Measuring costs of guideline-driven mental health care: the Texas Medication Algorithm Project

Kashner, T. Michael; Rush, A. John; Altshüler, Kenneth Z.

doi:10.1002/(sici)1099-176x(199909)2:3<111::aid-mhp52>3.0.co;2-m

Cited by 23 publications

(19 citation statements)

References 107 publications

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“…Data were drawn from an administrative database developed to assess utilization of services in TMAP 47. Medication visits were defined by a visit code of “psychiatric diagnosis” or “medication-related service” and a provider type that reflected one of the types of providers licensed to prescribe medication in Texas (MD, DO, physician assistant, or nurse practitioner).…”

Section: Treatmentmentioning

confidence: 99%

Predictors of Attrition During One Year of Depression Treatment: A Roadmap to Personalized Intervention

Warden

Rush

Carmody

et al. 2009

Journal of Psychiatric Practice

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Objective-Attrition from treatment in the short and long term for major depressive disorder (MDD) is clearly an adverse outcome. To assist in tailoring the delivery of interventions to specific patients to reduce attrition, this study reports the incidence, timing, and predictors of attrition from outpatient treatment in public mental health clinics.Methods-Outpatients with psychotic and nonpsychotic MDD receiving measurement-based care in the Texas Medication Algorithm Project (N = 179) were evaluated to determine timing and rates of attrition as well as baseline sociodemographic, clinical, and attitudinal predictors of attrition.Results-Overall, 23% (42/179) of the patients left treatment by 6 months, and 47% (84/179) left by 12 months. Specific beliefs about the impact of medication, such as its perceived harmfulness, predicted attrition at both 6 and 12 months. Younger age (p = 0.0004) and fewer side effects at baseline (p = 0.0376) were associated with attrition at 6 months. Younger age (p = 0.0013), better perceived physical functioning (p = 0.0007), and more negative attitudes about psychiatric medications at baseline (p = 0.0075) were associated with attrition at 12 months.Conclusions-Efforts to elicit attitudes about medications and tailoring educational and other retention interventions for patients with negative beliefs about antidepressants both when initiating a new medication and throughout treatment may reduce attrition. Particular focus on younger patients and those requiring frequent visits may be helpful.

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Section: Treatmentmentioning

confidence: 99%

Predictors of Attrition During One Year of Depression Treatment: A Roadmap to Personalized Intervention

Warden

Rush

Carmody

et al. 2009

Journal of Psychiatric Practice

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“…These data were integrated with administrative data obtained from various sources that include social service, criminal justice, health, mental health, alcohol and drug systems as well as information on involuntary examinations under the Florida Baker Act (civil commitment statue), and mortality. Numerous investigators have acknowledged the viability and advisability of administrative data to evaluate quality of care for large populations, given these data promote accuracy, impartiality, and cost savings (Kashner et al, 1999;Owen et al, 2003;Pandiani, Banks, Bramley, Pomeroy, & Simon, 2002;Unutzer et al, 2000). Some authors even more emphatically recommend that when evaluating mental health care, new data should only be collected if available administrative data are ''inaccessible, incomplete, or of poor quality,'' (Pandiani et al, 2002, p. 283).…”

Section: Data Sourcesmentioning

confidence: 99%

“…Second, these guidelines were selected because a comprehensive review of the literature revealed that a majority of the articles reviewed referenced the APA guidelines as those most often adopted in clinical practice (Azocar et al, 2001;DeRubeis & Crits-Christoph, 1998;Owen et al, 2000;Unutzer et al, 2000;Young et al, 2001). Third, the APA guidelines were selected for use in this study because of the challenges expressed by other researchers in operationalizing and using other guidelines for research purposes (Dickey et al, 2003;Kashner et al, 1999;Trivedi & Kleiber, 2001).…”

Section: Selection Of Practice Guidelinesmentioning

confidence: 99%

Adherence to Practice Guidelines, Clinical Outcomes, and Costs Among Medicaid Enrollees With Severe Mental Illnesses

Stiles¹,

Boothroyd²,

Dhont³

et al. 2009

Eval Health Prof

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The treatment of Medicaid enrollees diagnosed with depression or schizophrenia was examined to determine whether adherence to treatment guideline was associated with health care financing strategy, clinical outcomes, and cost-effectiveness. Individuals in a fee-for-service condition were significantly more likely to receive treatment consistent with guidelines than those in managed care. Mental health costs were higher for individuals diagnosed with schizophrenia, individuals in an acute phase of illness at intake into the study, and those receiving treatment consistent with practice guidelines. Being in an acute phase of illness and having treatment that comported with recommended practice guidelines were associated with higher total social costs. Policy implications of the findings and recommendations for future research are discussed.

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“…9 Kashner et al discuss the development of the costeffectiveness component of the Texas Medication Algorithm Project in this issue. 10 Other quality improvement studies have added similar cost components. 5 Meta-analysis may become even more important as the lack of statistical precision for broader health and cost outcome measures is a ubiquitous problem.…”

Section: Where Systematic Reviews May Become Important: Real-world Efmentioning

confidence: 99%

What type of information is needed to inform mental health policy?

Sturm

1999

J. Mental Health Policy Econ.

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Measuring costs of guideline-driven mental health care: the Texas Medication Algorithm Project

Cited by 23 publications

References 107 publications

Predictors of Attrition During One Year of Depression Treatment: A Roadmap to Personalized Intervention

Predictors of Attrition During One Year of Depression Treatment: A Roadmap to Personalized Intervention

Adherence to Practice Guidelines, Clinical Outcomes, and Costs Among Medicaid Enrollees With Severe Mental Illnesses

What type of information is needed to inform mental health policy?

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