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Value of health information exchanges to support public health reporting
Published in Edward M. Rafalski, Ross M. Mullner, Healthcare Analytics, 2022
A typical patient is treated by multiple physicians in multiple settings for several comorbid conditions. They are often responsible for coordinating their own care, seeking providers who belong to different delivery systems and are unaware of any given provider’s actions thereby receiving needless duplicative clinical workups as a result. According to NEJM about 16 physicians coordinate care for chronic conditions for one patient. Between 42% and 70% of Medicare patients admitted to the hospital received services from a mean of 10 or more physicians during their stay. AHRQ reports that 42% patients routinely fall between the cracks in transfers and have significant problems in information exchange. One in five discharged patients have an adverse event within 3 weeks, missing information necessary for ensuring discharge compliance.
Physical Activity in Individuals with Chronic Conditions
Published in James M. Rippe, Increasing Physical Activity, 2020
Physical Activity can play an important role for individuals who have chronic conditions. It can assist in the therapy of a chronic condition such as in formal rehabilitation programs. Physical activity can also lower the risk of developing chronic conditions and play an important role in reducing likelihood of comorbid conditions in individuals with chronic conditions (1, 4). Moreover, physical activity can play an important role in preventing chronic conditions from getting worse over time.
A framework for medical rehabilitation: Restoring function and improving quality of life
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Despite the emerging science of rehabilitation, there remain many unanswered questions: What is the ideal/minimally effective dose and intensity of rehabilitation interventions? What is the optimal interprofessional model of care? What is the ideal balance between compensation and remediation? What is the sustainability of rehabilitation benefits? Does comprehensive self-management education work? How could tele-rehabilitation and artificial intelligence reduce the cost of rehabilitation? How can biologically active agents enhance the benefits of rehabilitation? How do we manage those with other comorbid conditions?
Mental Health Needs of Aging Veterans: Recent Evidence and Clinical Recommendations
Published in Clinical Gerontologist, 2022
Michele J. Karel, Laura O. Wray, Geri Adler, Alisa O’ Riley Hannum, Katherine Luci, Laura A. Brady, Marsden H. McGuire
Among older Veterans, mental illness is associated with significant increases in medical comorbidity, including dementia, and mortality (Beristianos, Yaffe, Cohen, & Byers, 2016; Bohnert et al., 2013; Byers, Covinsky, Barnes, & Yaffe, 2012; Phillips et al., 2009; Zivin et al., 2015). Mental illness is also associated with decreased social support (Durai et al., 2011; Kuwert, Knaevelsrud, & Pietrzak, 2014) and increased suicide risk in older Veterans (Fanning & Pietrzak, 2013). Further, comorbid medical and mental illness may also be associated with increased health care utilization and costs (Trivedi et al., 2018; Yoon et al., 2012). To address these concerns over the past decade, VHA has integrated mental health professionals across the continuum of care, including primary and geriatric care, to enhance access to mental health services for Veterans of all ages (Karlin & Karel, 2014; Karlin & Zeiss, 2010; Kearney, Post, Pomerantz, & Zeiss, 2014). While access to mental health services for Veterans has improved, it is not clear to what extent older Veterans are accessing mental health services across the continuum of care and how well their care needs are being addressed.
A clinical approach to treatment resistance in depressed patients: What to do when the usual treatments don’t work well enough?
Published in The World Journal of Biological Psychiatry, 2021
Seetal Dodd, Michael Bauer, Andre F. Carvalho, Harris Eyre, Maurizio Fava, Siegfried Kasper, Sidney H. Kennedy, Jon-Paul Khoo, Carlos Lopez Jaramillo, Gin S. Malhi, Roger S. McIntyre, Philip B. Mitchell, Angela Marianne Paredes Castro, Aswin Ratheesh, Emanuel Severus, Trisha Suppes, Madhukar H. Trivedi, Michael E. Thase, Lakshmi N. Yatham, Allan H. Young, Michael Berk
Given the high level of heterogeneity among persons with MDD, deconstruction of their ‘depression’ diagnosis into elements of formulation may be helpful (Macneil et al. 2012). Most formulation models emphasise the impact of understanding predisposing, precipitating, perpetuating and protective factors. Understanding a person’s depression in terms of formulation elements may be helpful to conceptualise the person’s current situation. For example, these may include (i) high genetic loading for persistent depression among multiple family members, (ii) possible underlying aetiological factors that may be different for those with earlier or later age of onset, (iii) the impact of early or ongoing life events that perpetuate depression, (iv) lifestyle factors, comorbid substance use, medical or psychiatric conditions, (v) early life experiences, development and subsequent cognitive schemas, (vi) personality strengths and difficulties and (vii) current supports. Figure 1 demonstrates a hypothetical deconstruction of a population of persons presenting with major depression that remain resistant to treatment.
The Individualized Addictions Consultation Team Residential Program: A Creative Solution for Integrating Care for Veterans With Substance Use Disorders Too Complex for Other Residential Treatment Programs
Published in Journal of Dual Diagnosis, 2021
Sarah Keating, Sadie E. Larsen, Jane Collingwood, Heather M. Smith
Substance use disorders (SUDs) are prevalent in the United States, particularly among military veterans (Teeters et al., 2017). Within the Department of Veteran Affairs (VA) system, alcohol use disorder is particularly common. In the fiscal year 2012, nearly 400,000 veterans were diagnosed with alcohol use disorder, with approximately a third of those receiving specialty alcohol use disorder treatment, and about 15,000 participating in residential treatment within the VA for alcohol use (Finlay et al., 2017). The VA is among the main providers of treatment for alcohol and other drug use within the United States (Chang et al., 2016), with 69 residential treatment programs dedicated to the rehabilitation of veterans diagnosed with SUDs. Individuals who are admitted to residential treatment programs often have comorbid diagnoses that can complicate care. About half of those with severe mental illness (SMI) have a co-occurring SUD (Drake et al., 2004). This vulnerable dual diagnosis group suffers higher rates of relapse, hospitalizations, violence, incarceration, homelessness, victimization and serious infections such as HIV and hepatitis C (Drake et al., 2004; Teeters et al., 2017). In this paper we evaluated one residential treatment model, the Individualized Addictions Consultation Team (I-ACT) program, that was designed to personalize both group and individual treatment to most effectively reach a population with a primary SUD and other complicating comorbid factors (e.g., psychosis, cognitive limitations).