Addressing Physical Health in Social Work Practice

The current base of literature highlights the importance of physical health and it’s impact on an individual’s mental health and overall well-being. The purpose of this research is to examine how often social workers target physical health in practice with clients and if there is an underutilization of the research regarding the impact of physical health on psychological health in practice with clients. The research specifically examines how physical health is incorporated into assessment, diagnosis, and over the course of treatment in clinical social work practice. This study used qualitative research, which includes data collection, data analysis, and using grounded theory to develop themes that arise from the data. Nine clinical social workers from a variety of practice settings were interviewed to gather data about the inclusion of physical health in social work practice. Themes found include the provision of psychoeducation about physical health into treatment, informal inclusion of physical health into treatment as the social worker and client see fit, and the impact of exercise, sleep, and dietary habits on an individual’s mental health. The current research findings have many similarities and contradictions with the various findings from the literature review. The present research project had many strengths and limitations alike. The results of the current research project indicate how clinical social workers are presently incorporating physical health into assessment, diagnosis, and treatment. Future research is needed that focuses on how physical health can be formally addressed and measured in clinical social work practice

A New Medicare End-of-Life Benefit for Nursing Home Residents

A new Medicare benefit is needed to support end-of-life care for those spending their final days in a nursing home, say the authors of this article. Arguing that the current hospice benefit is a poor fit with the nursing home setting, the authors recommend a new benefit that would enable nursing home residents to receive individualized palliative and psychosocial services in addition to rehabilitative services

The Influence of Medicare Home Health Payment Incentives: Does Payer Source Matter?

During the late 1990s, an interim payment system (IPS) was instituted to constrain Medicare home health care expenditures. Previous research has largely focused on the implications of the IPS for Medicare patients, but our study broadens the analysis to consider patients with other payer sources. Using the National Home and Hospice Care Survey, we found similar effects of the IPS across payer types. Specifically, the IPS was associated with a decrease in access to care for the sickest patients, less agency assistance with activities of daily living, and shorter length-of-use. However, these changes did not translate into worse discharge outcomes.Medicare, health, incentives

Lifelong Learning: The Archival Profession in the 21st Century

U ovom radu autorica, uvažavajući brze i stalne promjene informatičkih sustava, naglašava važnost permanentnog obrazovanja tijekom cijelog radnog vijeka arhivista. Navodi promjene koje su se desile tijekom njenog staža: format dokumenata i metodologija obrade; arhivska služba je obuhvatila registraturno i privatno gradivo; među arhivistima ima sve više žena i pripadnika etničkih i nacionalnih manjina; povećanje broja arhivskih organizacija, obrazovnih programa i časopisa; pojava međunarodnih normi opisa. Kako bi adekvatno odgovorilo na nastale promjene, temeljno arhivsko obrazovanje treba biti usredotočeno na analizu arhivskih pitanja. Po završetku školovanja, arhivist mora imati priliku pohađanja kratkih, intenzivnih seminara o određenim temama i metodama. Međunarodna arhivska zajednica se prekasno usmjerila na permanentno obrazovanje. Dva su razloga tome: odabir tema i odgovarajući način obuke. Odabir teme je najbolje prepustiti samim arhivistima. Nacionalno udruženje može odrediti temu i organizirati seminar ili slijediti smjernice samita europskih arhivista te odabrati temu koja odgovara pan-europskim potrebama. Obuka se može provoditi na razne načine: u sklopu međunarodnih ili nacionalnih savjetovanja, ljetni tečajevi na sveučilištima, predavanja jednog ili više predavača na razini arhivske institucije, učenje uz pomoć videa, World Wide Weba i sličnih tehnika učenja na daljinu. Svaki način ima svoje prednosti i nedostatke, koji se mogu ukloniti kombiniranjem načina obuke. Bez obzira na način obuke, permanentno obrazovanje zahtijeva aktivno sudjelovanje arhivista koji želi proširiti svoje znanje, arhivske institucije koja podržava kontinuiran profesionalan razvoj zaposlenika te predavača. Niti jedan način ne odgovara svim zahtjevima, a da bi se udovoljilo potrebama arhivista 21. stoljeća, treba ponuditi široku paletu načina i mogućnosti permanentnog obrazovanja

The Effect of FDA Advisories on Branded Pharmaceutical Firms' Valuations and Promotion Efforts

