Journal of Mental Health Policy and Economics最新文献

{"title":"Thirty-day Readmission Rates and Associated Factors: A Multilevel Analysis of Practice Variations in French Public Psychiatry.","authors":"Coralie Gandré, Jeanne Gervaix, Julien Thillard, Jean-Marc Macé, Jean-Luc Roelandt, Karine Chevreul","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Inpatient psychiatric readmissions are often used as an indicator of the quality of care and their reduction is in line with international recommendations for mental health care. Research on variations in inpatient readmission rates among mental health care providers is therefore of key importance as these variations can impact equity, quality and efficiency of care when they do not result from differences in patients' needs.</p><p><strong>Aims of the study: </strong>Our objectives were first to describe variations in inpatient readmission rates between public mental health care providers in France on a nationwide scale, and second, to identify their association with patient, health care providers and environment characteristics.</p><p><strong>Methods: </strong>We carried out a study for the year 2012 using data from ten administrative national databases. 30-day readmissions in inpatient care were identified in the French national psychiatric discharge database. Variations were described numerically and graphically between French psychiatric sectors and factors associated with these variations were identified by carrying out a multi-level logistic regression accounting for the hierarchical structure of the data.</p><p><strong>Results: </strong>Significant practice variations in 30-day inpatient readmission rates were observed with a coefficient of variation above 50%. While a majority of those variations was related to differences within sectors, individual patient characteristics explained a lower part of the variations resulting from differences between sectors than the characteristics of sectors and of their environment. In particular, an increase in the mortality rate and in the acute admission rate for somatic disorders in sectors' catchment area was associated with a decrease in the probability of 30-day readmission. Similarly, an increase in the number of psychiatric inpatient beds in private for-profit hospitals per 1,000 inhabitants in sectors' catchment area was associated with a decrease in this probability, which also varied with overall sectors' case-mix characteristics and with the level of urbanisation of the area.</p><p><strong>Discussion: </strong>The extent of the variations and the factors associated with it question the adequacy of care and suggest that some of them may be unwarranted. Our findings should however be interpreted in consideration of several limits inherent to data quality and availability as we relied on information from administrative databases. While we considered a wide range of factors potentially associated with variations in 30-day readmissions, our model indeed only explained a limited part of the variations resulting from differences between sectors.</p><p><strong>Implications for health policies: </strong>Our findings underscored that practice variations in psychiatry are a reality that merits the full attention of decision makers as they can impact the quality, equity an","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 1","pages":"17-28"},"PeriodicalIF":1.6,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35998591","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":"How does Economic Recession Affect Substance Use? A Reality Check with Clients of Drug Treatment Centres.","authors":"Pol Bruguera,&nbsp;Jillian Reynolds,&nbsp;Eilish Gilvarry,&nbsp;Fleur Braddick,&nbsp;Abdul Latheef Marath-Veettil,&nbsp;Peter Anderson,&nbsp;Zofia Mielecka-Kubien,&nbsp;Eileen Kaner,&nbsp;Antoni Gual","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The relationship between economic downturns and substance use has been studied in numerous economic crises occurring worldwide, but the precise relationship between the two remains unclear.</p><p><strong>Aims: </strong>The aim of the present study was to undertake a survey on behaviour and perspectives related to the latest European economic crisis among illegal drug users attending substance treatment services.</p><p><strong>Design and methods: </strong>We conducted a questionnaire-based survey in drug dependence treatment settings, in three geographically different jurisdictions (England, Catalonia and Poland), including 180 drug users.</p><p><strong>Results: </strong>Most of the participants of the survey (58.3%) reported an increase in drug use during the crisis, compared with only 25.6% of the sample who reported a decrease in drug use. The main reason given for increasing drug use was greater amount of free time available. Other important reasons were greater substance availability during this period, more stress at work and seeking comfort in response to the loss of a stable source of income, social status and/or family. Those who reported cutting down on the amount of drug use during the economic recession, reported economic difficulties as the main reason. Other important factors were family and friends' economic problems and the fear of losing their job. Illegal drug use reduction was compensated by increased smoking in 46.3% of the patients, and increased alcohol use in 39.4%.