Bipolar Disorder and Substance Abuse Joseph Goldberg, MD

Size: px
Start display at page:

Download "Bipolar Disorder and Substance Abuse Joseph Goldberg, MD"

Transcription

1 Diabetes and Depression in Older Adults: A Telehealth Intervention Julie E. Malphurs, PhD Asst. Professor of Psychiatry and Behavioral Science Miller School of Medicine, University of Miami Research Coordinator, Mental Health Miami VA Medical Center Disclosures No financial relationships with any commercial interests to report Learning Objectives To become familiar with the telehealth program and the use of this home-based technology in clinical care settings To examine the feasibility of using telehealth devices in a geriatric population with cooccurring depression and diabetes To discuss the potential role of telehealth in the treatment and management of cooccurring mental and physical illnesses in older populations 1

2 Late-Life Life Depression Incidence of major depression declines with age, but minor depression is much more common Depressive symptoms occur in 15% 25% of older adults (>65 years) that fail to meet criteria but cause distress and interfere with functioning Fewer than half of depressed seniors are recognized as being depressed and of those who are identified fewer than half receive treatment U.S. Dept of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Dept of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, NIH, NIMH, 1999; JAGS December 2007 Major Depression Is Associated with Chronic Medical Illness % 25% Prevalence of Major Depression (%) % 4% 5% 10% 6% 14% 0 Community Primary Care Clinic Medical Inpatient Setting Katon W, Schulberg H. Gen Hosp Psychiatry. 1992;14: Rosen J, Mulsant BH, Pollock BG. Nursing Home Med. 1997;5: Nursing Home Impact of Untreated Depression: Morbidity & Mortality Patient morbidity Poorer health outcomes Suicide attempts Accidents Lost jobs Alcohol Use & Abuse Marital Problems Mortality Older white men have highest suicide rates Fatal accidents Death due to related medical complications Societal costs Caregiver burden Higher medical costs Increased healthcare utilization Preskorn SH. Outpatient Management of Depression: A Guide for the Primary Care Practitioner. 2nd ed. Caddo, OK: Professional Communications, Inc.; 1999: Chapter 2. 2

3 Prevalence of Diabetes in the United States In millions Type 2 Diagnosed Non-Insulin Using Type 2 Diagnosed Insulin 4.3 Using 1.1 Type 1 Diabetes Type 2 Undiagnosed Age-Specific Prevalence of Diagnosed Diabetes, by Race/Ethnicity and Sex, United States, 2002 (CDC, 2004) Ethnic Minority Elderly and Depression HISPANIC >65 will increase by more than 450% by 2050 Depressive disorder prevalence in primary care increased from 4.5% to 8.6% between Higher prevalence of depressive symptoms (11-40%) Higher depressionassociated mortality from both suicide and medical disorders AFRICAN-AMERICAN >65 will increase by 131% by 2030 Lower rates of depression recognition and treatment Poorer medical outcomes associated with comorbid depression (EX: diabetes and stroke/hyperglycemia/renal failure/hypertriglyceridemia) 3

4 DIABETES & OLDER ADULTS Diabetes affects at least 20% of persons over the age of 65 Total direct and indirect medical costs in US estimated at 102 billion per year AGS Guidelines (JAGS :S ) Major Depression and Diabetes Mellitus 28% (Lloyd, et al., 2000) 31% (Anderson, et al., 2001) 26% (Gavard, et al., 1993) Significant association between depressive symptoms and high Hgb A1C in men HbA1c & Depressive Symptoms Significant association between depressive symptoms and glucose dysregulation in persons with diabetes Self-care Glucose metabolism Ciechanowski, et al., 2003; Lustman, et al.,