The US Food and Drug Administration (FDA) expends considerable efforts in regulating medications approved for use. Yet the impact of medication labeling changes on brand pharmaceutical products, and whether and what firms do to respond to increased information regarding the safety and efficacy of a drug, have not be characterized. We propose a behavioral framework for examining the effects of FDA advisories on branded pharmaceutical firms and their products. We empirically assess the impact of recent FDA advisories on the stock market valuations of a sample of branded pharmaceutical manufacturing firms using event study methods. We examine whether and how branded pharmaceutical manufacturers respond to an advisory by assessing changes in promotion compared to non-affected firms. We find firms targeted by an advisory have average stock price declines of 3% in three days and 11% in five days following the advisory release, and in turn appear to decrease total physician-directed promotion spending, journals ads and detailing visits significantly six months following the advisory release; the provision of free samples is unaffected. We find no changes among therapeutic substitutes unaffected by the advisory. Results of sensitivity analyses suggest firms with market dominant positions experience similar decreases in stock market valuations and physician-directed promotion compared to pooled results. The results are also robust to alternative definitions of the timing of advisory release dates and the severity of advisories’ wording. Theory and empirical results suggest the public release of FDA advisories negatively impacts firm’s short-term market valuations. The results suggest an additional rationale for previously documented declines in prescribing after FDA advisory releases – significant declines in physician-directed promotion following FDA advisory releases; the combined (and likely correlated) effects of the release of the advisory and declines in physician-directed promotion on prescribing behavior are likely larger than the sum of the independent effects.

Changes in Physician Antipsychotic Prescribing Preferences, 2002–2007

Objective Physician antipsychotic prescribing behavior may be influenced by comparative effectiveness evidence, regulatory warnings, and formulary and other restrictions on these drugs. This study measured changes in the degree to which physicians are able to customize treatment choices and changes in physician preferences for specific agents after these events. Methods The study used 2002–2007 prescribing data from the IMS Health Xponent database and data on physician characteristics from the American Medical Association for a longitudinal cohort of 7,399 physicians. Descriptive and multivariable regression analyses were conducted of the concentration of prescribing (physician-level Herfindahl index) and preferences for and likelihood of prescribing two first-generation antipsychotics and six second-generation antipsychotics. Analyses adjusted for prescribing volume, specialty, demographic characteristics, practice setting, and education. Results Antipsychotic prescribing was highly concentrated at the physician level, with a mean unadjusted Herfindahl index of .33 in 2002 and .29 in 2007. Psychiatrists reduced the concentration of their prescribing more over time than did other physicians. High-volume psychiatrists had a Herfindahl index that was half that of low-volume physicians in other specialties (.18 versus .36), a difference that remained significant (p<.001) after adjustment for physician characteristics. The share of physicians preferring olanzapine dropped from 29.9% in 2002 to 10.3% in 2007 (p<.001) while the share favoring quetiapine increased from 9.4% to 44.5% (p<.001). Few physicians (<5%) preferred a first-generation antipsychotic in 2002 or 2007. Conclusions Preferences for specific antipsychotics changed dramatically during this period. Although physician prescribing remained heavily concentrated, the concentration decreased over time, particularly among psychiatrists.National Institute of Mental Health (U.S.) (Grant R01MH093359)National Institute of Mental Health (U.S.) (Grant P30 MH090333)National Institute of Mental Health (U.S.) (Grant R01MH087488)Agency for Healthcare Research and Quality (Grant R01HS017695)Robert Wood Johnson Foundation (Investigator Award in Health Policy Research

How Quickly Do Physicians Adopt New Drugs? The Case of Second-Generation Antipsychotics

Objective The authors examined physician adoption of second-generation antipsychotic medications and identified physician-level factors associated with early adoption. Methods The authors estimated Cox proportional-hazards models of time to adoption of nine second-generation antipsychotics by 30,369 physicians who prescribed antipsychotics between 1996 and 2008, when the drugs were first introduced, and analyzed the total number of agents prescribed during that time. The models were adjusted for physicians’ specialty, demographic characteristics, education and training, practice setting, and prescribing volume. Data were from IMS Xponent, which captures over 70% of all prescriptions filled in the United States, and the American Medical Association Physician Masterfile. Results On average, physicians waited two or more years before prescribing new second-generation antipsychotics, but there was substantial heterogeneity across products in time to adoption. General practitioners were much slower than psychiatrists to adopt second-generation antipsychotics (hazard ratios (HRs) range .10−.35), and solo practitioners were slower than group practitioners to adopt most products (HR range .77−.89). Physicians with the highest antipsychotic-prescribing volume adopted second-generation antipsychotics much faster than physicians with the lowest volume (HR range .15−.39). Psychiatrists tended to prescribe a broader set of antipsychotics (median=6) than general practitioners and neurologists (median=2) and pediatricians (median=1). Conclusions As policy makers search for ways to control rapid health spending growth, understanding the factors that influence physician adoption of new medications will be crucial in the efforts to maximize the value of care received by individuals with mental disorders as well as to improve medication safety.National Institute of Mental Health (U.S.) (R01 MH093359)Robert Wood Johnson Foundation (Investigator Award in Health Policy Research)Agency for Healthcare Research and Quality (R01HS017695)National Institute of Mental Health (U.S.) ((NIMH) R34 MH082682)National Institute of Mental Health (U.S.) ((NIMH) P30 MH090333)National Institute of Mental Health (U.S.) ((NIMH) R01 MH087488)National Science Foundation (U.S.) (0915674

