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PubMed2006

Return to work expectation predicts work in chronic musculoskeletal and behavioral health disorders: prospective study with clinical implications.

STUDY DESIGN: Prospective cohort study with 18-month follow-up. OBJECTIVE: To investigate if long-term sick listed persons' own predictions of their future return to work (RTW) have an impact on their RTW when controlling for other established factors. METHOD: Postal questionnaires at baseline were sent to persons who had been on sick leave for more than 90 days, and were employed in five municipalities and four county councils in Sweden. A follow-up regarding their RTW was performed 18 months later. RESULTS: After 18 months 135 out of 508 persons (27%) had returned to work, full or part-time. In a multivariate logistic regression, the sick listed persons' own prediction of their RTW proved to be highly significant (OR=8.28, 95% CI: 3.31-20.69). Only six out of 132 persons with a negative view of their RTW did return to wok. Other predictive factors that were found for RTW were: being on sick leave for a period of less than 1 year (OR=2.09, 95% CI: 1.19-3.67), having less pain than persons in the quartile with most pain (OR=2.65, 95% CI: 1.21-5.81), perceiving that one was welcome back to work (OR=1.98, 95% CI: 1.10-3.58), and being under 55 years of age (OR=2.37, 95% CI: 1.07-5.23 for age between 45 and 54 years and the same trend for age below 45 years OR=1.85, 95% CI: 0.82-4.20). CONCLUSION: Persons with a positive prediction should get help to realise their potential for RTW. Offering traditional rehabilitation measures to a person with a negative prediction of his/her RTW, could be a waste of resources if done ahead of improving self-confidence and view of what is possible. The problems in this group might decrease or be easier to handle if decisions about the future are taken within a year.

Adult↗
PubMedDate not supplied

Access of behavioral health patients to prescribing professionals.

OBJECTIVE: Advanced practice nurses (APNs), including clinical nurse specialists and nurse practitioners, now have prescribing privileges in all states. This study examined the proportion of Department of Veteran Affairs (VA) mental health patients who were seen by any prescribing professional and specifically the proportion and characteristics of patients who were treated exclusively by APNs. METHOD: Logistic regression models were used to examine data on all patients who received care in VA specialty mental health clinics in 2002 (n=767,920). We first identified patient characteristics independently associated with prescriber contact and, secondly, among those with prescriber contact, exclusive contact with an APN. We also compared characteristics of patients seen exclusively by an APN with those who saw both a physician and an APN. RESULTS: The strongest predictors of both whether a veteran saw a prescriber (66.6%) and whether that prescriber was exclusively an APN (6.7%) were indicators of severity. Specifically, more severe diagnoses, such as schizophrenia or bipolar disorder, receipt of VA disability payments and greater service use increased the odds that a veteran would have had a prescriber contact, decreased the odds that they would see an APN exclusively and, among those who saw an APN, increased the odds that they would also see a physician. CONCLUSIONS: Patients who see physician prescribers have more severe mental health problems than those who see APNs. Our results indicate that APNs and physicians treat distinguishable patient populations, suggesting that APNs may not be substitutes for physicians.

Adult↗
PubMedDate not supplied

Screening for health behaviors in ambulatory clinical settings: does smoking status predict hazardous drinking?

Although a link between alcohol consumption and smoking behavior is well documented, the majority of studies have focused on individuals dependent on both alcohol and nicotine. The present study examined the likelihood of hazardous drinking as a function of smoking status, gender, age, ethnicity, and education in a sample of 676 medical and dental patients whose drinking covered the spectrum from abstinence to high levels. We hypothesized that hazardous drinking would be more common among young, male respondents who were current smokers and that past smokers would show a risk of hazardous drinking that was intermediate between that of current smokers and nonsmokers. Results showed that younger age, fewer years of education, male gender, and current smoking status were significant predictors of hazardous drinking. However, there was no relationship between a past history of smoking and current risk of hazardous drinking. Evaluation of the Fagerstrom Tolerance Questionnaire (FTQ) showed that it was no more useful as a screening instrument than a single question that elicited current smoking status. These findings suggest that patients who report current smoking should routinely be asked about their current alcohol consumption. Interventions should then be tailored to address smoking and, if appropriate, hazardous drinking as well.

Adult↗
PubMed2000

Behavioral health expenditures and state organizational structure.

The authors present a study on expenditures by state mental health, substance abuse, and developmental disability agencies in the United States for the period between 1981 and 1993. The relationship between agency spending and organizational structure of state bureaucracy was examined. Results indicate that organizational structure is a determinant of agency spending. The more independent an agency, the higher its spending; conversely, the more independent its competitor, the lower the agency's spending. The number of levels between an agency and the governor's office was not significant in explaining agency expenditures.

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PubMed1998

A provider assessment of the Massachusetts Medicaid Managed Behavioral Health Program: year four.

A stratified, random sample of 80 providers in the Massachusetts Medicaid Managed Mental Health/Substance Abuse Program were interviewed by phone to assess their views of the program in year four. Providers continued to believe that access and quality were the same or better than a year earlier, that client severity continued to increase while length of stay decreased, that readmissions and emergency room admissions were the same as a year earlier, and that aftercare was the same or better than a year earlier. Substantial problems were reported in the integration of services, in linkages with support services, and with administration of the program.

Adult↗
PubMed1992

An educational test of health behavior models in relation to emergency helping.

This study used a true experimental design to evaluate the quality and occurrence of emergency helping behavior among university first-aid students in response to a supplemental educational unit designed to improve bystander helping. The educational unit addressed the inhibitors of emergency helping behavior within the framework of bystander behavior models and was delivered using several behavior modification strategies. Using chi-square analysis, it was found that the 43 treatment students exposed to the supplemental unit responded appropriately to a simulated emergency more often than 41 similar control students not exposed to the unit (32.6% vs. 7.3%, p = .004) and that the effect was confined primarily to women (p = .001). Future emergency care education incorporating similar theory-based educational strategies might improve trained bystander responsiveness and thus enhance the efficiency of prehospital care. Theoretical and future research implications are discussed.

Curriculum↗