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Patel S.R.,Columbia University | Schnall R.,Columbia University | Little V.,The Institute for Family Health | Lewis-Fernandez R.,Columbia University | Pincus H.A.,Presbyterian University College
Journal of Immigrant and Minority Health | Year: 2014

Increasing interest has been shown in shared decision making (SDM) to improve mental health care communication between underserved immigrant minorities and their providers. Nonetheless, very little is known about this process. The following is a qualitative study of fifteen primary care providers at two Federally Qualified Health Centers in New York and their experience during depression treatment decision making. Respondents described a process characterized in between shared and paternalistic models of treatment decision making. Barriers to SDM included discordant models of illness, stigma, varying role expectations and decision readiness. Respondents reported strategies used to overcome barriers including understanding illness perceptions and the role of the community in the treatment process, dispelling stigma using cultural terms, orienting patients to treatment and remaining available regarding the treatment decision. Findings from this study have implications for planning SDM interventions to guide primary care providers through treatment engagement for depression. © 2013, Springer Science+Business Media New York.

Acri M.C.,New York University | Bornheimer L.A.,New York University | O'Brien K.,New York University | Sezer S.,The Institute for Family Health | And 3 more authors.
Social Work in Health Care | Year: 2016

Disruptive behavior disorders (DBDs) are chronic, impairing, and costly behavioral health conditions that are four times more prevalent among children of color living in impoverished communities as compared to the general population. This disparity is largely due to the increased exposure to stressors related to low socioeconomic status including community violence, unstable housing, under supported schools, substance abuse, and limited support systems. However, despite high rates and greater need, there is a considerably lower rate of mental health service utilization among these youth. Accordingly, the current study aims to describe a unique model of integrated health care for ethnically diverse youth living in a New York City borough. With an emphasis on addressing possible barriers to implementation, integrated models for children have the potential to prevent ongoing mental health problems through early detection and intervention. © 2016 Taylor & Francis.

Calman N.,The Institute for Family Health | Little V.,The Institute for Family Health | Garozzo S.,Ulster Green ARC
Progress in Community Health Partnerships: Research, Education, and Action | Year: 2015

Background: A comprehensive look at health status in developmentally disabled populations shows poorer physical, oral, and vision health, and higher rates of heart disease and obesity. Generally, individuals with developmental disabilities have difficulty locating able providers, and face significant barriers in accessing health services. The health care system’s failure to achieve effective collaboration between medical, mental health, and residential providers too often results in substandard care and poor outcomes for these populations. Methods: A creative partnership between two organizations in rural upstate New York, Ulster Green ARC and the Institute for Family Health, has made substantial inroads toward addressing this problem. The organizations have transformed a relationship borne of a financially failing health care model into a successful, comprehensive care network for a severely developmentally disabled populationbased in a Federally Qualified Health Center. Conclusions: The success of this effort is largely owing to an innovative use of health information technology to share information. © 2015 The Johns Hopkins University Press.

Pilipenko N.,The Institute for Family Health | Karekla M.,University of Cyprus | Georgiou A.,Nicosia General Hospital | Feldman J.,Yeshiva University
Psychology, Health and Medicine | Year: 2016

The impact of psychiatric illnesses upon asthma patients' functioning is not well understood. This study examined the impact of psychiatric comorbidity upon illness management in asthma patients using empirically-derived psychiatric comorbidity groups. Participants were a clinic sample of Greek-speaking asthma patients (N = 212) assessed using the Patient Health Questionnaire (PHQ) Somatoform, Depression, Panic Disorder (PD), Other Anxiety Disorder, Eating Disorder (ED) and Alcohol sub-scales. The associations between sub-scales were examined using multiway frequency analysis. The following groups were derived: Somatoform disorder and/or Any Depressive disorder (n = 63), Somatoform disorder and/or Other Anxiety disorder (n = 51), Somatoform disorder and/or Any ED (n = 60), and Any Anxiety group including PD and/or Other Anxiety disorder (n = 24). Across all groups, psychiatric illness was associated with significantly worse asthma control (p < .01). Participants in Any Anxiety group, OR = 4.61, 95% CI [1.90, 11.15], Somatoform and/or Any Depressive disorder, OR = 2.06, 95% CI [1.04, 4.09] and Somatoform and/or Other Anxiety disorder, OR = 2.75, 95% CI [1.35, 5.60] were at higher risk for asthma-related Emergency Room (ER) visits compared to controls. However only Somatoform and/or Any Depressive disorder, OR = 3.67, 95% CI [1.60, 8.72], Somatoform and/or Other Anxiety disorder, OR = 5.50, 95% CI [2.34, 12.74], and Somatoform and/or Any ED, OR = 4.98, 95% CI [2.14, 11.60] group membership were risk factors for asthma-related hospitalizations. Results suggest that while comorbid psychiatric disorders generally negatively impact asthma illness management, different psychiatric comorbidities appear to have disparate effects upon illness management outcomes. © 2016 Taylor & Francis

Calman N.S.,The Institute for Family Health | Calman N.S.,Mount Sinai School of Medicine | Hauser D.,The Institute for Family Health | Hauser D.,Mount Sinai School of Medicine | And 5 more authors.
Annals of Family Medicine | Year: 2013

PURPOSE The patient-centered medical home (PCMH) model has great potential for optimizing the care of chronically ill patients, yet there is much to be learned about various implementations of this model and their impact on patient care processes and outcomes. METHODS We examined changes in patterns of health care use in a network of Federally Qualifi ed Health Centers throughout a 9-year period of practice transformation that included recognition of all centers by the National Committee for Quality Assurance (NCQA) as Level 3 PCMH practices. We analyzed deidentified data from electronic health records for the period 2003 to 2011 to identify patterns of service use for all 4,595 patients with diabetes. We also examined a subsample of 545 patients who were in care throughout the study period to track improvement in glycated hemoglobin levels as a clinical measure over time. RESULTS Through the transition to a PCMH, the mean number of encounters with outreach, diabetes educators, and psychosocial services increased for all diabetic patients; virtually all patients had visits with a primary care clinician, but the mean number of visits decreased slightly. Among patients in the subsample, mean annual levels of glycated hemoglobin decreased steadily during the 9-year study period, mainly driven by a reduction in patients having baseline levels exceeding 9%. CONCLUSIONS This retrospective study conducted in a real-world setting using electronic health record data demonstrates a shift in resource use by diabetic patients from the primary care clinician to other members of the care team. The findings suggest that PCMH implementation has the potential to alter processes of care and improve outcomes of care, especially among those with higher disease burden.

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