5 Major Depression and Diabetes Mellitus Medline and PsycINFO databases and published reference lists were used to identify studies that measured the association of depression with glucose control. A total of 24 studies satisfied the inclusion and exclusion criteria for the meta-analysis. Depression was significantly associated with hyperglycemia (Z = 5.4, P < ). Lustman et.al. Diabetes Care 2000 Jul;23(7): Major Depression and Diabetes Mellitus 183 African-American men with diabetes 30% had significant depressive symptoms (CES-D >22) Greater depressive symptoms significantly associated with higher serum levels of cholesterol and triglycerides (P<0.050). Gary et.al. Diabetes Care 2000 Jan;23(1):23-9 Impact of Co-Occurring Diabetes and Depression Significantly poorer physical and mental functioning (SF-36; SF-12) Decreased adherence to dietary recommendations Decreased adherence to exercise Decreased adherence to medication use Increased symptom reporting Increased mortality Higher health care costs 5

6 Models of Care UPBEAT (Unified Psychogeriatric Biopsychosocial Evaluation And Treatment) PRISM-E (Primary Care Research in Substance abuse and Mental health care for the Elderly) Pathways PROSPECT (Prevention of Suicide in Primary Care Elderly) IMPACT (Improving Mood-Promoting Access to Collaborative Treatment) TACTICS (Telemedicine & Care Coordination to Improve Care for Seniors) Pathways Study Collaborative Care Model Depression (diabetes HMO patients) Randomized Controlled trial Improved depression and antidepressant adherence outcomes Katon, et al. (2004). The Pathways Study: a randomized trial of collaborative care in patients with diabetes and depression. Arch gen Psych. PROSPECT Study Collaborative Care Model Multi-Site; Randomized Control Primary Care Patients (depressed, 60+) Improved depression outcomes Reduced Mortality post-5 years in patients with diabetes Bruce, et al. (2004); JAMA; Bogner, et al. (2007); Diabetes Care 6

7 Models of Care for Late-life Depression: TACTICS Examine effectiveness of home-health monitoring device for daily management of depression and diabetes Medical and psychiatric outcomes and utilization tracked Llorente & Soto, in Psychiatric Disorders and Diabetes Mellitus TACTICS INTERVENTION Primary Objective: to examine the effectiveness of an intervention using care coordination with telemedicine for older veterans with co-occurring occurring Type II diabetes mellitus (DM) and depressive symptoms Home Telehealth 7

8 TACTICS Outcomes 128 veterans enrolled Enhance both Diabetes and Depression simultaneously 60 or older Diagnosis of Type II DM Significant depressive symptoms Baseline Characteristics from TACTICS Clinical Demonstration Program Demographics: Age 65.0 Gender M 92.5% F 7.5% Ethnicity African American 17.2% Latino 33.6% Non-Latino White 49.2 % Caregiver Yes 65% No 35% Baseline Clinical Characteristics from TACTICS Clinical Demonstration Program Baseline NLW Latino Black Measure Weight Depression Score (PHQ- 9) HgbA1c 7.35% 7.65% 7.56% Blood 129/71 132/75 130/76 Pressure Total Cholesterol Triglycerides* * Indicates significant difference between groups p<.05 8

9 Baseline-6- month Comparisons (Total Sample) Measure Baseline 6-months post Sig enrollment Depression Score (PHQ-9) HgbA1c 7.6% 7.1%.008* Weight Total Cholesterol * Triglycerides * Within-Group Comparisons (Baseline-6-months) Measure Baseline 6-months post enrollment Non-Latino White Depression Score (PHQ-9) HgbA1c 7.4% 7.0% Sig Weight Total Cholesterol * Triglycerides Within-Group Comparisons (Baseline-6-months) Measure Baseline 6-months post Sig enrollment Latino/Hispanic Depression Score (PHQ-9) HgbA1c 7.6% 6.9%.03* Weight Total Cholesterol * Triglycerides

10 Within-Group Comparisons (Baseline-6-months) Measure Baseline 6-months post Sig enrollment Black Depression Score (PHQ-9) HgbA1c 7.8% 7.3% Weight Total Cholesterol Triglycerides Limited data at 12-months, but preliminary data shows trend for maintenance of both decreased HgbA1c, Total Cholesterol and depressive symptoms TACTICS Outcomes Hospital admissions and ER visits were reduced by 67% and 60% 81% reduction in combined total cost for admissions and ER in FY 06 (from $56,794 6 months pre- to $10,906 6 months postenrollment) 10

