Journal of Mental Health Policy and Economics最新文献

{"title":"Economic Burden of Mental Illnesses in Pakistan.","authors":"Muhammad Ashar Malik, Murad Moosa Khan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The economic consequences of mental illnesses are much more than health consequences. In Low and Middle Income Countries (LMIC) the economic impact of mental illnesses is rarely analyzed. This paper attempts to fill the gap in research on economics of mental health in LMIC. We provide economic burden of mental illness in Pakistan that can serve as an argument for reorienting health policy, resource allocation and priority settings.</p><p><strong>Aim: </strong>To estimate economic burden of mental illnesses in Pakistan.</p><p><strong>Methods: </strong>The study used prevalence based cost of illnesses approach using bottom-up costing methodology. We used Aga Khan University Hospital, Psychiatry department data set (N = 1882) on admission and ambulatory care for the year 2005-06. Healthcare cost data was obtained from finance department of the hospital. Productivity losses, caregiver and travel cost were estimated using socio-economic features of patients in the data set and data of national household survey. We used stratified random sampling and methods of ordinary least square multiple linear regressions to estimate cost on medicines for ambulatory care. All estimates of cost are based on 1000 bootstrap samples by ICD-10 disease classification. Prevalence data on mental illnesses from Pakistan and regional countries was used to estimate economic burden.</p><p><strong>Results: </strong>The economic burden of mental illnesses in Pakistan was Pakistan Rupees (PKR) 250,483 million (USD 4264.27 million) in 2006. Medical care costs and productivity losses contributed 37% and 58.97% of the economic burden respectively. Tertiary care admissions costs were 70% of total medical care costs. The average length of stay (LOS) for admissions care was around 8 days. Daily average medical care cost of admitted patients was PKR 3273 (USD 55.72). For ambulatory care, on average a patient visited the clinic twice a year. The estimated average yearly cost for all mental illnesses was PKR 81,922 (USD 1394.65) and PKR 19,592 (USD 333.54) for admissions and ambulatory care respectively. In the sensitivity analysis productivity losses showed high variability (from USD 1022.17 million to USD 4007.01 million). Assuming a gate keeping role of primary healthcare (PHC) demonstrated a saving of USD 1577.19 million in total economic burden.</p><p><strong>Implications for health policy: </strong>This study set out to generate evidence using a low cost innovative approach relevant to many LMICs. In Pakistan, like many LMICs, patients access tertiary care directly, even for illness that can be efficiently managed at PHC level. In economic terms the non-medical consequences of mental illnesses are far greater than medical consequences. Based on these finding we recommend, firstly, that mental illnesses should be prioritized equally as other illnesses in health policy and secondly there needs to be integration of mental health in primary health care i","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"19 3","pages":"155-66"},"PeriodicalIF":1.6,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34344564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Medicaid Financing and Equalization of African Americans' and Whites' Outpatient and Emergency Treatment Expenditures.","authors":"Lonnie R Snowden,&nbsp;Neal Wallace,&nbsp;Kate Cordell,&nbsp;Genevieve Graaf","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>We investigated whether a new funding opportunity to finance mental health treatment, provided to autonomous county-level mental health systems without customary cost sharing requirements, equalized African American and White children's outpatient and emergency treatment expenditure inequalities. Using Whites as a benchmark, we considered expenditure patterns favoring Whites over African Americans (\"disparities\") and favoring African Americans over Whites (\"reverse disparities\").</p><p><strong>Methods: </strong>Settlement-mandated Early Periodic Screening Diagnosis and Treatment (EPSDT) expenditure increases began in the third quarter of 1995. We analyzed Medi-Cal paid claims for mental health services delivered to youth (under 18 years of age) over 64 quarters for a study period covering July 1, 1991 through June 30, 2007 in controlled cross-sectional (systems), longitudinal (quarters) analyses.</p><p><strong>Results: </strong>Settlement-mandated increases in EPSDT treatment funding was associated with relatively greater African American vs. White expenditures for outpatient care when systems initially spent more on Whites. When systems initially spent more on African Americans, relative increases were greater for Whites for outpatient and emergency services.</p><p><strong>Conclusions: </strong>With new funding that requires no matching funds from the county, county mental health systems did reduce outpatient treatment expenditure inequalities. This was found to be true in counties that initially favored African Americans and in counties that initially favored Whites. Adopting a systems level perspective and taking account of initial conditions and trends can be critical for understanding inequalities.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"19 3","pages":"167-74"},"PeriodicalIF":1.6,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34344565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the Beck Depression Inventory to the EQ-5D-3L in Patients with Depressive Disorders.","authors":"Thomas Grochtdreis,&nbsp;Christian Brettschneider,&nbsp;Andr Hajek,&nbsp;Katharina Schierz,&nbsp;Juergen Hoyer,&nbsp;Hans-Helmut Koenig","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>For cost-utility analyses, data on health state utilities, as provided by the EQ-5D-3L, is needed but not always available. This study specified mapping algorithms from the Beck Depression Inventory (BDI) index to the EQ-5D-3L index adjusted for specific socio-demographic variables for patients with depressive disorders.</p><p><strong>Aims of the study: </strong>The objective of this study was to specify mapping algorithms from the BDI index to the preference-based EQ-5D index for patients with depressive disorders, adjusting for specific socio-demographic variables.