Emerson J.S.,Tennessee State University |
Hull P.C.,Vanderbilt University |
Cain V.A.,Tennessee State University |
Novotny M.L.,Tennessee State University |
And 2 more authors.
Journal of Ambulatory Care Management | Year: 2012
The patient-centered medical home (PCMH) is being promoted as a cornerstone for transforming primary care. Physician organizations (POs) are playing a more prominent role by facilitating practices' transformation to PCMH. Using a framework of organizational integration, we investigate the changing relationship between POs and practices through qualitative interviews. Through increased integration, POs can support both the big-picture and day-to-day activities of practice transformation. Most PO-practice unit connections reflected new areas of engagement-competencies that POs were not developing in the past-that are proving integral to the broad-scale practice change of PCMH implementation. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams &Wilkins.
PubMed | Georgetown University, University of North Texas Health Science Center, Bureau of Population Health and c ABPN
Type: | Journal: Journal of dual diagnosis | Year: 2017
There is increasing literature supporting the adverse effects of disasters on substance use and psychiatric disorders. The co-occurrence of psychiatric disorders with substance use intensifies the challenge of treatment delivery. Thus the aim of this study was to examine the prevalence of substance use, treatment characteristics, and demographics of discharges from substance abuse treatment in New Orleans, post-Hurricane Katrina. Trends associated with discharges that have a co-occurring psychiatric and substance use disorder (COD) were also assessed. The secondary aim of this study was to examine the association of successful substance abuse treatment completion among those with a COD post-Hurricane Katrina.Substance abuse treatment discharge data (N = 16,507) from New Orleans, Louisiana, for years 2006 through 2011 was obtained from the Treatment Episode Data Set -Discharge (TEDS-D). Multiple logistic regression was employed to examine the association of discharges with a COD and completion of substance abuse treatment. Demographic, psychiatric, and treatment characteristics of discharges in 2006 were compared to characteristics in 2011. Trends of characteristics were also assessed through the study period.Roughly a third (35.2%) of all discharges in New Orleans from 2006 to 2011 had a COD. After controlling for race, employment, treatment service setting at discharge, primary substance problem, and the discharges principal source of referral, discharges with a COD were 29% less likely to complete treatment as compared to those with no COD (AOR: 0.71, 95% CI: [0.56, 0.90], p = 0.004). Treatment completion among discharges with a COD has significantly declined from 36.8% in 2006 to 18.7% in 2011 (p < .0001). Notable significant trends in homelessness, criminality, and heroin use were identified among discharges with a COD.Substance abuse treatment undergoes various changes in the event of a natural disaster. These changes may increase challenges for successful treatment completion for vulnerable populations such as those with a COD. Results of this study demonstrate that discharges with a COD are less likely to complete treatment as compared to those with no COD disorder. Unmet treatment needs may also increase odds of criminalization and homelessness.