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March 25, 2010 Volume VI, No. 43

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

In a breakthrough for behavioral health, a new online, three-minute checklist helps to indicate whether a patient has any of four major mental health conditions. I completed this checklist myself in less than three minutes. This could definitely be a valuable diagnostic tool for physicians and provide some insight for patients who may be suffering from certain mental health conditions.

Also in this issue, you will discover if feeling lonely could affect blood pressure as well as how physicians are prescribing certain psychiatric drugs.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Physicians & Psychiatric Drug Prescriptions
  2. Link Between Loneliness & Blood Pressure
  3. Embedded Case Managers
  4. SAMHSA's 10 by 10 Pledge
  5. Healthcare Trends: Targeting Depression Through DM
  6. 3-Minute Checklist for Psychiatric Illnesses
  7. Medical Homes in 2010

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Publisher:
Melanie Matthews, mmatthews@hin.com

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How Physicians Prescribe Psychiatric Drugs

A new SAMHSA study outlines the conditions that physicians around the country reported treating with psychiatric drugs such as antipsychotics, antidepressants and anti-anxiety drugs.

Psychiatric medications are one of the most widely prescribed categories of drugs in the nation; yet few studies have comprehensively examined the types of illnesses being treated with these medications. In particular, there has been a great deal of interest and some concern about how psychiatric drugs are being prescribed for medical conditions not included in their FDA-approved labeling — or “off-label” — use. In most instances it is legal and a common practice for physicians to prescribe drugs off-label, even though less may be known about a drug’s risks and benefits for an unapproved indication. Although this study did not evaluate whether drugs were prescribed for on- or off-label use, the study reveals that in the vast majority of cases physicians are prescribing psychiatric medications for patients with psychiatric conditions. These medications are also sometimes prescribed to treat other conditions. This is particularly true of anti-anxiety drugs.

The study looked at the prescription patterns for three major types of psychiatric drugs: antipsychotic drugs, antidepressant drugs and anti-anxiety drugs, but did not evaluate clinical appropriateness per se. The study found that antipsychotic drugs were prescribed for psychiatric conditions 99 percent of the time, including mood disorders (39 percent), schizophrenia or other psychotic disorders (35 percent), cognitive disorders such as dementia (7.4 percent), anxiety (6 percent) and attention-deficit/conduct-disruptive behavior disorders (6 percent). In terms of antidepressant drugs, the study found that 93 percent of prescriptions were for psychiatric conditions, primarily mood disorders (65 percent), anxiety (16 percent), schizophrenia and other psychotic disorders (2.6 percent). Other non-psychiatric diagnoses for which antidepressants were prescribed included headaches (1.1 percent), connective tissue disease (e.g., fibromyalgia) (1 percent) and back problems (0.7 percent).

Although the study found that the majority of prescriptions written for anti-anxiety medication were used to treat psychiatric conditions (72 percent), a significant percentage (28 percent) were used for non-psychiatric diagnoses including anxiety related to medical interventions (6 percent), allergic reactions (4 percent) and back problems (2.5 percent).

To learn more about this research, please visit:
http://www.samhsa.gov/newsroom/advisories/1003221222.aspx

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Feeling Lonely Adds to Rate of Blood Pressure Increase at 50 and Older

A University of Chicago study shows, for the first time, a direct relation between loneliness and larger increases in blood pressure four years later — a link that is independent of age and other factors that could cause blood pressure to rise, including BMI, smoking, alcohol use and demographic differences such as race and income. The researchers also looked at the possibility that depression and stress might account for the increase but found that those factors did not fully explain the increase in blood pressure among lonely people 50 years and older.

Like blood pressure, loneliness is sometimes not easy to detect. People who have many friends and a social network can feel lonely if they find their relationships unsatisfying, the researchers said. Conversely, people who live rather solitary lives may not be lonely if their few relationships are meaningful and rewarding.

