Antipsychotic Drug Use: Managing Cardiometabolic and Cost Effects

Across the US, 30%, or approximately one third of people meet the criteria for at least one mental illness.1 Of those with severe mental illness (SMI), namely schizophrenia and bipolar disorder, the mortality rate is more than twofold compared to the general population.2 The cardiovascular risk factors that contribute to cardiovascular related deaths, including metabolic disease and type II diabetes, are not only modifiable, but staggeringly higher for those with SMI.3 Though antipsychotic drug prescription is the standard protocol for SMI treatment, such drug effects on cardiovascular risk factors and related deaths exacerbate the much higher mortality rate for the severely mentally ill population. Due to both the prevalence of SMI and the physical comorbidities that it entails, analysis of healthcare costs associated with this population are an essential part of general health and policy improvement for the U.S. Therefore, a breakdown of the healthcare costs of this population requires not only acknowledgment of the modes of treatment for mental illness specifically, but also the identification and cost-analysis of the commonly associated physical comorbidities. This is especially important considering SMI is almost always considered chronic, and many SMI patients qualify for either Medicare, Medicaid, or both. Certain gaps in coverage can lead to lack of preventive care, exacerbating the cost burden. From a clinician’s perspective, assessing relevant scientific studies and reviews to change the relationship between primary care and psychiatry is necessary to dampen the high mortality rate of the SMI population. From a policy-maker’s perspective, analyzing the cause and effect balance between managing costs of care directed at the SMI itself against the adjunct costs from physical comorbidity calls for a change in the structure of therapeutic care and how the SMI population accesses primary care. The Collaborative Care model is a health care model that unifies psychiatric, behavioral, and primary care to support the mental, behavioral, and physical health of patients. By supporting holistic healthcare, the high cost of care for the SMI population will be diminished. The model includes four parts: patient-centered care, populationbased care, measurement-based treatment to target, and evidence-based care. Swapping oral antipsychotics with injectable versions will be especially cost-effective by improving adherence rates, and thus, reducing institutionalization and other hospitalizations. By enforcing the Collaborative Care model through community health center interventions, clinicians and policy makers will be able to work together to effectively leverage the health of the SMI population while eroding the high health care expenditure that this population currently imposes on states

Water for People, Water for Life

This report documents the serious water crisis we are facing at the beginning of the 21st century. This crisis is one of water governance, essentially caused by the ways in which we mismanage water. But the real tragedy is the effect it has on the everyday lives of poor people, who are blighted by the burden of water-related disease, living in degraded and often dangerous environments, struggling to get an education for their children and to earn a living, and to get enough to eat. The executive summary offers an analysis of the problem as well as pilot case studies for water management and recommendations for future action

How to design and evaluate interventions to improve outcomes for patients with multimorbidity

Multimorbidity is a major challenge for patients and healthcare providers. The limited evidence of the effectiveness of interventions for people with multimorbidity means that there is a need for much more research and trials of potential interventions. Here we present a consensus view from a group of international researchers working to improve care for people with multimorbidity to guide future studies of interventions. We suggest that there is a need for careful consideration of whom to include, how to target interventions that address specific problems and that do not add to treatment burden, and selecting outcomes that matter both to patients and the healthcare system. Innovative design of these interventions will be necessary as many will be introduced in service settings and it will be important to ensure methodological rigour, relevance to service delivery, and generalizability across healthcare systems

Can Accountable Care Organizations Improve the Value of Health Care by Solving the Cost and Quality Quandaries?

Explores proposed models and configurations of accountable care organizations, which combine provider payment and delivery system reforms, and their potential to slow the rise of healthcare costs. Outlines key issues and program features under debate