</p><p><strong>Discussion and conclusions: </strong>While this result has potential interest for those developing policies and interventions to reduce drug-related harm, longitudinal studies and future research involving a broader population of drug-users (including those not in treatment) could shed further light on these behavioural mechanisms linking changes in drug use with economic recessions.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 1","pages":"11-16"},"PeriodicalIF":1.6,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35998590","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":"Health State Utilities for Patient's Current Health from Bipolar Type I Disorder.","authors":"Masoumeh Banihashemian,&nbsp;Arash Rashidian,&nbsp;Faeze Gholamian,&nbsp;Mahboubeh Parsaeian,&nbsp;Najmeh Moradi,&nbsp;Homayoun Amini","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Bipolar Type I Disorder (BID) is a disabling mental disorder among young adults that places enormous psychological, social, and economic burdens on patients, their families, and health care systems and decreases quality of life (QOL). Few studies have investigated the quality-adjusted life-years (QALY), health state preferences, and utilities in patients with BID.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim of study: &lt;/strong&gt;The aim of this study was to elicit health state utilities for current health among a sample of individuals with BID irrespective of their clinical conditions at the time of evaluation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;One hundred individuals with BID were consecutively enrolled in this cross-sectional study. Preferences were elicited from patients with visual analogous scale (VAS) and time trade-off (TTO). To assess quality of life, the Farsi version of the World Health Organization's QOL Instrument-Short Version (WHOQOL-BREF) was used. In addition, health state was assessed with the Short Form-36 (SF-36) health survey, and then a specially- derived reduced version of the SF-36 (the `SF-6D') was calculated as an alternative to existing preference-based measures of health for conducting economic evaluation of various interventions. Moreover, several clinical measures were administered to participants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean (S.D.) VAS, TTO, and SF-6D utility scores were 0.59 (0.21), 0.44 (0.33), and 0.61 (0.11), respectively. There were significant associations of most selected clinical characteristics with VAS and TTO scores. Additionally, there were strong correlations between all domains of WHOQOL-BREF and VAS scores as well as moderate to strong correlations with TTO scores. Furthermore, there were strong correlations between all scales of SF-36 scores and VAS scores as well as moderate to strong correlations between the scales of SF-36 scores and TTO scores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The current study showed that even unstable patients could evaluate their own health states. Furthermore, the present study showed substantial decrements in health-related life preferences among persons with BID. Additionally, the patients with most recent depressive or mixed episodes reported lower VAS scores than those with most recent manic episodes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This study was performed on a group of patients with BID in a referral psychiatric center. This sample can potentially make a selection bias. Furthermore, this study was cross-sectional.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;Generally, clinical features could explain more than half of the variances in VAS utility scores. Among all clinical features, severity of symptoms and duration of disease were among the main factors significantly associated with the utility decreases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implication for health policies: &lt;/strong&gt;The present study data provide health state preferences useful fo","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 1","pages":"3-10"},"PeriodicalIF":1.6,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35998589","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 Cost-effectiveness of the Online MindSpot Clinic for the Treatment of Depression and Anxiety in Australia.","authors":"Yu-Chen Lee,&nbsp;Lan Gao,&nbsp;Blake F Dear,&nbsp;Nickolai Titov,&nbsp;Cathrine Mihalopoulos","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The MindSpot Clinic (MindSpot) offers internet-delivered cognitive behavior therapy (iCBT) courses for people with anxiety and depressive disorders in Australia. The efficacy credentials of the courses offered at MindSpot are now well established but not the credentials of cost-effectiveness. The current study is aimed to evaluate the cost-effectiveness of the Wellbeing Course offered in MindSpot in comparison with the routine/usual care (defined as care in the absence of MindSpot) for people with symptoms of depression or/and anxiety from the perspective of Australian Department of Health.