11 Summary Diabetes and depression frequently co-occur Co-occurrence of these disorders is associated with poorer medical outcomes Addressing both disorders simultaneously is feasible Cultural aspects of care may improve outcomes A Care Coordination program that utilizes a home monitoring device was cost- and outcomes effective in improving disease self-management of both conditions Acknowledgements TACTICS Clinical Team: Maria Llorente, MD Jerry Steffe, ARNP y Jessica Soto, RD Fariba Ostovary, ARNP Yolette Olivier 11

Suicide & Older Adults Julie E. Malphurs, PhD

Suicide & Older Adults Julie E. Malphurs, PhD Suicide & Older Adults Julie E. Malphurs, PhD Lead Program Analyst, Mental Health Service Miami VA Healthcare System & Asst. Professor of Research Department of Psychiatry and Behavioral Science Center

More information

Elderly males, especially white males, are the people at highest risk for suicide in America.

Elderly males, especially white males, are the people at highest risk for suicide in America. Statement of Ira R. Katz, MD, PhD Professor of Psychiatry Director, Section of Geriatric Psychiatry University of Pennsylvania Director, Mental Illness Research Education and Clinical Center Philadelphia

More information

Robert Okwemba, BSPHS, Pharm.D. 2015 Philadelphia College of Pharmacy

Robert Okwemba, BSPHS, Pharm.D. 2015 Philadelphia College of Pharmacy Robert Okwemba, BSPHS, Pharm.D. 2015 Philadelphia College of Pharmacy Judith Long, MD,RWJCS Perelman School of Medicine Philadelphia Veteran Affairs Medical Center Background Objective Overview Methods

More information

CARE MANAGEMENT FOR LATE LIFE DEPRESSION IN URBAN CHINESE PRIMARY CARE CLINICS

CARE MANAGEMENT FOR LATE LIFE DEPRESSION IN URBAN CHINESE PRIMARY CARE CLINICS CARE MANAGEMENT FOR LATE LIFE DEPRESSION IN URBAN CHINESE PRIMARY CARE CLINICS Dept of Public Health Sciences February 6, 2015 Yeates Conwell, MD Dept of Psychiatry, University of Rochester Shulin Chen,

More information

BACKGROUND. ADA and the European Association recently issued a consensus algorithm for management of type 2 diabetes

BACKGROUND. ADA and the European Association recently issued a consensus algorithm for management of type 2 diabetes BACKGROUND More than 25% of people with diabetes take insulin ADA and the European Association recently issued a consensus algorithm for management of type 2 diabetes Insulin identified as the most effective

More information

Dr. Anna M. Acee, EdD, ANP-BC, PMHNP-BC Long Island University, Heilbrunn School of Nursing

Dr. Anna M. Acee, EdD, ANP-BC, PMHNP-BC Long Island University, Heilbrunn School of Nursing Dr. Anna M. Acee, EdD, ANP-BC, PMHNP-BC Long Island University, Heilbrunn School of Nursing Overview Depression is significantly higher among elderly adults receiving home healthcare, particularly among

More information

Mental Health Referral Practices and Diabetic Management at Community Medical Alliance Clinic (Bell Site) Northeast Community Clinic (NECC)

Mental Health Referral Practices and Diabetic Management at Community Medical Alliance Clinic (Bell Site) Northeast Community Clinic (NECC) Mental Health Referral Practices and Diabetic Management at Community Medical Alliance Clinic (Bell Site) Northeast Community Clinic (NECC) MaryAnn Garcia, SUNY Downstate Medical College NMF PCLP Scholar

More information

Healthy Coping in Diabetes Self Management

Healthy Coping in Diabetes Self Management Healthy Coping in Diabetes Self Management Support for this product was provided by a grant from the Robert Wood Johnson Foundation in Princeton, New Jersey, 2009 Objectives Describe the relationship among

More information

Type 1 Diabetes ( Juvenile Diabetes)

Type 1 Diabetes ( Juvenile Diabetes) Type 1 Diabetes W ( Juvenile Diabetes) hat is Type 1 Diabetes? Type 1 diabetes, also known as juvenile-onset diabetes, is one of the three main forms of diabetes affecting millions of people worldwide.

