Suchergebnisse

Under the assumption that the treatment of substance abuse begins well before substance abusers actually enroll in treatment, this paper conceptualizes the process of recruitment into treatment, and investigates attrition of treatment seeking clients during the treatment recruitment stage. The paper identifies two stages prior to treatment enrollment, treatment exploration and treatment recruitment, and presents the results of a study of 1,924 homeless, mentally ill, chemical abusing men who looked for community-based treatment in New York City between 1991 and 1996. Only 326 of these men actually entered treatment. The rest were lost either prior to or during the recruitment stage. The paper focuses on the 823 men who reached the treatment recruitment stage, and attempts to correlate their sociodemographic, psychological, and substance abuse characteristics with the different types of attrition during treatment recruitment. The results show that certain client characteristics predict rejection and certain other characteristics predict acceptance by the treatment programs.

We examined patterns of changes in psychiatric symptoms among mentally ill chemical abusers (MICAs) in long-term residential treatment. Clients were evaluated with various measures of psychopathology, referred to a therapeutic community (TC) or community residence, and reassessed after 2, 6, and 12 months of treatment with regard to anxiety, depressive symptoms, and psychotic ideation. Reductions in mean values of psychopathology were found only for anxiety and depressive symptoms at the TC during the first 2 months of treatment. However, an examination of changing patterns of symptoms revealed a more complex set of findings. At both programs, a significant number of MICAs showed reductions in psychopathology during treatment, a significant minority exhibited no improvements in psychiatric symptoms, and a few reported new symptoms of anxiety, depression, and psychotic ideation. We conclude that the symptoms of the vast majority of MICAs are highly labile during treatment.

Purpose. To estimate the employer costs associated with employee obesity. Design. The study used cross-sectional analysis of employee health-risk assessment, disability, workers' compensation, and medical claims data from 2006 to 2008. Setting. The study took place in the United States from 2006 to 2008. Subjects. A panel database with 29,699 employees drawn from a panel of employers and observed for 3 years each (N = 89,097) was used. Measures. Workdays lost owing to illness and disability; the cost of medical, short-term disability, and workers' compensation claims; and employees' adjusted body mass indices (BMI) were measured. Analysis. We model the number and probability of workdays lost from illness, short-term disability, and workers' compensation events; short-term disability and workers' compensation payments; and health care spending as a function of BMI. We estimate spline regression models and fit results using a third-degree fractional polynomial. Results. Probability of disability, workers' compensation claims, and number of days missed owing to any cause increase with BMI above 25, as do total employer costs. The probability of a short-term disability claim increases faster for employees with hypertension, hyperlipidemia, or diabetes. Normal weight employees cost on average $3830 per year in covered medical, sick day, short-term disability, and workers' compensation claims combined; morbidly obese employees cost more than twice that amount, or $8067, in 2011 dollars. Conclusion. Obesity is associated with large employer costs from direct health care and insurance claims and indirect costs from lost productivity owing to workdays lost because of illness and disability.

Purpose. To develop a risk-scoring tool to identify in a base year patients likely to have high medical spending in the subsequent year and to understand the role obesity and obesity reduction may play in mitigating this risk. Design. Cross-sectional analysis, using commercial claims and health risk assessment data. Setting. United States, 2004–2009. Subjects. Panel of 192,750 person-year observations from 116,868 unique working-age employees of large companies. Measures. Probability of high medical expenses (80th percentile or above) in the following year; adjusted body mass index (BMI). Analysis. Generate risk scores by modeling the likelihood of high next-year expenses as a function of base-year age, sex, medical utilization, comorbidities, and BMI. Estimate the effect of simulated bariatric intervention on patient risk scores. Results. Individuals with higher BMI were more likely to be categorized in the very high risk group, in which the average annual medical expense was $8621. A weight-loss intervention transitioning a patient to the next lower obesity class was predicted to reduce this risk by 1.5% to 27.4%—comparable to hypothetically curing a patient of depression or type 2 diabetes. Conclusion. A logistic model was used to capture the effect of BMI on the risk of high future medical spending. Weight-loss interventions for obese patients may generate significant savings by reducing this risk.