</p><p><strong>Methods: </strong>An economic model using a one-year decision-tree framework was constructed. The four health states in the model included: fully recovered; partially recovered; no improvement; and deteriorated. The probabilities between the four health states in the model were derived from a series of individual client datasets and from the Australian National Survey of Mental Health and Wellbeing. The EuroQol Five Dimension -- Five Level was used to derive the utilities, and costs were expressed in 2014 Australian dollars. Sensitivity analyses were conducted to examine the robustness of results to key model parameters.</p><p><strong>Results: </strong>In the base case analysis, for people seeking treatment, care offered at Mindspot cost less and achieved greater benefits compared to the comparator. By adopting MindSpot, an additional 505 of fully recovered and 223 of partially recovered clients can be achieved per annum compared to routine/usual care. The result of the sensitivity analyses indicated the result of the analysis were robust.</p><p><strong>Conclusions: </strong>This study found that the iCBT treatments provided by MindSpot were highly cost-effective in comparison with current routine/usual care in the Australia setting. However, future research using a prospective matched comparator that comprehensively assesses all the respective costs is required to verify the current study findings.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 4","pages":"155-166"},"PeriodicalIF":1.6,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35708476","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":"Cost-effectiveness and Budget Impact of Specialized Psychotherapy for Borderline Personality Disorder: A Synthesis of the Evidence.","authors":"Pim Wetzelaer,&nbsp;Joran Lokkerbo,&nbsp;Arnoud Arntz,&nbsp;Thea van Aselt,&nbsp;Filip Smit,&nbsp;Silvia Evers","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Specialized outpatient psychotherapy for patients with borderline personality disorder (BPD) is expected to reduce their use of other health care resources. It is currently unknown to what extent the costs of providing these interventions can be expected to be offset by a reduction in other health care costs in the Netherlands. To establish the cost-effectiveness and budget impact of specialized outpatient psychotherapy, the estimated incremental costs are synthesized with the estimated incremental effects. We have developed a method for the synthesis of all relevant evidence on clinical effectiveness as well as health care resource use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim of the study: &lt;/strong&gt;The aim of this article is to present a method for the synthesis of evidence for cost-effectiveness and budget impact analysis with a specific application to specialized outpatient psychotherapy for borderline personality disorder in the Netherlands.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic search of the English-language literature is performed to retrieve evidence on the clinical effectiveness and the health care resource use following 12 months of specialized outpatient psychotherapy for borderline personality disorder. The available evidence is used as an input for a model-based economic evaluation. Simulated patient-level data are used to provide overall estimates of the incremental costs and incremental effects, which serve to assess the cost-effectiveness and budget impact of specialized outpatient psychotherapy for borderline personality disorder in the Netherlands.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The results indicate that specialized outpatient psychotherapy for BPD can be considered cost-effective and that its scaling up to Dutch national level would require an investment of 2.367 million (95% C.I.: 1,717,000 - 3,272,000) per 1,000 additional patients with BPD. Sensitivity analyses demonstrated the robustness of our findings in light of several uncertain components and assumptions in our calculations, but also their sensitivity to the choice of included studies based on the comparator condition and the assumption of high intervention costs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;We present a method for the synthesis of evidence from different types of studies in a way that respects the uncertainty surrounding those findings. Limitations of the study pertain to the inclusion of findings from studies with suboptimal designs, the transferability of research findings, and uncertainty regarding the time horizon considered. More research is needed on the sensitivity of our findings to the choice of included studies based on the comparator condition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;THE results suggest that the provision of specialized outpatient psychotherapy for BPD leads to a reduction in other health care resource use. Overall, the results are promising and encourage future studies on aspects that ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 4","pages":"177-190"},"PeriodicalIF":1.6,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35708478","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":"Do High Fidelity Wraparound Services for Youth with Serious Emotional Disturbances Save Money in the Long-Term?","authors":"Angela Snyder,&nbsp;James Marton,&nbsp;Susan McLaren,&nbsp;Bo Feng,&nbsp;Mei Zhou","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Treating youth with serious emotional disturbances (SED) is expensive often requiring institutional care. A significant amount of recent