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3.
BMC Health Serv Res ; 20(1): 157, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32122341

RESUMO

BACKGROUND: People living with dementia in care homes frequently exhibit "behaviour that challenges". Anti-psychotics are used to treat such behaviour, but are associated with significant morbidity. This study researched the feasibility of conducting a trial of a full clinical medication review for care home residents with behaviour that challenges, combined with staff training. This paper focusses on the feasibility of measuring clinical outcomes and intervention costs. METHODS: People living with moderate to severe dementia, receiving psychotropics for behaviour that challenges, in care homes were recruited for a medication review by a specialist pharmacist. Care home and primary care staff received training on the management of challenging behaviour. Data were collected at 8 weeks, and 3 and 6 months. Measures were Neuropsychiatric Inventory-Nursing Home version (NPI-NH), cognition (sMMSE), quality of life (EQ-5D-5 L/DEMQoL) and costs (Client Services Receipt Inventory). Response rates, for clinical, quality of life and health economic measures, including the levels of resource-use associated with the medication review and other non-intervention costs were calculated. RESULTS: Twenty-nine of 34 participants recruited received a medication review. It was feasible to measure the effects of the complex intervention on the management of behaviour that challenges with the NPI-NH. There was valid NPI-NH data at each time point (response rate = 100%). The sMMSE response rate was 18.2%. Levels of resource-use associated with the medication review were estimated for all 29 participants who received a medication review. Good response levels were achieved for other non-intervention costs (100% completion rate), and the EQ-5D-5 L and DEMQoL (≥88% at each of the time points where data was collected). CONCLUSIONS: It is feasible to measure the clinical and cost effectiveness of a complex intervention for behaviour that challenges using the NPI-NH and quality of life measures. TRIAL REGISTRATION: ISRCTN58330068. Retrospectively registered, 15 October 2017.


Assuntos
Medicina do Comportamento/economia , Demência/tratamento farmacológico , Demência/psicologia , Assistência Farmacêutica/economia , Psicotrópicos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Revisão de Uso de Medicamentos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Casas de Saúde , Resultado do Tratamento , Reino Unido
5.
Int J Behav Med ; 27(2): 140-141, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32140932

RESUMO

This is one in a series of statistical guidelines designed to highlight common statistical considerations in behavioral medicine research. The goal is to briefly discuss appropriate ways to analyze and present data in the International Journal of Behavioral Medicine (IJBM). Collectively the series will culminate in a set of basic statistical guidelines to be adopted by IJBM and integrated into the journal's official Instructions for Authors, and also to serve as an independent resource. If you have ideas for a future topic, please email the Statistical Editor, Suzanne Segerstrom at segerstrom@uky.edu.


Assuntos
Medicina do Comportamento , Interpretação Estatística de Dados , Guias como Assunto , Humanos
7.
Diabetes Res Clin Pract ; 161: 108071, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32057961

RESUMO

AIMS: Identify the prevalence of health psychology use in children with type 1 diabetes (T1D) and evaluate how individual and contextual characteristics are associated with use. METHODS: Children ages 8-16 years with T1D and their parents were recruited from two tertiary diabetes clinics. Cross-sectional data included parent and adolescent surveys and hemoglobin A1c. Parents self-reported the child's use of health psychology in the last year along with individual factors (e.g., predisposing factors including demographics, enabling factors including health insurance type, evaluated need including mental health diagnoses and perceived need including self-management barriers). Association of health psychology use with individual (e.g., demographics, enabling factors, evaluated and perceived need) and contextual (e.g., clinical site) characteristics was evaluated using logistic regression. RESULTS: Of 363 eligible participants, 267 (74%) participated. Health psychology use was reported by only 8.2% (n = 22) of participants and was significantly associated with evaluated need factor of mental health diagnosis (OR 5.8; p < 0.001) and perceived need factor of parent-reported self-management barriers. Use was not associated with other individual or contextual factors. CONCLUSIONS: Though infrequent, health psychology use was positively associated with mental health diagnoses and self-management barriers.