</p><p><strong>Methods: </strong>A sample of 1,074 consecutive patients with depressive disorders from a psychotherapeutic outpatient clinic was included in the study. Standardized clinical interviews were applied to establish reliable diagnoses. For the prediction of the EQ-5D-3L index from the BDI index and selected patient socio-demographic characteristics, ordinary least squares regression with robust standard errors was used. Model prediction properties were tested using the root mean squared error and repeated random sub-sampling cross-validation.</p><p><strong>Results: </strong>The BDI index predicted the EQ-5D-3L index with a significant proportion of variance explained. The highest model goodness of fit was estimated for models with the BDI index and age as independent variables. The root mean squared error of the predicted EQ-5D-3L index in the validation samples was 0.23 for all models.</p><p><strong>Discussion: </strong>The mean observed EQ-5D-3L index values and the mean predicted EQ-5D-3L index values seemed not to differ between models. However, a reduction of variability using cross-validation led to those (rather) accurate mean predicted values. One limitation of this study was the restricted generalizability. Moreover, some uncertainty was introduced in model predictive performance by usage of a dependent estimation sample for validation.</p><p><strong>Implications for further research: </strong>The specified mapping algorithms from the BDI index to the EQ-5D-3L index for patients with depressive disorders are acceptable as approximation in cost-utility analyses. A further validation in independent samples is necessary to obtain more confidence in their performance.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"19 2","pages":"79-89"},"PeriodicalIF":1.6,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34589384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Prevention Pay? Costs and Potential Cost-savings of School Interventions Targeting Children with Mental Health Problems.","authors":"Lisa Wellander,&nbsp;Michael B Wells,&nbsp;Inna Feldman","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In Sweden, the local government is responsible for funding schools in their district. One funding initiative is for schools to provide students with mental health problems with additional support via extra teachers, personal assistants, and special education classes. There are evidence-based preventive interventions delivered in schools, which have been shown to decrease the levels of students' mental health problems. However, little is known about how much the local government currently spends on students' mental health support and if evidence-based interventions could be financially beneficial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;The aim of this study was to estimate the costs of providing additional support for students' mental health problems and the potential cost-offsets, defined as reduced school-based additional support, if two evidence-based school interventions targeting children's mental health problems were implemented in routine practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study uses data on the additional support students with mental health problems received in schools. Data was collected from one school district for students aged 6 to 16 years. We modeled two Swedish school interventions, Comet for Teachers and Social and Emotional Training (SET), which both had evidence of reducing mental health problems. We used a cost-offset analysis framework, assuming both interventions were fully implemented throughout the whole school district. Based on the published studies, the expected effects and the costs of the interventions were calculated. We defined the cost-offsets as the amount of predicted averted additional support for students with ongoing mental health problems who might no longer require receiving services such as one-on-one time with an extra teacher, a personal assistant, or to be placed in a special education classroom. A cost-offset analysis, from a payer's perspective (the local government responsible for school financing), was conducted comparing the costs of both interventions with the potential cost-savings due to a reduction in the prevalence of mental health problems and averted additional support required.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The school district was comprised of 6,256 students, with 310 students receiving additional support for their mental health problems. Of these, 143 received support in their original school due to either having ADHD (n = 111), psychosocial problems (n = 26), or anxiety/depression (n = 6). The payers' total cost of additional support was 2,637,850 Euro per school year (18,447 Euro per student). The cost of running both interventions for the school district was 953,643 Euro for one year, while the potential savings for these interventions were estimated to be 627,150 Euro. The estimated effects showed that there would be a reduction of students needing additional support (25 for ADHD, eight for psychosocial problems, and one for anxiety/depress","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"19 2","pages":"91-101"},"PeriodicalIF":1.6,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34589385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Services Use of Children and Adolescents before Admission to Psychiatric Inpatient Care.","authors":"Ingrid Zechmeister-Koss,&nbsp;Roman Winkler,&nbsp;Corinna Fritz,&nbsp;Leonhard Thun-Hohenstein,&nbsp;Heinz Tuechler","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Although 20% of children and adolescents in Europe suffer from overt mental health problems, their illness-related service utilisation is often unknown. If at all, existing research has only addressed the health care sector while services requirements in mental health care go far beyond the health care system, including the social, the educational and the criminal justice system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of study: &lt;/strong&gt;This paper aims at describing the service contact patterns of children and adolescents within and outside the health care sector before