federal and state funding has been dedicated to expanding home and community-based services for these youth as an alternative to institutional care. High Fidelity Wraparound (Wrap) is an evolving, evidence-informed practice to help sustain community-based placements for youth with an SED through the use of intensive, customized care coordination among parents, multiple child-serving agencies, and providers. While there is growing evidence on the benefits of Wrap, few studies have examined health care spending associated with Wrap participation and none have examined spending patterns after the completion of Wrap. Merging health care spending data from multiple agencies and programs allows for a more complete picture of the health care costs of treating these youth in a system-of-care framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of study: &lt;/strong&gt;(i) To compare overall health care spending for youth who transitioned from institutional care into Wrap (the treatment group) versus youth not receiving Wrap (the control group) and (ii) to compare changes in health care spending, overall and by category, for both groups before (the pre-period) and after (the post-period) Wrap participation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The treatment group (N=161) is matched to the control group (N=324) temporally based on the month the youth entered institutional care. Both total health care spending and spending by category are compared for each group pre- and post-Wrap participation. The post-period includes the time in which the youth was receiving Wrap services and one year afterwards to capture long-term cost impacts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the year before Wrap participation, the treatment group averaged USD 8,433 in monthly health care spending versus USD 4,599 for the control group. Wrap participation led to an additional reduction of USD 1,130 in monthly health care spending as compared to the control group in the post-period. For youth participating in Wrap, these spending reductions were the result of decreases in mental health inpatient spending and general outpatient spending.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Youth participating in Wrap had much higher average monthly costs than youth in the control group for the year prior to entering Wrap, suggesting that the intervention targeted youth with the highest mental health utilization and likely more complex needs. While both groups experienced reductions in spending, the treatment group experienced larger absolute reductions, but smaller relative reductions associated with participation. These differences were driven mainly by reductions in mental health inpatient spending. Larger reductions in general outpatient spending for the treatment group suggest spillover benefits in terms of physical health care spending. Further analysis is needed t","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 4","pages":"167-175"},"PeriodicalIF":1.6,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35708477","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 Affordable Care Act's Dependent Care Coverage Expansion and Behavioral Health Care.","authors":"Chandler B McClellan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>In September 2010, the Affordable Care Act (ACA) extended dependent care coverage to individuals under the age of 26, allowing young adults to remain on their parent's private insurance.</p><p><strong>Aims of the study: </strong>This policy offers a natural experiment to examine the impact of expanded insurance coverage on mental health and substance use treatment utilization and payment composition.</p><p><strong>Methods: </strong>Using National Survey on Drug Use and Health (NSDUH) and Medical Expenditure Panel Survey (MEPS) data between 2005 and 2014, this study employs a difference-in-differences approach with 23-25 year olds as the treatment group and 27-30 year olds as the control group to examine the impact of the expansion on insurance coverage, behavioral health treatment utilization, and treatment payment source.</p><p><strong>Results: </strong>Results indicate that the dependent care coverage expansion is associated with an increase in insurance coverage, greater mental health treatment utilization, and an increase in payment for behavioral health treatment by private insurance.</p><p><strong>Discussion: </strong>This study shows that insurance coverage increased and financial barriers to getting behavioral health treatment fell. Improving access to care only led to increases in mental health treatment utilization, while substance use treatment utilization remained unchanged.</p><p><strong>Implications: </strong>The ACA succeeded in extending insurance benefits to a population that has been historically underinsured. Along with those benefits, young adults enjoyed greater access to behavioral health care and a measure of financial protection from high costs. While the evidence has yet to be presented for the full implementation of the ACA, if these results are typical of its other provisions, then the ACA will have achieved some of its most important objectives.