Assuntos
Medicina do Comportamento/métodos , Diabetes Mellitus Tipo 1/psicologia , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Autogestão
8.
JAMA Netw Open ; 3(1): e1919954, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31995214

RESUMO

Importance: The number of patients presenting to emergency departments (EDs) for psychiatric care continues to increase. Psychiatrists often make a conservative recommendation to admit patients because robust outpatient services for close follow-up are lacking. Objective: To assess whether the availability of a 45-day behavioral health-virtual patient navigation program decreases hospitalization among patients presenting to the ED with a behavioral health crisis or need. Design, Setting, and Participants: This randomized clinical trial enrolled 637 patients who presented to 6 EDs spanning urban and suburban locations within a large integrated health care system in North Carolina from June 12, 2017, through February 14, 2018; patients were followed up for up to 45 days. Eligible patients were aged 18 years or older, with a behavioral health crisis and a completed telepsychiatric ED consultation. The availability of the behavioral health-virtual patient navigation intervention was randomly allocated to specific days (Monday through Friday from 7 am to 7 pm) so that, in a 2-week block, there were 5 intervention days and 5 usual care days; 323 patients presented on days when the program was offered, and 314 presented on usual care days. Data analysis was performed from March 7 through June 13, 2018, using an intention-to-treat approach. Interventions: The behavioral health-virtual patient navigation program included video contact with a patient while in the ED and telephonic outreach 24 to 72 hours after discharge and then at least weekly for up to 45 days. Main Outcomes and Measures: The primary outcome was the conversion of an ED encounter to hospital admission. Secondary outcomes included 45-day follow-up encounters with a self-harm diagnosis and postdischarge acute care use. Results: Among 637 participants, 358 (56.2%) were men, and the mean (SD) age was 39.7 (16.6) years. The conversion rates were 55.1% (178 of 323) in the intervention group vs 63.1% (198 of 314) in the usual care group (odds ratio, 0.74; 95% CI, 0.54-1.02; P = .06). The percentage of patient encounters with follow-up encounters having a self-harm diagnosis was significantly lower in the intervention group compared with the usual care group (36.8% [119 of 323] vs 45.5% [143 of 314]; P = .03). Conclusions and Relevance: Although the primary result did not reach statistical significance, there is a strong signal of potential positive benefit in an area that lacks evidence, suggesting that there should be additional investment and inquiry into virtual behavioral health programs. Trial Registration: ClinicalTrials.gov identifier: NCT03204643.


Assuntos
Terapia Comportamental/métodos , Serviço Hospitalar de Emergência , Transtornos Mentais/terapia , Admissão do Paciente/estatística & dados numéricos , Telemedicina/organização & administração , Adulto , Medicina do Comportamento/métodos , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , North Carolina , Autogestão/educação , Resultado do Tratamento , Adulto Jovem
9.
Spine (Phila Pa 1976) ; 45(2): E90-E98, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31513109

RESUMO

STUDY DESIGN: Retrospective administrative claims database analysis. OBJECTIVE: Identify distinct presurgery health care resource utilization (HCRU) patterns among posterior lumbar spinal fusion patients and quantify their association with postsurgery costs. SUMMARY OF BACKGROUND DATA: Presurgical HCRU may be predictive of postsurgical economic outcomes and help health care providers to identify patients who may benefit from innovation in care pathways and/or surgical approach. METHODS: Privately insured patients who received one- to two-level posterior lumbar spinal fusion between 2007 and 2016 were identified from a claims database. Agglomerative hierarchical clustering (HC), an unsupervised machine learning technique, was used to cluster patients by presurgery HCRU across 90 resource categories. A generalized linear model was used to compare 2-year postoperative costs across clusters controlling for age, levels fused, spinal diagnosis, posterolateral/interbody approach, and Elixhauser Comorbidity Index. RESULTS: Among 18,770 patients, 56.1% were female, mean age was 51.3, 79.4% had one-level fusion, and 89.6% had inpatient surgery. Three patient clusters were identified: Clust1 (n = 13,987 [74.5%]), Clust2 (n = 4270 [22.7%]), Clust3 (n = 513 [2.7%]). The largest between-cluster differences were found in mean days supplied for antidepressants (Clust1: 97.1 days, Clust2: 175.2 days, Clust3: 287.1 days), opioids (Clust1: 76.7 days, Clust2: 166.9 days, Clust3: 129.7 days), and anticonvulsants (Clust1: 35.1 days, Clust2: 67.8 days, Clust3: 98.7 days). For mean medical visits, the largest between-cluster differences were for behavioral health (Clust1: 0.14, Clust2: 0.88, Clust3: 16.3) and nonthoracolumbar office visits (Clust1: 7.8, Clust2: 13.4, Clust3: 13.8). Mean (95% confidence interval) adjusted 2-year all-cause postoperative costs were lower for Clust1 ($34,048 [$33,265-$34,84]) versus both Clust2 ($52,505 [$50,306-$54,800]) and Clust3 ($48,452 [$43,007-$54,790]), P < 0.0001. CONCLUSION: Distinct presurgery HCRU clusters were characterized by greater utilization of antidepressants, opioids, and behavioral health services and these clusters were associated with significantly higher 2-year postsurgical costs. LEVEL OF EVIDENCE: 3.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Fusão Vertebral/estatística & dados numéricos , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Adulto , Analgésicos Opioides/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Medicina do Comportamento/estatística & dados numéricos , Análise por Conglomerados , Feminino , Recursos em Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Fusão Vertebral/economia , Aprendizado de Máquina não Supervisionado
10.
Curr Opin Pediatr ; 31(6): 797-806, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31693590