they are admitted to a child and adolescent mental health hospital. Additionally, we evaluate the private out-of-pocket payments that occur for primary carers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;A cohort of consecutive admissions to a child and adolescent hospital in Austria was prospectively analysed. We collected data on service use and out-of-pocket expenses before hospital admission from primary carers through face-to-face interviews using an adapted version of the European Child and Adolescent Mental Health Service Receipt Inventory (EU-CAMHSRI). Clinical data came from validated questionnaires (CBCL, YSR) and from the anamnestic documentation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result: &lt;/strong&gt;Ninety percent from a cohort of 441 patients had some contact with services or took medication before they were admitted to hospital. Most often, services in the health care outpatient setting were used. Outside of the health care system, support in school, as well as counselling services, were used most frequently, whereas the persons hardly sought support in living or employment. Roughly 32,400 per 100 patients was spent privately, yet these out-of pocket expenses were very unevenly distributed. Service use and out-of-pocket spending increased with social status and were gender-specific. The more severe external behaviour symptoms were, the more non-health care services were used.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Mentally ill children and adolescents use a broad range of services across sectors before admission to hospital. Service use is associated with specific symptoms of the disease, yet not with the diagnosis. For some carers, this is linked to considerable financial burden because many of those services are only partly publicly funded or are not part of the health sector. A limitation of the study is the uncertainty of self-reports. Furthermore, we do not know whether the services used were needs-based and effective, and what the utilisation patterns of non-hospitalised children and adolescents are.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policies: &lt;/strong&gt;Mental health policy for children and adolescents in Austria needs to focus on how to organise a needs-oriented and coordinated services mix across different sectors that is equally accessible regardless of the patients' socio-economic background.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for future research: &lt;/strong&gt;To support planning, further rese","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"19 2","pages":"103-13"},"PeriodicalIF":1.6,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34589386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Voluntary and Involuntary Retirement on Mental Health: Evidence from Older Irish Adults.","authors":"Irene Mosca,&nbsp;Alan Barrett","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The few studies that have attempted to identify the causal effects of retirement on mental health and well-being have provided conflicting evidence. Hence, whether retirement affects mental health positively or negatively is still unclear.</p><p><strong>Aims of the study: </strong>Our primary objective is to investigate the impact of retirement on mental health as measured by the 20-item Center for Epidemiological Studies Depression Scale (CES-D).</p><p><strong>Methods: </strong>We use data from the first two waves of The Irish Longitudinal Study on Ageing (TILDA). This is a nationally representative sample of individuals aged 50 and over and living in Ireland. To deal with possible endogeneity problems, we use first-differenced estimation models and control for a broad range of life events occurring between the two waves. These include transition to retirement but also demographic, social, economic and physical health events. As part of the TILDA survey, reasons for retirement are asked. We exploit this information and distinguish between individuals who retired voluntarily, involuntarily or because of own ill health.</p><p><strong>Results: </strong>We find that involuntary, or forced, retirement has a negative and statistically significant effect on mental health. In the case of voluntary retirement, negative mental health effects are also found but the magnitude is smaller and the effects are not statistically significant in all models. We also find that retirement due to poor ill health is negatively associated with mental health. These negative effects seem to diminish with time.</p><p><strong>Discussion: </strong>The finding of differences in the extent of mental health impacts across the various reasons for retirement is an important addition to the literature. While our estimation approach reduces potential endogeneity problems, time-variant unobservables are not removed through our first differencing approach.</p><p><strong>Implications for health care provision and use: </strong>Individuals who are retiring involuntarily are more likely than others to be suffering depressive symptoms. Hence, they are more likely to present at GPs with such symptoms.</p><p><strong>Implications for health policies: </strong>It would be preferable if involuntary retirement can be avoided. Transitions paths from work to retirement could help protect people's mental health.</p><p><strong>Implications for further research: </strong>Reasons for retirement should now feature in analyses of this type.