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 3","pages":"111-130"},"PeriodicalIF":1.6,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35469993","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 Mental Health Treatment Financing, Community-Based Organization's Treatment Programs, and Latino-White Children's Financing Disparities.","authors":"Lonnie R Snowden,&nbsp;Neal Wallace,&nbsp;Kate Cordell,&nbsp;Genevieve Graaf","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Latino child populations are large and growing, and they present considerable unmet need for mental health treatment. Poverty, lack of health insurance, limited English proficiency, stigma, undocumented status, and inhospitable programming are among many factors that contribute to Latino-White mental health treatment disparities. Lower treatment expenditures serve as an important marker of Latino children's low rates of mental health treatment and limited participation once enrolled in services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;We investigated whether total Latino-White expenditure disparities declined when autonomous, county-level mental health plans receive funds free of customary cost-sharing charges, especially when they capitalized on cultural and language-sensitive mental health treatment programs as vehicles to receive and spend treatment funds. Using Whites as benchmark, we considered expenditure pattern disparities favoring Whites over Latinos and, in a smaller number of counties, Latinos over Whites.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Using segmented regression for interrupted time series on county level treatment systems observed over 64 quarters, we analyzed Medi-Cal paid claims for per-user total expenditures for mental health services delivered to children and youth (under 18 years of age) during a study period covering July 1, 1991 through June 30, 2007. Settlement-mandated Medicaid's Early Periodic Screening, Diagnosis and Treatment (EPSDT) expenditure increases began in the third quarter of 1995. Terms were introduced to assess immediate and long term inequality reduction as well as the role of culture and language-sensitive community-based programs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Settlement-mandated increased EPSDT treatment funding was associated with more spending on Whites relative to Latinos unless plans arranged for cultural and language-sensitive mental health treatment programs. However, having programs served more to prevent expenditure disparities from growing than to reduce disparities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;EPSDT expanded funding increased proportional expenditures for Whites absent cultural and language-sensitive treatment programs. The programs moderate, but do not overcome, entrenched expenditure disparities. These findings use investment in mental health services for Latino populations to indicate treatment access and utilization, but do not explicitly reflect penetration rates or intensity of services for consumers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for policy: &lt;/strong&gt;New funding, along with an expectation that Latino children's well documented mental health treatment disparities will be addressed, holds potential for improved mental health access and reducing utilization inequities for this population, especially when specialized, culturally and linguistically sensitive mental health treatment programs are present to serve as recipients of funding.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 3","pages":"137-145"},"PeriodicalIF":1.6,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35469995","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":"Clinicians' Views on Therapeutic Outcomes of Systemic Interventions and on the Ability of the EQ-5D to Capture these Outcomes.","authors":"Saskia J Schawo,&nbsp;Werner B F Brouwer,&nbsp;Leona Hakkaart","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Systemic interventions focus on improvements of interactions between clients and their environments, and are increasingly used to treat adolescents with problems of substance use and delinquency. Clients' progress may include broad and non-medical effects. When performing economic evaluations of these interventions, the common outcome of costs per quality adjusted life year (cost/QALY) may not capture all of these effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;The current study is an explorative study. It aims to investigate which outcomes clinicians consider relevant to the therapeutic success of systemic interventions and whether these, according to them, are sufficiently captured by the EQ-5D instrument.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Semi-structured interviews were performed with seven clinicians at two mental health institutions in the Netherlands. Clinicians were asked to list the most relevant outcomes of systemic interventions. They were asked whether they considered the EQ-5D dimensions to sufficiently capture these outcomes or if they missed aspects or outcome domains.