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June 10, 2010 Volume VI, No. 54

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

According to a survey conducted by SAMHSA, 17.3 million Americans over age 12 are heavy drinkers and 58.1 million Americans have participated in binge drinking. To help decrease these rates of substance use, Magellan Health Services has developed an intervention program which is this week's featured prevention story.

Also in this issue, learn if depression can affect diabetes self-care as well as the comorbidities that can exist with behavioral health conditions.

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

This week's DM news:

Table of Contents

  1. Depression & Diabetes Self-Care
  2. ADHD Comorbidities
  3. Comorbidities & Behavioral Health
  4. Mental Health “Frequent Fliers”
  5. Boosting Medication Adherence
  6. Targeting Depression Through DM
  7. Substance Use Intervention Program
  8. Health Risk Assessments

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Please send comments, questions and replies to jpapay@hin.com.

Melanie Matthews, mmatthews@hin.com

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Diabetes Self-Care May Be as Good With Depression as Without It

Patients with diabetes who also have depression are known to have adverse cardiovascular outcomes and a risk of death that is higher than counterparts who do not suffer from depression. Physician researchers thought that these outcomes might occur because depressed patients found it difficult to maintain good diabetes self-care — namely taking medications, checking blood glucose, monitoring blood pressure, exercising and eating the right foods. But now, a team of Seattle-based researchers at the University of Washington (UW) and Group Health Research Institute have found that patients with diabetes who are also depressed had similar levels of glycemia, blood pressure and lipid control compared with counterparts without depression.

Researchers examined medical records from nearly 4,000 Group Health Cooperative patients for the analysis, comparing three depression groups: minor, major and no depression. The results are somewhat surprising, said lead author Susan Heckbert, M.D., Ph.D., M.P.H., UW professor of epidemiology and affiliate investigator at Group Health Research Institute. “We were expecting that depression might well be associated with patients having difficulty with taking medications consistently, exercising and eating right, and that this might affect risk factor control,” said Dr. Heckbert. “Patients tell us that when they are depressed, they sometimes have more difficulty maintaining consistent diabetes self-care.”

According to Dr. Heckbert, more research is needed to understand why depression in patients with diabetes is associated with less favorable cardiovascular outcomes and higher death rates. “This study suggests that worse risk factor control may not be responsible and that other mechanisms such as biological effects of depression need to be further evaluated,” said Dr. Heckbert.

To learn more about this research, please visit:

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Researchers Identify Common ADHD Comorbidities

Among children and adolescents with attention-deficit/hyperacitivity disorder (ADHD), more than 80 percent had a diagnosis of at least one other psychiatric disorder, most commonly oppositional defiant disorder and conduct disorder, according to new research.

A group of researchers sought to assess comorbidity types and frequencies and age and gender characteristics in a large sample of children and adolescents ages 3 to 18 years with ADHD. Anxiety disorders were equally prevalent among boys and girls. Mood disorders were more common among girls and more common among older children/adolescents. In the preschool age group, communication disorders were common, but decreased with age. Among preschoolers, oppositional defiant disorder was more common among males.

ADHD is highly comorbid and exhibits specific age and gender characteristics that evolve with age, the researchers concluded. Understanding of these features can aid in the formulation of differential diagnoses and in the choice of medication in children/adolescents with ADHD.

To learn more about this research, please visit:

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Comorbidities in Behavioral Health Patients

A large portion of McKesson Health Solutions' chronically ill beneficiaries suffer from depression and schizophrenia, says Jim Hardy, senior vice president of care management services. Increasingly, McKesson seeks nurses with a background in behavioral healthcare to provide disease and case management to this population, especially during hospitalizations and at discharge. He describes the challenges inherent in navigating the medical and mental health systems needed by these clients and suggests ways to bridge behavioral healthcare gaps.

To listen to this complimentary HIN podcast, please visit:

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Identifying Mental Health “Frequent Fliers” to the ED

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's experts are Joe Eppling, assistant vice president of post acute and behavioral health services at East Jefferson General Hospital in Louisiana, and Julie Szempruch, associate vice president and chief nursing officer for the Midtown Mental Health Center at Wishard Health Services in Indiana.