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"19 1","pages":"33-44"},"PeriodicalIF":1.6,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34320764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"19 1","pages":"1-2"},"PeriodicalIF":1.6,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34430608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body Weight and Suicidal Behavior in Adolescent Females: The Role of Self-Perceptions.","authors":"Travis Minor,&nbsp;Mir M Ali,&nbsp;John A Rizzo","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Suicide is the third leading cause of death among adolescents and recent data indicate that the suicide rate, particularly for young girls, is increasing. Excess body weight among adolescents has also been documented widely over the last two decades and is considered one of the most pressing public health concerns today. Previous literature has examined the relationship between actual body weight and suicidal behavior, but there is little evidence on self-perception of weight and suicidal behaviors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim of the study: &lt;/strong&gt;This study examines the relationship between body weight and suicidal behaviors using a rich longitudinal data set of a large nationally-representative sample of female adolescents to account for a number of confounding factors. The study explores the relationship, not only between actual weight status and suicidal behaviors, but also between self-perception of weight and suicidal behaviors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;Using data from a nationally-representative sample of adolescents in the United States, the study ascertains the effect of body weight status on suicidal behaviors by estimating endogeneity-corrected models including school-level fixed effects to account for bi-directionality and unobserved confounders. Actual body weight status was calculated using interviewer-measured height and weight. The study also used a measure of self-perceived weight status to compare how actual versus self-perceived weight status affects suicidal behavior. Thinking about committing suicide and attempting to commit suicide in the past 12 months were utilized as dichotomous measures of suicidal behaviors. Potential mediators between suicidal behaviors and weight status such as family history of suicide, participation in risky health behaviors and parental characteristics were also controlled for in the analysis. The analytical sample consists of 5,430 adolescent females aged 11 to 18.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The results suggest that both self-perceived and measured weight status (overweight or obese) increase a female adolescent's probability of suicidal ideation, with self-perceived weight status causing a larger increase in suicidal ideation. There is some evidence that body weight status affects suicide attempts, but these results are much less robust. Finally, endogeneity bias is shown to be of concern in all estimates, and failing to account for this bias is likely to understate any estimated effect.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policy: &lt;/strong&gt;The results have important implications for the design of public health programs to prevent adolescent suicide, especially among female adolescents. Understanding the mechanisms through which adolescents are motivated to take such dire actions will help to allocate resources into the treatment areas which are most effective in stemming the rise of suicidal behaviors. This study identifies one key factor, self-perception of w","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"19 1","pages":"21-31"},"PeriodicalIF":1.6,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34320763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient, Physician and Organizational Influences on Variation in Antipsychotic Prescribing Behavior.","authors":"Yan Tang,&nbsp;Chung-Chou H Chang,&nbsp;Judith R Lave,&nbsp;Walid F Gellad,&nbsp;Haiden A Huskamp,&nbsp;Julie M Donohue","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Physicians face the choice of multiple ingredients when prescribing drugs in many therapeutic categories. For conditions with considerable patient heterogeneity in treatment response, customizing treatment to individual patient needs and preferences may improve outcomes.</p><p><strong>Aims of the study: </strong>To assess variation in the diversity of antipsychotic prescribing for mental health conditions, a necessary although not sufficient condition for personalizing treatment. To identify patient caseload, physician, and organizational factors associated with the diversity of antipsychotic prescribing.</p><p><strong>Methods: </strong>Using 2011 data from Pennsylvania's Medicaid program, IMS Health's HCOSTM database, and the AMA Masterfile, we identified 764 psychiatrists who prescribed antipsychotics to 10 patients. We constructed three physician-level measures of diversity/concentration of antipsychotic prescribing: number of ingredients prescribed, share of prescriptions for most preferred ingredient, and Herfindahl-Hirschman index (HHI). We used multiple membership linear mixed models to examine patient caseload, physician, and healthcare organizational predictors of physician concentration of antipsychotic prescribing.</p><p><strong>Results: </strong>There was substantial variability in antipsychotic prescribing concentration among psychiatrists, with number of ingredients ranging from 2-17, share for most preferred ingredient from 16%-85%, and HHI from 1,088-7,270. On average, psychiatrist prescribing behavior was relatively diversified; however, 11% of psychiatrists wrote an average of 55% of their prescriptions for their most preferred ingredient. Female prescribers and those with smaller shares of disabled or serious mental illness patients had more concentrated prescribing behavior on average.</p><p><strong>Discussion: </strong>Antipsychotic prescribing by individual psychiatrists in a large state Medicaid program varied substantially across psychiatrists. Our findings illustrate the importance of understanding physicians' prescribing behavior and indicate that even among specialties regularly prescribing a therapeutic category, some physicians rely heavily on a small number of agents.</p><p><strong>Implications for health policies, health care provision and use: </strong>Health systems may need to offer educational interventions to clinicians in order to improve their ability to tailor treatment decisions to the needs of individual patients.</p><p><strong>Implications for future research: </strong>Future studies should examine the impact of the diversity of antipsychotic prescribing to determine whether more diversified prescribing improves patient adherence and outcomes.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"19 1","pages":"45-59"},"PeriodicalIF":1.6,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834853/pdf/nihms-771979.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34320765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"18 4","pages":"163-4"},"PeriodicalIF":1.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}