RESUMO

PURPOSE OF REVIEW: Neurodevelopmental-behavioural paediatrics (NBP) is a field of medical practice that has arisen in response to recent changes in child health epidemiology. This review considers how the profession of NBP is addressing clinical need, and discusses possibilities for future development of the field. RECENT FINDINGS: Research publications relevant to NBP clinical practice focus primarily on cause (e.g. biology, imaging, neuropsychology), early detection, diagnostic methodologies and initial treatment strategies, with emphasis on psychotropic medication. Translation of this research implies that NBP clinical services should be undertaken using algorithmic methodologies, and evaluated against treatment attributable outcomes. These strategies and outcomes potentially define the central purpose of the profession; however, they may not be sufficient to best help the children seen. SUMMARY: Two sets of information inform and extend consideration of NBP purpose and strategy. Firstly, longitudinal and adult studies indicate that even with treatment, problems persist in adult life for a significant proportion of children with neurodevelopmental-behavioural disorders. Secondly, NBP clinical practice deals with significant, irreducible complexity and uncertainty, arising from both child-diagnostic and contextual factors. Complexity limits the extent to which evidence-based clinical algorithms are able to inform care. Suggestions for how to address both challenges are offered.


Assuntos
Transtornos do Comportamento Infantil , Deficiências do Desenvolvimento , Transtornos do Neurodesenvolvimento , Pediatria , Adulto , Medicina do Comportamento , Criança , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/terapia , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/terapia , Humanos , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/terapia , Neurologia
12.
Implement Sci ; 14(1): 94, 2019 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684977

RESUMO

BACKGROUND: In a quasi-experimental study, facilitation was used to support implementation of the behavioral medicine approach in physiotherapy. The facilitation consisted of an individually tailored multifaceted intervention including outreach visits, peer coaching, educational materials, individual goal-setting, video feedback, self-monitoring in a diary, manager support, and information leaflets to patients. A behavioral medicine approach implies a focus on health related behavior change. Clinical behavioral change was initiated but not maintained among the participating physiotherapists. To explain these findings, a deeper understanding of the implementation process is necessary. The aim was therefore to explore the impact mechanisms in the implementation of a behavioral medicine approach in physiotherapy by examining dose, reach, and participant experiences. METHODS: An explorative mixed-methods design was used as a part of a quasi-experimental trial. Twenty four physiotherapists working in primary health care were included in the quasi-experimental trial, and all physiotherapists in the experimental group (n = 15) were included in the current study. A facilitation intervention based mainly on social cognitive theory was tested during a 6-month period. Data were collected during and after the implementation period by self-reports of time allocation regarding participation in different implementation methods, documentation of individual goals, ranking of the most important implementation methods, and semi-structured interviews. Descriptive statistical methods and inductive content analysis were used. RESULTS: The physiotherapists participated most frequently in the following implementation methods: outreach visits, peer coaching, educational materials, and individual goal-setting. They also considered these methods to be the most important for implementation, contributing to support for learning, practice, memory, emotions, self-management, and time management. However, time management support from the manager was lacking. CONCLUSIONS: The findings indicate that different mechanisms govern the initiation and maintenance of clinical behavior change. The impact mechanisms for initiation of clinical behavior change refers to the use of externally initiated multiple methods, such as feedback on practice, time management, and extrinsic motivation. The lack of self-regulation capability, intrinsic motivation, and continued support after the implementation intervention period were interpreted as possible mechanisms for the failure of maintaining the behavioral change over time.