Question: Do either of your organizations try to determine who would use the medical ED for mental health needs before they come in?

Response: (Julie Szempruch) We are well aware of the fact that people have unmet needs and lack quick availability of service. We have such limited services in the area that it’s hard to get people into the mental clinics quickly enough to see the doctors. There’s a small window in having patients utilize these clinics — if you miss that window, the patient will likely accelerate to the next level and/or seek their care in the ED.

(Joe Eppling) Through the mental health task force, we occasionally talk about certain patients needing certain services. We always try to provide the safety net to prevent those patients from going to the ED. However, with limited resources, sometimes patients end up going to the ED in order to get linked quickly with services.

(Julie Szempruch) We also see a fairly large amount of patients for whom homelessness is a key issue. If they feel like they have no other options and no place to go, it’s possible that they can become somewhat suicidal, at which point their basic needs take precedence. If we can help them to feel like they have a safe place to go, that environment might be enough to enable them to seek treatment at a more relevant place.

For more information on mental health patients in the ED, please visit:

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Top 5 Occasions to Boost Medication Adherence

Medication adherence programs can improve patient care and lower healthcare costs by more effectively managing chronic medication utilization. We wanted to see at which points in care organizations were most heavily focused on improving medication adherence.

Click here to view the chart.

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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:

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Magellan Rolls Out National Phase of Substance Use Intervention Program

Magellan Health Services has developed a national medication-assisted treatment (MAT) intervention to battle substance use disorders. The MAT intervention focuses on increasing the appropriate use of proven medications as part of the discharge treatment plan for members completing inpatient treatment for a primary alcohol and other drugs (AOD) diagnosis.

Based on professional standards, such as those developed by the American Psychiatric Association's Physician Consortium for Performance Improvement®, a taskforce of Magellan clinical leaders created the MAT program. This national intervention seeks to increase the use of medications such as acamprosate, naltrexone, disulfiram and buprenorphine in treatment of substance use disorders where clinically appropriate and focuses on patients who have been discharged from inpatient substance use treatment programs. The MAT intervention monitors the number of cases in which physicians are prescribing medications and measures member readmission rates. As part of this intervention, Magellan also continually heightens outreach efforts and collaboration with its health plan partners to help incorporate these medications into client formularies. Additionally, Magellan is hosting a number of provider trainings to illustrate the importance of using appropriate medications when developing members' substance use disorder treatment plans.

In 2007, as part of its consensus standards for the treatment of substance use disorders, the National Quality Forum noted that "pharmacotherapy should be a standard component of treatment for substance use disorders when effective drugs exist." Although studies have demonstrated that medications can assist in the successful management of relapse and/or withdrawal symptoms related to alcohol and opioid abuse when used in conjunction with traditional psychosocial interventions, a paper published in Psychiatric Services regarding a Department of Veterans' Affairs study reported that medications continue to be underutilized as part of patient treatment plans after discharge. Magellan's MAT intervention is intended to address this gap for their members.

Magellan's Southwest Care Management Center, located in Richardson, Texas, was the first center to pilot a program that increased the use of appropriate pharmacological therapy in treatment for members with an AOD diagnosis who received inpatient services for alcohol or opioids by 150 percent from 2004 to 2007. Additionally, preliminary results from a 2008-2010 pilot program in which readmission rates are being studied at Magellan's Southeast Care Management Center in Alpharetta, Georgia, indicate a reduction in inpatient readmissions at six months among patients receiving MAT. Based on the initial success of these programs and supported by respected organizational data, Magellan moved forward with its national intervention, which was launched June 1, 2010.

To learn more about this research, please visit:

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Health Risk Assessments

Aggregate data from health risk assessments (HRAs) provides a roadmap for healthcare organizations to deliver health promotion and disease management interventions to targeted individuals — with the goal of improving clinical and financial outcomes. Join the more than 35 organizations that have already completed our survey on HRAs and get a FREE executive summary of the compiled results.

To participate in this survey and receive its results, please visit:

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