression. More than half of these visits (56%) also resulted in an antidepressant being prescribed. Primary care visits for depression tended to be slightly longer than other primary care visits, but only about half as long as patient visits with psychiatrists. CONCLUSIONS: The pharmacologic treatment of depression by primary care physicians may be better focused than previously assumed. Future research should examine the informal psychological treatment routinely provided by primary care physicians to patients with depressive disorders.

Adolescent↗
PubMed1991

Depressed patients who do and do not receive psychiatric consultation in general hospitals.

A chart review was conducted of depressed patients at three general hospitals without psychiatric units. A substantial proportion of the patients did not receive psychiatric consultation. These patients tended to be less seriously ill than those who were evaluated by consulting psychiatrists. Despite the fact that a majority of patients treated without consultation reported disturbances of mood, appetite, and sleep, as well as somatic pain for which no source was readily apparent, only a small proportion received antidepressants in standard dosages. Issues surrounding the indications for and attitudinal barriers to antidepressant use in primary care are discussed.

Antidepressive Agents↗
PubMed1991

General hospitals and the severely mentally ill: changing patterns of diagnosis.

OBJECTIVE: The author's goal is to determine whether there has been a recent change in the number and proportion of severely ill psychiatric patients treated in general hospitals. METHOD: He analyzed the discharge data from the National Hospital Discharge Survey for the years between 1970 and 1987, focusing particularly on the discharges of patients with psychiatric versus nonpsychiatric diagnoses. The number and proportion of discharges of patients with psychiatric diagnoses in four major diagnostic groups (depression, bipolar spectrum disorders, schizophrenia, and other psychoses) were determined. RESULTS: Between 1970 and 1987, discharges of patients with psychiatric diagnoses from general hospitals increased by a factor of 0.8. The percentage of discharges of patients with the diagnoses of depression (18.0%-22.7%), schizophrenia (9.4%-13.6%), and paranoid or other nonorganic psychoses (3.1%-4.0%) remained relatively constant. The percentage of discharges of patients with the diagnosis of nondepressed bipolar disorder increased from 0.6% in 1970 to 3.2% in 1987. CONCLUSIONS: Although there has been a recent absolute increase in the number of general hospital patients with severe psychiatric diagnoses, the increase has been tempered by a concomitant increase in the number of patients with nonsevere diagnoses. Changes in classification systems (DSM-II or ICDA-8 to DSM-III or ICD-9-CM) and questions regarding the rigor with which the nosologic changes have been incorporated into practice complicate the interpretation of these findings.

Hospitalization↗