Assuntos
Medicina do Comportamento/métodos , Comportamentos Relacionados com a Saúde , Assistência Centrada no Paciente/métodos , Modalidades de Fisioterapia , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Mentores , Planejamento de Assistência ao Paciente/organização & administração , Educação de Pacientes como Assunto/métodos , Avaliação de Processos em Cuidados de Saúde , Pesquisa Qualitativa , Suécia
14.
Health Psychol ; 38(9): 769-771, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436462

RESUMO

This special issue highlights the unique potential that health psychology-behavioral medicine has to dramatically contribute to understanding, prevention, and control of the growing prevalence of multimorbidity (i.e., concurrent prevalence of more than 1 chronic health disease or condition in an individual). The 9 articles published here include 8 full, peer-reviewed articles and an invited commentary. Topics include relevance, measurement, mechanisms, and interventions for multimorbidity. Some articles survey relevant empirical literature, detail the representation of multimorbidity in behavioral intervention trials, or present new empirical data, whereas others present guidelines and system-level proposals to improve health care for patients with multiple health conditions. These articles offer proposals, challenges, and future directions for which health psychology-behavioral medicine is admirably suited to contribute to understanding multimorbidity and improving public health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Medicina do Comportamento/métodos , Multimorbidade/tendências , Psicologia/métodos , Doença Crônica , Humanos
15.
Health Psychol ; 38(9): 772-782, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436463

RESUMO

The increasing prevalence of multimorbidity in the United States and the rest of the world poses problems for patients and for health care providers, care systems, and policy. After clarifying the difference between comorbidity and multimorbidity, this article describes the challenges that the prevalence of multimorbidity presents for well-being, prevention, and medical treatment. We submit that health psychology and behavioral medicine have an important role to play in meeting these challenges because of the holistic vision of health afforded by the foundational biopsychosocial model. Furthermore, opportunities abound for health psychology/behavioral medicine to study how biological, social and psychological factors influence multimorbidity. This article describes three major areas in which health psychologists can contribute to understanding and treatment of multimorbidity: (a) etiology; (b) prevention and self-management; and (c) clinical care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Medicina do Comportamento/métodos , Multimorbidade/tendências , Psicologia/métodos , Doença Crônica , Humanos
16.
Health Psychol ; 38(9): 851-854, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436466

RESUMO

Increasing specialization, underinvestment in primary care and behavioral health, and the growing prevalence of multiple chronic conditions (MCC) across all age groups have led to a substantial mismatch between the way health care is currently organized and delivered and the needs of people with MCC. People with multimorbidity are especially challenged in navigating fragmented health systems designed to treat diseases rather than people. The harms associated with this fragmentation, such as adverse events resulting from conflicting treatments and increased costs, have been well documented. As a result, there have been renewed calls for more patient-centered care, with a particular emphasis on the importance of the integration of primary care and behavioral health as fundamental for achieving this goal. There is an enormous opportunity to improve individual and population health by developing, implementing, evaluating, scaling, and spreading effective interventions to prevent and manage multimorbidity. This will require integration of behavioral health and primary care and broader efforts to create healthy communities, including efforts to address the social determinants of health, as well as the alignment of clinical medicine, public health, and community services to support these efforts. Evidence is needed for the most effective strategies to manage multimorbidity as well as for models of health care delivery and population health to foster health and well-being for all. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Medicina do Comportamento/métodos , Multimorbidade/tendências , Atenção Primária à Saúde/métodos , Humanos
17.
Int J Behav Med ; 26(6): 577-579, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31414378

RESUMO

From the Editors: This is one in a series of statistical guidelines designed to highlight common statistical considerations in behavioral medicine research. The goal was to briefly discuss appropriate ways to analyze and present data in the International Journal of Behavioral Medicine (IJBM). Collectively, the series will culminate in a set of basic statistical guidelines to be adopted by IJBM and integrated into the journal's official Instructions for Authors and also to serve as an independent resource. If you have ideas for a future topic, please email the Statistical Editor, Suzanne Segerstrom at segerstrom@uky.edu.