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The clinicians mentioned several broad effects relevant for the evaluation of systemic interventions. These were aspects of family functioning, parental functioning, social competencies, school attendance, etc. They considered several EQ-5D dimensions relevant (i.e. in particular 'usual activities' and 'anxiety/depression'), yet they indicated that the instrument lacked systemic dimensions (i.e. family relations and relations with others) and addiction-related aspects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The interviewed clinicians considered several dimensions of the EQ-5D useful in evaluating effects of systemic interventions, yet they expressed the need to add additional dimensions particularly relevant to systemic aspects to the instrument when performing economic evaluations of systemic interventions. The explorative analysis was limited by the small number of interviewed clinicians. Furthermore, a relatively high proportion of clinicians were specialized in Multidimensional Family Therapy, a type of systemic intervention particularly used to treat adolescents with substance use disorders and related problems. Hence the importance of addiction-related improvements may have been over-emphasized in this group of respondents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;Practical implications of the current study may be the need for enhancements of the current health economic methodology for evaluating systemic interventions as to capture additional aspects specifically relevant to these interventions. This may lead to different choices in the use of instruments for the evaluation of treatment progress and success in clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policies: &lt;/strong&gt;By improving the health economic toolkit to evaluate systemic interventions one may prov","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 3","pages":"131-136"},"PeriodicalIF":1.6,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35469994","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":"Cost-effectiveness Analysis of an Aftercare Service vs Treatment-As-Usual for Patients with Severe Mental Disorders.","authors":"Eshagh Barfar,&nbsp;Vandad Sharifi,&nbsp;Homayoun Amini,&nbsp;Yasaman Mottaghipour,&nbsp;Masud Yunesian,&nbsp;Mehdi Tehranidoost,&nbsp;Payam Sobhebidari,&nbsp;Arash Rashidian","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There have been claims that community mental health principles leads to the maintenance of better health and functioning in patients and can be more economical for patients with severe and chronic mental disorders. Economic evaluation studies have been used to assess the cost-effectiveness of national health programs, or to propose efficient strategies for health care delivery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;The current study is intended to test the cost-effectiveness of an Aftercare Service when compared with Treatment-As-Usual for patients with severe mental disorders in Iran.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study was a parallel group randomized controlled trial. A total of 160 post-discharge eligible patients were randomized into two equal patient groups, Aftercare Service (that includes either Home Visiting Care, or Telephone Follow-up for outpatient treatment) vs Treatment-As-Usual, using stratified balanced block randomization method. All patients were followed for 12 months after discharge. The perspective of the present study was the societal perspective. The outcome measures were the rate of readmission at the hospitals after discharge, psychotic symptoms, manic symptoms, depressive symptoms, illness severity, global functioning, quality of life, and patients' satisfaction with the services. The costs included the intervention costs and the patient and family costs in the evaluation period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There was no significant difference in effectiveness measures between the two groups. The Aftercare Service arm was about 66,000 US$ cheaper than Treatment-As-Usual arm. The average total cost per patient in the Treatment-As-Usual group was about 4651 USD, while it was reduced to 3823 US$ in the Aftercare Service group; equivalent to a cost reduction of about 800 USD per patient per year.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion and limitations: &lt;/strong&gt;Given that there was no significant difference in effectiveness measures between the two groups (slightly in favor of the intervention), the Aftercare Service was cost-effective. The most important limitation of the study was the relatively small sample size due to limited budget for the implementation of the study. A larger sample size and longer follow-ups are warranted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision, use and policies: &lt;/strong&gt;Considering the limited resources and equity concerns for health systems, the importance of making decisions about healthcare interventions based on cost-effectiveness evidence is increasing. Our results suggest that the aftercare service can be recommended as an efficient service delivery mode, especially when psychiatric bed requirements are insufficient for a population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for further research: &lt;/strong&gt;Further research should continue the work done with a larger sample size and longer follow-ups to further establish the cost-effectiveness analysis of an aftercar","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 3","pages":"101-110"},"PeriodicalIF":1.6,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35469992","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}