The research team based its research on a study of 229 people aged 50 to 68. The randomly chosen group included whites, African Americans and Latinos who were part of a long-term study on aging. Members of the group were asked a series of questions to determine if they perceived themselves as lonely. They were asked to rate connections with others through a series of topics, such as “I have a lot in common with the people around me,” “My social relationships are superficial” and “I can find companionship when I want it.”

During the five-year study, a clear connection was found between feelings of loneliness reported at the beginning of the study and rising blood pressure over that period. “The increase associated with loneliness wasn’t observable until two years into the study, but then continued to increase until four years later,” according to researcher Louise Hawkley, senior research scientist with the Center for Cognitive and Social Neuroscience. Even people with modest levels of loneliness were impacted. Among all the people in the sample, the loneliest people saw their blood pressure go up by 14.4 mm more than the blood pressure of their most socially contented counterparts over the four-year study period. Lonely people’s apprehension about social connections may underlie the blood pressure increase. According to Hawkley, “loneliness is characterized by a motivational impulse to connect with others but also a fear of negative evaluation, rejection and disappointment. We hypothesize that threats to one’s sense of safety and security with others are toxic components of loneliness, and that hypervigilance for social threat may contribute to alterations in physiological functioning, including elevated blood pressure.”

To learn more about this research, please visit:
http://news.uchicago.edu/news.php?asset_id=1907

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Embedded Case Managers — Navigating Care Transitions, Gaps in Care and Patient Compliance

The contributions of an embedded case manager to the practice quickly become evident, explains Diane Littlewood, R.N., regional manager of case management for health services, Geisinger Health Plan, which in turn bolsters physician buy-in for the program. She describes the upfront basics that help to ensure that health plan and provider expectations for embedded case management are met.

To listen to this complimentary HIN podcast, please visit:
http://www.hin.com/podcasts/podcast.htm#113

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SAMHSA's 10 by 10 Pledge in Behavioral Healthcare

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's experts are Laura Galbreath, director of policy and advocacy for the National Council for Community Behavioral Healthcare (National Council) and Liz Reardon, president of Reardon Consulting, consultant to the National Council and former managed care director for Vermont Medicaid.

Question: Can you provide details on SAMHSA's 10 by 10 pledge and its role in behavioral healthcare?

Response: People with severe mental illness (SMI) appear to have some of the worst mortality rates in the public health system. It is key that we pursue the single point of accountability to enhance the continuity of care for this underserved population. In 2007, the community led by the Center for Mental Health Services (CMHS) at SAMHSA under HHS came together to say that this is a priority. We need to address the full health of the people that we are serving in mental health systems. We also want to promote wellness and make sure that people with mental illness are taking action to prevent and reduce the early mortality by 10 years over the next 10-year period.

Building off of this "10 by 10" pledge, the National Association of State Mental Health Program Directors (NASMHPD) last year pulled together 10 health indicators for clinical care and two process indictors to say that for every client that comes into our system, we need to make sure that this information is collected. This is essential both to make sure that they have proper mental healthcare and that their overall healthcare is being addressed when they come here. This is a responsibility of the mental health system. This has been widely distributed and well received. Now we have to make sure that this happens, and that we bring the lessons of integrated care to providing a medical home and addressing the whole health for the population that we serve.

For behavioral health providers, we recommend two pathways to follow. Providers who want to become a full-scope person-centered healthcare home for people with SMI should look at models like Cherokee Health Systems. They provide full scope primary care services in what is thought of as a primary care practice, as well as the full scope behavioral health practice, which includes 24-hour crisis telephone, mobile crisis teams, substance abuse services and residential services — the full range of services offered in a specialty health services home.

However, we realize that not every system is going to be able to do that. In that case, the other pathway that behavioral health providers can follow is to partner with the full scope primary care organization to create that person-centered healthcare home for individuals. We want to organize a parallel to the impacts of the primary care model, which is the best evidence-based practice we have for collaborative care in addressing depression and in primary care settings. We want to take that impact model, flip it and ask how can we bring this to the community mental health system.

