Department of Community Medicine and Population Health

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Browsing Department of Community Medicine and Population Health by Subject "COMORBIDITY"

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    A Prospective Study of the Associations Among Housing Status and Costs of Services in a Homeless Population
    (American Psychiatric Publishing, 2015) Fuehrlein, Brian S.; Cowell, Alexander J.; Pollio, David; Cupps, Lori; Balfour, Margaret E.; North, Carol S.; University of Texas Southwestern Medical Center Dallas; US Department of Veterans Affairs; Veterans Health Administration (VHA); VA North Texas Health Care System; Research Triangle Institute; University of Alabama Tuscaloosa; Washington University (WUSTL)
    Objective: The complex needs of homeless populations result in use of a wide range of services and high costs for housing programs and psychiatric and general medical care. Allocation of resources often is not congruent with assessed needs. A series of cost-congruence hypotheses was developed to test assumptions that needs are associated with resources provided for appropriate services in homeless populations. Methods: Individuals (N=255) who were homeless were followed for two years and were categorized by housing status over time (consistently housed, housed late, lost housing, or consistently homeless). Detailed information about the individuals was obtained at baseline, and follow-up data were collected one and two years later. Extensive data about the costs of services provided by type (medical, psychiatric, substance abuse, and homeless maintenance and amelioration) were derived from 23 agencies, and service use information was collected from the agencies and by self-report. Multiple regression models were used to test the hypotheses. Results: Medical, psychiatric, and homeless maintenance costs varied by housing status. Serious mental illness predicted costs for psychiatric services, as expected, but also costs for substance abuse services and acute behavioral health care and total costs. Alcohol use disorders predicted substance abuse service costs. Conclusions: This study followed a homeless cohort prospectively and provided estimates of costs of service use derived from a large number of agencies. This research increases the understanding of patterns of service use in a homeless population and informs the provision of services appropriate to the complex needs of this difficult-to-serve population.
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    Relationship Between General Illness and Mental Health Service Use and Expenditures Among Racially-Ethnically Diverse Adults >= 65 Years
    (American Psychiatric Publishing, 2015) Jimenez, Daniel E.; Le Cook, Benjamin; Kim, Giyeon; Reynolds, Charles F., III; Alegria, Margarita; Coe-Odess, Sarah; Bartels, Stephen J.; University of Miami; Harvard University; University of Alabama Tuscaloosa; University of Pittsburgh; Cambridge Health Alliance; Swarthmore College; Dartmouth College
    Objectives: The association of general medical illness and mental health service use among older adults from racial-ethnic minority groups is an important area of study given the disparities in mental health and general medical services and the low use of mental health services in this population. The purpose of this report is to describe the impact of comorbid general medical illness on mental health service use and expenditures among older adults and to evaluate disparities in mental health service use and expenditures in a racially-ethnically diverse sample of older adults with and without comorbid general medical illness. Methods: Data were obtained from the Medical Expenditure Panel Survey (years 2004-2011). The sample included 1,563 whites, 519 African Americans, and 642 Latinos (N = 2,724) age >= 65 with probable mental illness. Two-part generalized linear models were used to estimate and compare mental health service use among adults with and without a comorbid general medical illness. Results: Mental health service use was more likely for older adults with comorbid general medical illness than for those without it. Once mental health services were accessed, no differences in mental health expenditures were found. Comorbid general medical illness increased the likelihood of mental health service use by older whites and Latinos. However, the presence of comorbidity did not affect racial-ethnic disparities in mental health service use. Conclusions: This study highlighted the important role of comorbid general medical illness as a potential contributor to using mental health services and suggests intervention strategies to enhance engagement in mental health services by older adults from racial-ethnic minority groups.