Exploring Personal Medicine as Part of Self-Directed Care: Expanding Perspectives on Medical Necessity

Snethen, Gretchen; Bilger, Andrea; Maula, Erme C.; Salzer, Mark S.

doi:10.1176/appi.ps.201500311

Cited by 21 publications

(25 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Descriptive analysis of nontraditional purchases revealed that the most common were for needs related to transportation, communication, medical expenses, housing, and health and wellness. These findings were surprisingly consistent with those from the study of a mental health self-directed care program in Pennsylvania, in which the most common nontraditional expenditures were related to transportation, maintaining health, diet and fitness, and handling stress (51), and with those from a study of a mental health self-directed care program in Florida, in which the most common nontraditional expenditures were in the categories of fitness, wellness, medical needs, transportation, and self-help (15). As others have noted, the consistency of these nontraditional purchases suggests that services and supports available from the traditional mental health system are inadequate to meet consumer needs (16).…”

Section: Discussionsupporting

confidence: 84%

“…As others have noted, the consistency of these nontraditional purchases suggests that services and supports available from the traditional mental health system are inadequate to meet consumer needs (16). These results also suggest that participants have insight into what would best support their recovery and that enhancing their range of choices facilitates the development of the personal medicine necessary to enhance their own mental health (51).…”

Section: Discussionmentioning

confidence: 72%

See 1 more Smart Citation

Mental Health Self-Directed Care Financing: Efficacy in Improving Outcomes and Controlling Costs for Adults With Serious Mental Illness

Cook

Shore

Burke-Miller

et al. 2019

View full text Add to dashboard Cite

Self-directed care allows individuals with disabilities and elderly persons to control public funds to purchase goods and services that help them remain outside institutional settings. This study examined effects on outcomes, service costs, and user satisfaction among adults with serious mental illness. Methods: Public mental health system clients were randomly assigned to self-directed care (N=114) versus services as usual (N=102) and assessed at baseline and 12 and 24 months. The primary outcome was self-perceived recovery. Secondary outcomes included psychosocial status, psychiatric symptom severity, and behavioral rehabilitation indicators. Mixedeffects random-regression analysis tested for longitudinal changes in outcomes between the two conditions. Differences in service costs were analyzed with negative binomial and zero-inflated negative binomial regression models. Results: Compared with the control group, self-directed care participants had significantly greater improvement over time in recovery, self-esteem, coping mastery, autonomy support, somatic symptoms, employment, and education. No betweengroup differences were found in total per-person service costs in years 1 and 2 or both years combined. However, selfdirected care participants were more likely than control group participants to have zero costs for six of 12 individual services and to have lower costs for four. The most frequent nontraditional purchases were for transportation (21%), communication (17%), medical care (15%), residential (14%), and health and wellness needs (11%). Client satisfaction with mental health services was significantly higher among intervention participants, compared with control participants, at both follow-ups. Conclusions: The budget-neutral self-directed care model achieved superior client outcomes and greater satisfaction with mental health care, compared with services as usual.

show abstract

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 72%

Mental Health Self-Directed Care Financing: Efficacy in Improving Outcomes and Controlling Costs for Adults With Serious Mental Illness

Cook

Shore

Burke-Miller

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Statistics showed that the average length of hospital stay in the United States is 6.9 days/person, Australia is 7.4 days/person, and Ireland is 9.0 days/person while the average length of hospital stay for Grade-A tertiary hospital of China is 13.5 days/person. [ 9 ] Researches also showed that the excessive length of hospital stay is not entirely due to the needs of clinical diagnosis and treatment. Moreover, the phenomenon might be a large extent, results from defects of the medical management control, and low work efficiency.…”

Section: Discussionmentioning

confidence: 99%

Research on 2041 Cases of High Inpatient Expenditure and Influence Factors during 3 Years in a Single Center

Pan

Wei

et al. 2016

Chinese Medical Journal

View full text Add to dashboard Cite

Background:The study was to explore the causes of high inpatient expenditure through analyzing the distribution characteristics as well as the influence factors of high inpatient expenditure cases during 3 years within a Grade-A tertiary hospital through various aspects and multiple angles, thus identifying the major influence factors for high medical expenditure to develop further research.Methods:We retrospectively studied 2041 inpatient cases which cost more than RMB 100,000 Yuan per case in a Grade-A tertiary hospital from 2013 to 2015. We analyzed the compositions of the medical cost to evaluate the major factors that cause the high inpatient expenditure. All the data and materials were collected from medical record system, and the statistical methods included t-test, variance of analysis, and multivariate linear regression.Results:The average cost of the 2,041 cases was RMB 152,173 Yuan for medicines and materials of medical costs, which respectively accounted for 33.03% and 32.32% of the total cost; and the average length of hospital stay was 28.39 days/person. Diseases of skeletal and muscular system, circulatory system, and tumor were the top three disease categories of high inpatient expenditure, which accounted for 39.00%, 33.46%, and 18.03%, respectively. Complications, criticality of the disease, gender of the patients, the occurrence of death, and the excessive length of hospital stay all had great impacts on average medical expenditure, while age, hospital infection, and surgery showed no significant impact on average medical cost.Conclusions:The main factors for high inpatient expenditure included the inadequate use of high-value medicines and materials, lacking cost control measures within the hospital, the excessive length of hospital stay for inpatients, and the unnecessary treatment for the patients.

show abstract

“…community in a manner similar to everyone else. There is ample evidence suggesting that community participation is a medical necessity itself, having a positive impact on the physical, cognitive, and mental health of individuals with serious mental illnesses (11,12). Physical health issues are associated with limited energy and pain, which could reduce enthusiasm for participation and lead to diminished stamina.…”

mentioning

confidence: 99%

Associations Between Physical Health Limitations and Community Participation Among People With and Without Serious Mental Illnesses

Townley

Terry

Brusilovskiy³

et al. 2019

Self Cite

View full text Add to dashboard Cite

Research has suggested that individuals with serious mental illnesses are not as physically healthy as the general population and are more likely to experience physical illnesses such as diabetes, obesity, and cardiovascular and respiratory diseases. Less is known about how physical health may be related to community participation among individuals with serious mental illnesses, although research with adults in the general population has suggested strong negative associations between health impairments and engagement in a variety of activity domains. Methods: In this study, the authors drew from two national data sets to examine the relationship between physical health impairments and community participation among 300 participants with serious mental illnesses and 300 participants without serious mental illnesses. Results: For participants in both groups, physical health concerns and use of mobility aids were associated with lower reported rates of community participation. Conclusions: Findings shed light on the complex association between physical health impairments and community participation while also suggesting the need to focus on other potential barriers to participation among individuals with serious mental illnesses.

show abstract

Exploring Personal Medicine as Part of Self-Directed Care: Expanding Perspectives on Medical Necessity

Cited by 21 publications

References 30 publications

Mental Health Self-Directed Care Financing: Efficacy in Improving Outcomes and Controlling Costs for Adults With Serious Mental Illness

Mental Health Self-Directed Care Financing: Efficacy in Improving Outcomes and Controlling Costs for Adults With Serious Mental Illness

Research on 2041 Cases of High Inpatient Expenditure and Influence Factors during 3 Years in a Single Center

Associations Between Physical Health Limitations and Community Participation Among People With and Without Serious Mental Illnesses

Contact Info

Product

Resources

About