Assuntos
Medicina do Comportamento/métodos , Interpretação Estatística de Dados , Humanos
18.
Health Psychol ; 38(8): 669-671, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31368750

RESUMO

Behavioral interventions can be offered within a wide range of contexts, including public health, medicine, surgery, physical rehabilitation, nutrition, and other health services. These differing services compete for the same resources and it is difficult to compare their value. Systematic standardized methodologies for valuing outcomes are available and are being applied by economists and health services researchers, but are not widely used in our field. With support from the Society for Health Psychology, the National Cancer Institute (NCI), and the Office for Behavioral and Social Sciences Research (OBSSR) at the National Institutes of Health, two working group meetings were held to consider the use of well-established cost-effectiveness methodologies for the evaluation of behavioral and public health interventions. In this special section, we acknowledge a wide range of variability in terms of behavioral interventions typically delivered in nonclinical versus more traditional clinical settings. Three articles address (1) standardizing methods for conducting cost-effectiveness and cost-utility analyses, (2) providing examples to illustrate progress in applying these methods to evaluate interventions delivered in whole or in part in clinical settings, and (3) providing nonclinical intervention examples selected to highlight the challenges and opportunities for evaluating the cost-effectiveness of interventions in more diverse settings. The ability of our field to communicate cost-effectiveness data to policy makers, employers, and insurers that incorporates implementation costs is central to the likelihood of our interventions being adopted by practitioners and reimbursed by payers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia Comportamental/economia , Terapia Comportamental/métodos , Medicina do Comportamento/economia , Medicina do Comportamento/métodos , Análise Custo-Benefício/métodos , Humanos
19.
J Altern Complement Med ; 25(10): 1026-1034, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31460769

RESUMO

Objectives: The Open Source Wellness (OSW) model was designed to function as a behavioral pharmacy; an affordable, accessible delivery system for a universal experiential prescription: MOVE (physical activity), NOURISH (healthy meals), CONNECT (social support), and BE (stress reduction). This study evaluates the OSW model in a billable group medical visit (GMV) format in a federally qualified health center (FQHC). Intervention: Patients with behaviorally mediated conditions, including cardiovascular disease, diabetes, and depression, as well as poor social determinants of health, such as food insecurity, were prescribed participation in the OSW program by their medical team. Groups met for 2 h each week for 16 weeks to complete 30 min of socially engaging physical activity, 5 min of mindfulness meditation, a 10-min interactive, didactic health lesson, a 5-min nutrition lesson, and 60 min of small-group coaching over a plant-based meal. Paraprofessional health coaches worked with participants in small groups to provide support and create accountability to goals. In addition, participants received a $10 voucher to Food Farmacy, which provided free produce. Subjects: The sample consisted of 49 patients from the Hayward Wellness Center, an FQHC in Hayward, California. They were mostly women, 59.6%, and racially and ethnically diverse: 23.1% African American, 5.8% Asian, 26.9% Hispanic/Latino, 11.5% Pacific Islander, and 32.7% Caucasian. Participants averaged 59.1 years of age (SD = 10.6). Outcome measures: Blood pressure and weight were recorded weekly. Demographic and acute care utilization data were drawn from the electronic medical record. Self-report questionnaires assessed diet, exercise, and mood on a monthly basis. Methods and results: Longitudinal data were analyzed with linear mixed models. Participants (n = 49) demonstrated significant increases in daily servings of fruits and vegetables, b = 0.31, p < 0.01, and exercise, b = 11.50, p < 0.01, as well as significant reductions in body mass index, b = -0.10, p = 0.05. Acute care utilization decrease was not statistically significant, b = -0.07, p = 0.14. Depressed patients (n = 11) saw reductions in depression, b = -1.72, p < 0.01, and hypertensive patients (n = 24) saw reductions in systolic blood pressure, b = -4.04, p < 0.01, but not diastolic blood pressure, b = 0.04, p = 0.95. Conclusions: This study demonstrates the effectiveness of the OSW behavioral pharmacy model within a GMV context; pathways for adaptation, spread/scale, and incorporation of this work as a component of the broader health ecosystem and national commitment to health equity are discussed.


Assuntos
Medicina do Comportamento/métodos , Doença Crônica/terapia , Consultas Médicas Compartilhadas , Idoso , Pressão Sanguínea/fisiologia , Peso Corporal/fisiologia , Assistência à Saúde , Dieta , Exercício Físico , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Apoio Social
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