Regional Variation in Physician Adoption of Antipsychotics: Impact on US Medicare expenditures

Background—Regional variation in US Medicare prescription drug spending is driven by higher prescribing of costly brand-name drugs in some regions. This variation likely arises from differences in the speed of diffusion of newly-approved medications. Second-generation antipsychotics were widely adopted for treatment of severe mental illness and for several off-label uses. Rapid diffusion of new psychiatric drugs likely increases drug spending but its relationship to non-drug spending is unclear. The impact of antipsychotic diffusion on drug and medical spending is of great interest to public payers like Medicare, which finance a majority of mental health spending in the U.S.National Institute of Mental Health (U.S.) (R01 MH093359

The Relationship Between Older Adults' Knowledge of Their Drug Coverage and Medication Cost Problems

To determine whether chronically ill patients have gaps in knowledge about their prescription drug coverage and establish the relationship between gaps and medication cost problems. Design : Nationwide, cross-sectional survey. Setting : Nationwide survey conducted via the Internet. Participants : Three thousand one hundred nineteen adults aged 50 and older (1,400 of whom were aged ≥65) who had prescription drug coverage and at least one chronic illness. Measurements : Patients were asked about features of their drug benefits and whether they had experienced problems due to medication costs in the prior year. Results : Twenty-five percent of respondents reported not knowing their usual prescription copayments, and 41% did not know whether there were caps on their drug coverage. Nonwhite race and lower income were independent risk factors for lack of knowledge about these aspects of pharmacy benefits. Lack of knowledge regarding the limits of coverage was associated with a greater likelihood of cutting back on medication use because of cost pressures, forgoing basic needs because of medication costs, borrowing money to pay for prescriptions, and worrying about medication costs (all P <.05). Conclusion : Many older adults with prescription drug coverage do not know important features of their pharmacy benefits. Racial minorities and those with low incomes may have the greatest difficulty understanding coverage and as a result may be at greatest risk for underusing their benefits. Education about Medicare reforms and other efforts to increase prescription coverage should accompany these policies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66286/1/j.1532-5415.2005.00527.x.pd

Out-of-pocket and health care spending changes for patients using orally administered anticancer therapy after adoption of state parity laws

IMPORTANCE Oral anticancer medications are increasingly important but costly treatment options for patients with cancer. By early 2017, 43 states andWashington, DC, had passed laws to ensure patients with private insurance enrolled in fully insured health plans pay no more for anticancer medications administered by mouth than anticancer medications administered by infusion. Federal legislation regarding this issue is currently pending. Despite their rapid acceptance, the changes associated with state adoption of oral chemotherapy parity laws have not been described. OBJECTIVE To estimate changes in oral anticancer medication use, out-of-pocket spending, and health plan spending associated with oral chemotherapy parity law adoption. DESIGN, SETTING, AND PARTICIPANTS Analysis of administrative health plan claims data from 2008-2012 for 3 large nationwide insurers aggregated by the Health Care Cost Institute. Data analysis was first completed in 2015 and updated in 2017. The study population included 63 780 adults living in 1 of 16 states that passed parity laws during the study period and who received anticancer drug treatment for which orally administered treatment options were available. Study analysis used a difference-in-differences approach. EXPOSURES Time period before and after adoption of state parity laws, controlling for whether the patient was enrolled in a plan subject to parity (fully insured) or not (self-funded, exempt via the Employee Retirement Income Security Act). MAIN OUTCOMES AND MEASURES Oral anticancer medication use, out-of-pocket spending, and total health care spending. RESULTS Of the 63 780 adults aged 18 through 64 years, 51.4%participated in fully insured plans and 48.6%in self-funded plans (57.2%were women; 76.8%were aged 45 to 64 years). The use of oral anticancer medication treatment as a proportion of all anticancer treatment increased from 18%to 22%(adjusted difference-in-differences risk ratio [aDDRR], 1.04; 95%CI, 0.96-1.13; P = .34) comparing months before vs after parity. In plans subject to parity laws, the proportion of prescription fills for orally administered therapy without copayment increased from 15.0%to 53.0%, more than double the increase (12.3%-18.0%) in plans not subject to parity (P < .001). The proportion of patients with out-of-pocket spending of more than $100 per month increased from 8.4$19.44 at the 25th percentile, by $32.13 at the 50th percentile, and by$10.83 at the 75th percentile but increased at the 90th ($37.19) and 95th ($143.25) percentiles after parity (all P < .001, controlling for changes in plans not subject to parity). Parity laws did not increase 6-month total spending for users of any anticancer therapy or for users of oral anticancer therapy alone. CONCLUSIONS AND RELEVANCE While oral chemotherapy parity laws modestly improved financial protection for many patients without increasing total health care spending, these laws alone may be insufficient to ensure that patients are protected from high out-of-pocket medication costs