Beyond Parity: Primary Care Physicians' Perspectives On Access To Mental Health Care

Cunningham, Peter

doi:10.1377/hlthaff.28.3.w490

Cited by 368 publications

(232 citation statements)

References 14 publications

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“…The effect of criminal justice involvement was most pronounced in groups with high medical needs such as those with Medicare or Medicaid, and in groups with traditionally poor access to primary care such as the uninsured and those with serious psychological distress. 36,37 Differences in effect size across subgroups (and direction in the case of race/ethnicity) highlight the fact that the exposure of interest, criminal justice involvement, is not evenly distributed in our society and can have very different consequences for different subgroups. 38 Further work is needed to understand the mechanisms underlying these findings.…”

Section: Discussionmentioning

confidence: 99%

Increased Hospital and Emergency Department Utilization by Individuals with Recent Criminal Justice Involvement: Results of a National Survey

et al. 2014

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BACKGROUND: Individuals involved with the criminal justice system have increased health needs and poor access to primary care. OBJECTIVE: To examine hospital and emergency department (ED) utilization and related costs by individuals with recent criminal justice involvement. DESIGN: Cross-sectional survey. PARTICIPANTS: Non-institutionalized, civilian U.S. adult participants (n=154,356) of the National Survey on Drug Use and Health (2008-2011). MAIN MEASURES: Estimated proportion of adults who reported past year 1) hospitalization or 2) ED utilization according to past year criminal justice involvement, defined as 1) parole or probation, 2) arrest without subsequent correctional supervision, or 3) no criminal justice involvement; estimated annual expenditures using unlinked data from the Medical Expenditure Panel Survey. KEY RESULTS: An estimated 5.7 million adults reported parole or probation and an additional 3.9 million adults reported an arrest in the past year. Adults with recent parole or probation and those with a recent arrest, compared with the general population, had higher rates of hospitalization (12.3 %, 14.3 %, 10.5 %; P<0.001) and higher rates of ED utilization (39.3 %, 47.2 %, 26.9 %; P<0.001). Recent parole or probation was an independent predictor of hospitalization (adjusted odds ratio [AOR], 1.21; 95 % confidence interval [CI], 1.02-1.44) and ED utilization (AOR, 1.35; 95 % CI, 1.12-1.63); Recent arrest was an independent predictor of hospitalization (AOR, 1.26; 95 % CI, 1.08-1.47) and ED utilization (AOR, 1.81; 95 % CI, 1.53-2.15). Individuals with recent criminal justice involvement make up 4.2 % of the U.S. adult population, yet account for an estimated 7.2 % of hospital expenditures and 8.5 % of ED expenditures. CONCLUSIONS: Recent criminal justice involvement is associated with increased hospital and ED utilization and costs. The criminal justice system may offer an important point of contact for efforts to improve the

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Section: Discussionmentioning

confidence: 99%

Increased Hospital and Emergency Department Utilization by Individuals with Recent Criminal Justice Involvement: Results of a National Survey

et al. 2014

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“…Many areas have at least a minimally adequate number of non-prescribing mental health providers; however, rural areas and low-income areas are most likely to have an inadequate supply of such providers. Primary care providers report greater difficulties acquiring mental health referrals for their patients than for other types of specialty care (Cunningham 2009). Even when mental health providers are in adequate supply, they traditionally focus more on individual care and not family-centered care.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Trajectories and Service Needs for Military Families

Link

Palinkas

2013

Clin Child Fam Psychol Rev

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The deployment of US military personnel to recent conflicts has been a significant stressor for their families; yet, we know relatively little about the long-term family effects of these deployments. Using data from prior military service eras, we review our current understanding of the long-term functioning and needs of military families. These data suggest that overseas deployment, exposure to combat, experiencing or participating in violence during war deployment, service member injury or disability, and combat-related post-traumatic stress disorder (PTSD) all have profound impacts on the functioning of military families. We offer several recommendations to address these impacts such as the provision of family-centered, trauma-informed resources to families of veterans with PTSD and veterans who experienced high levels of combat and war violence. Recent efforts to address the needs of caregivers of veterans should be evaluated and expanded, as necessary. We should also help military families plan for predictable life events likely to challenge their resilience and coping capacities. Future research should focus on the following: factors that mediate the relationship between PTSD, war atrocities, caregiver burden, and family dysfunction; effective family-centered interventions that can be scaled-up to meet the needs of a dispersed population; and system-level innovations necessary to ensure adequate access to these interventions.

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“…Greater collaboration is needed between primary care physicians and specialty mental health professionals. In a recent survey, approximately two-thirds of primary care physicians reported that they could not get outpatient mental health care for their patients with mental health problems (23). In fact, barriers to accessing medical services are approximately twice as common for mental health care as they are for other types of medical services (23).…”

Section: Discussionmentioning

confidence: 99%

Assault and Mental Disorders: A Cross-Sectional Study of Urban Adult Primary Care Patients

Glover¹,

Olfson²,

Gameroff³

et al. 2010

Psychiatric Services

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Objective This study estimated the strength of associations between self-reported assault and psychiatric disorders among low-income, urban primary care patients who were predominantly female. Methods A sample of adult patients who consecutively presented at an urban primary care practice completed the Life Events Checklist (N=1,157). They were also screened for current major depression, panic disorder, generalized anxiety disorder, and substance use disorders with the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire; for bipolar disorder with the Mood Disorder Questionnaire; and for posttraumatic stress disorder (PTSD) with the PTSD Checklist–Civilian Version. A total of 977 of the respondents reported whether they had ever experienced an assault. Logistic regression was used to model associations between self-reported assault and screen status, controlling for relevant sociodemographic and clinical characteristics. Results Twenty-five percent of study participants endorsed a history of physical or sexual assault. Compared with patients without a history of assault, patients with a history of assault had significantly greater odds of screening positive for PTSD (odds ratio [OR]=1.97, 95% confidence interval [CI]=1.19–3.25), alcohol use disorder (OR=2.17, CI=1.07–4.41), and drug use disorder (OR=3.38, CI=1.14–9.98). Conclusion A history of assault was related to risk of screening positive for PTSD and a substance use disorder. These findings support assessment of trauma history among low-income primary care patients.

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Beyond Parity: Primary Care Physicians' Perspectives On Access To Mental Health Care

Cited by 368 publications

References 14 publications

Increased Hospital and Emergency Department Utilization by Individuals with Recent Criminal Justice Involvement: Results of a National Survey

Increased Hospital and Emergency Department Utilization by Individuals with Recent Criminal Justice Involvement: Results of a National Survey

Long-Term Trajectories and Service Needs for Military Families

Assault and Mental Disorders: A Cross-Sectional Study of Urban Adult Primary Care Patients

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