For more depression management benchmarks, please visit:
http://store.hin.com/product.asp?itemid=3935

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

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"Medical Home Monitor" tracks the construction of medical homes around the country and their impact on healthcare access, quality, utilization and cost. As providers and payors reframe care delivery, this twice monthly e-newsletter will cover the pilots, practice transformations, tools and technology that will guide healthcare organizations toward clinical excellence.

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Healthcare Trends & Studies: Targeting Depression Through DM

Nearly 6 percent of men and almost 10 percent of women worldwide will experience a depressive episode in any given year, and in America alone, approximately 18.8 million adults have depression. In an e-survey from the Healthcare Intelligence Network (HIN), 250 healthcare professionals shared how their organizations are targeting depression as part of their DM initiatives.

To download this complimentary white paper, please visit:
http://www.hin.com/library/registerdepdm.html

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3-Minute Checklist Helps to Identify Specific Psychiatric Illnesses

A one-page, 27-question, online checklist that can be completed in three minutes accurately indicates whether a patient may have any of four major mental health conditions, according to a study in the Annals of Family Medicine. For the millions of Americans grappling with depression, anxiety, post-traumatic stress disorder or bipolar disorder, the documented accuracy of the M-3 Symptom Checklist is a major breakthrough for mental healthcare, according to researchers from the University of North Carolina, Weill Medical College at Cornell University and the Boston University School of Medicine who conducted the study.

According to Larry Culpepper, M.D., M.P.H., chairman of the department of family medicine at Boston University School of Medicine, and a co-author of the study, "the M-3 offers a quick and accurate way to determine whether a person might have one of these four common psychiatric conditions. It also provides a clear and concise printed report detailing the results of the test, which can be shared and discussed with a person's family doctor or a mental health professional." The M-3 also screens for suicide risk and substance abuse, warning users who might be at risk for these and other conditions and urging that follow-up steps be taken.

The M-3 Checklist, which can be found at www.mymoodmonitor, is free, private, simple to use and does not require any personal information to be divulged. It can be taken online, and soon will be available on mobile devices. After beginning treatment, patients can monitor their progress by retaking the test at regular intervals on Microsoft’s HealthVault, which ensures the results remain private. Plus, the M-3 is particularly timely: hospitals, doctors and patients are preparing to use EMR systems to document all healthcare interactions and the M-3 is the first validated application to use EMR technology for mental healthcare. The recent Obama Administration economic stimulus package includes more than $20 billion in funding for the development of a nationwide EHR exchange over the next four years. According to the most recent estimate from the National Institute of Mental Health, the annual economic impact of untreated mood disorders is more than $70 billion. For sufferers of depression and anxiety, lack of treatment can lead to reduced productivity or job loss, strain on personal relationships, and in some cases, can trigger drug use and/or suicide. Unlike other health issues, the very onset of depression and anxiety symptoms can hinder efforts to seek help, and many sufferers are held back by shame or lethargy.

According to the study: “The M-3 is a valid, efficient, and feasible tool for screening common psychiatric illnesses, including bipolar disorder and PTSD, in primary care. Its diagnostic accuracy equals that of presently used single-disorder screens but with the additional benefit of being combined into a one-page tool. The M-3 potentially can reduce missed psychiatric diagnoses and facilitate proper treatment of identified cases.”

To learn more about this research, please visit:
http://www.bu.edu/phpbin/news/releases/...

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Medical Homes in 2010

Patient-centered medical home (PCMH) pilots are in high gear around the country and high on the healthcare reform agenda. Recent studies indicate that the PCMH can deliver quality care at little or no added cost. Complete HIN's fourth annual survey on your organization's PCMH experience by March 31 and get a FREE executive summary of the compiled results. More than 140 organizations have responded so far; your responses will be kept confidential.

To participate in this survey and receive its results, please visit:
hhttp://www.surveymonkey.com/s/medicalhome

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