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Biomedical subjects

Nancy Wolff

Publications and source records attributed to Nancy Wolff.

9 recordsLinked to original sources
PubMed2002

Clinicians as advocates: an exploratory study of responses to managed care by mental health professionals.

Utilization review and other managed care techniques require that health care professionals assume new responsibilities as patient advocates. This article explores the extent to which characteristics of providers or their experiences with managed care practices predict the nature and extent of advocacy behavior. Interviews of 142 mental health providers revealed that experiences of harmful utilization review and norms of professionalism significantly predicted advocacy behavior. However, providers who were concerned about disaffiliation were less likely to challenge the plan directly but more likely to alter their presentation of the case to reviewers. Providers who believe that managed care plans retaliate against advocacy behavior appear to substitute covert advocacy for direct advocacy. These results are preliminary but suggest that providers condition their advocacy behavior in response to their experiences with and perceptions of managed care plans.

Behavioral Medicine↗
PubMed2002

State mental hospitals and their host communities: the origins of hostile public reactions.

This article examines the hostile public reactions of a community that, through a state policy to consolidate all long-term behavioral health services, was to become the site of the state's only mental hospital. A telephone survey conducted in the host community (n = 800) and a matched community (n = 800) was used to test whether the origins of hostility toward consolidation were related to the public's negative attitudes toward mental illness and homelessness or to the beliefs about the discharge and supervisory behavior of the hospital. The host community was not found to have more negative views of mental illness, although it did have significantly more negative views about the homeless. Disapproval of consolidation was unrelated to negative views of mental illness or homelessness but was strongly related to the expected "bad" behavior of the hospital. These results suggest that the best way to improve relations between hospitals and their host communities is for hospitals to behave like "good" neighbors.

Attitude to Health↗
PubMed2002

The impact of drug pricing policies on the health of the elderly.

BACKGROUND: Prices for prescription drugs vary widely in the United States, from the prices charged by retail pharmacies to 50% below average wholesale prices (AWP), depending on the purchaser's bargaining power. At higher drug prices, expenditures for essential preventive interventions, such as those aimed at hypertension and hypercholesterolemia, buy less health for the elderly. The magnitude of this effect, however, is unknown. METHODS: Cost-effectiveness analyses of drug interventions, which estimate their health effects and costs, sometimes include analyses of the impact of drug prices. We use results from studies of preventive drugs used by the elderly to calculate the life-years that could be purchased for $1 million of expenditure at the AWP, and at prices 20% and 40% below the AWP. This range reflects the range of prices in the United States today. RESULTS: Drug prices have a substantial effect on the amount of health that can be purchased for $1 million, especially among elderly people with several health conditions. For example, at 40% below the AWP, $1 million spent on statins yields 90 years of life for patients aged 75 to 84 with a history of myocardial infarction. At the AWP, the number of life-years for $1 million drops to 48--a loss of 42 life-years. CONCLUSIONS: A Medicare drug benefit program that supports prices at the high end of the current range could yield substantially less health for the elderly, and one that promotes differential pricing could promote unequal access to preventive medications--and thus to health--by Medicare beneficiaries across the country.

Aged↗
PubMed2002

Release planning for inmates with mental illness compared with those who have other chronic illnesses.

The authors evaluated the effort of New Jersey jails to plan for the postrelease treatment needs of inmates with mental illness compared with inmates with heart disease and HIV infection or AIDS. Seventy percent of interviewees expressed a belief that release planning for persons with serious mental illness is very or extremely important. However, virtually all the jails reported providing "no real release planning." A majority of the jails provide aftercare plans for fewer than 10 percent of inmates with serious mental illness. A lack of release planning was noted for the other chronic conditions. Release planning for particular chronic problems is most common and complete in facilities with special treatment programs, such as a mental health unit.

Chronic Disease↗
PubMed2002

Risk, response, and mental health policy: learning from the experience of the United Kingdom.

Policy makers in the United States and the United Kingdom recognize that mentally disordered offenders present special challenges to law enforcement, mental health, and social service systems, as well as the community. Although various policy initiatives have advanced over the past twenty years to improve the management of mentally disordered offenders, mental health policy has chronically failed in both countries. Because safety concerns have emerged as the mental health system has been "deinstitutionalized," debate is growing about whether the community-care approach works-for the community. This study argues that mental health policy fails because policy makers focus on the wrong risks and design policies that manage these risks in ways that increase the possibility of adverse clinical and economic outcomes. The argument made here uses the case of persons with severe mental illness in the United Kingdom as an example of the complex relationship between risk and policy making in democratic governance. Emphasis is on the nature of risk in mental health policy and how government responds to policy and political risks. Mental health policy in Britain is then analyzed in terms of its response to and management of risks. Mental health policy has historically mismanaged the risk issue in the United Kingdom and as such has set in motion the growing community-care backlash. The path to a better outcome lies in the responsible management of the right risks. Lessons from the United Kingdom experience can be usefully applied to mental health issues in many industrial democracies.

Attitude to Health↗
PubMed2000

Using randomized controlled trials to evaluate socially complex services: problems, challenges and recommendations.

BACKGROUND: Following the lead of evidence-based medicine, practice based on effectiveness research has become the new gold standard of contemporary public policy. Studies of this sort are increasingly demanded to evaluate services provided by mental health, social services and criminal justice systems. AIMS: The paper questions whether the simple randomized controlled trial (RCT) paradigm as applied in clinical trials can be used "off the rack" to evaluate socially complex service (SCS) interventions. These are services that are characterized by complex, diverse and non-standardized staffing arrangements; ambiguous protocols; hard-to-define study samples and unevenly motivated subjects and dependence on broader social environments. The difficulty of ensuring precise protocols, equivalent groups (tied to a meaningful target population) and neutral and equivalent trial environments under real world conditions are explored, as are the implications of not achieving standardization and equivalence. METHODS: Limitations of effectiveness research as a research tool and information source are examined by comparing the assumptions underpinning the simple RCT to the characteristics of SCS interventions, as illustrated by programs targeted to mentally disordered offenders in Britain. RESULTS: SCSs violate the assumptions underpinning the simple RCT model in ways that draw into sharp question the validity, reliability and generalizability of inferences of SCS trials. DISCUSSION: The RCT is not a panacea. Effectiveness research of SCS interventions that is based on the RCT model is unlikely to yield valid, reliable and generalizable inferences without becoming more complex in design and more sensitive to issues of selection bias, unmeasured variables and endogeneity. Ten recommendations are offered for stylizing the RCT design to the characteristics of socially complex services. IMPLICATIONS: It remains an empirical issue whether RCT-based services effectiveness research can inform mental health policy. Without major design innovations, it is more likely that the information generated by this research will have limited practical use, especially if the RCT model is unable to control for the effect of social complexity and the interaction between social complexity and dynamic systemic change. Scientific evaluations of services make clinical and economic sense so long as they are designed to meet the challenges of the services of which they promise greater knowledge.

Journal Article↗