More information

SPEAK about: Older adults; depression and suicide

SPEAK about: Older adults; depression and suicide SPEAK about: Older adults; depression and suicide Suicide Prevention Education Awareness Kit New York State George E. Pataki Governor Office of Mental Health Sharon E. Carpinello, R.N., Ph.D. Commissioner

More information

Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller

Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller School of Medicine/University of Miami Question 1 You

More information

Mental Health. Health Equity Highlight: Women

Mental Health. Health Equity Highlight: Women Mental Health Background A person s ability to carry on productive activities and live a rewarding life is affected not only by physical health but by mental health. In addition, mental well-being can

More information

Evaluations. Viewer Call-In. www.t2b2.org. Phone: 800-452-0662 Fax: 518-426-0696. Geriatric Mental Health. Thanks to our Sponsors: Guest Speaker

Evaluations. Viewer Call-In. www.t2b2.org. Phone: 800-452-0662 Fax: 518-426-0696. Geriatric Mental Health. Thanks to our Sponsors: Guest Speaker Geriatric Mental Health June 1, 7 Guest Speaker Michael B. Friedman, LMSW Chairperson Geriatric Mental Health Alliance of New York Thanks to our Sponsors: School of Public Health, University at Albany

More information

UW Medicine Integrated Mental Health Care. Laura Collins MSW, Darcy Jaffe ARNP Jürgen Unützer, MD, MPH, MA

UW Medicine Integrated Mental Health Care. Laura Collins MSW, Darcy Jaffe ARNP Jürgen Unützer, MD, MPH, MA UW Medicine Integrated Mental Health Care Laura Collins MSW, Darcy Jaffe ARNP Jürgen Unützer, MD, MPH, MA Why Behavioral Health Care in Primary Care? 1. Access to care: Serve patients where they are 2.

More information

Partnering with a Community Clinic to Provide Diabetes Self-Management Services Utilizing a Telehealth Approach

Partnering with a Community Clinic to Provide Diabetes Self-Management Services Utilizing a Telehealth Approach Partnering with a Community Clinic to Provide Diabetes Self-Management Services Utilizing a Telehealth Approach A V É M A R I A R E N A R D, P S Y D, D E P A R T M E N T O F P S Y C H O L O G Y A N D C

More information

Collaborative Care in Health Systems

Collaborative Care in Health Systems Collaborative Care in Health Systems Competencies and Skills of Psychosomatic Medicine Psychiatrists James Rundell, MD, FAPM Jürgen Unützer, MD, MPH, MA Wayne Katon, MD, FAPM ACADEMY OF PSYCHOSOMATIC MEDICINE

More information

2012 Georgia Diabetes Burden Report: An Overview

2012 Georgia Diabetes Burden Report: An Overview r-,, 2012 Georgia Diabetes Burden Report: An Overview Background Diabetes and its complications are serious medical conditions disproportionately affecting vulnerable population groups including: aging

More information

PCHC FACTS ABOUT HEALTH CONDITIONS AND MOOD DIFFICULTIES

PCHC FACTS ABOUT HEALTH CONDITIONS AND MOOD DIFFICULTIES PCHC FACTS ABOUT HEALTH CONDITIONS AND MOOD DIFFICULTIES Why should mood difficulties in individuals with a health condition be addressed? Many people with health conditions also experience mood difficulties

More information

MedStar Family Choice (MFC) Case Management Program. Cyd Campbell, MD, FAAP Medical Director, MFC MCAC June 24, 2015

MedStar Family Choice (MFC) Case Management Program. Cyd Campbell, MD, FAAP Medical Director, MFC MCAC June 24, 2015 MedStar Family Choice (MFC) Case Management Program Cyd Campbell, MD, FAAP Medical Director, MFC MCAC June 24, 2015 Case Management Program Presentation Overview CM Programs Disease Management Complex

More information

Community Care Collaborative Integrated Behavioral Health Intervention for Chronic Disease Management 307459301.2.3 Pass 3

Community Care Collaborative Integrated Behavioral Health Intervention for Chronic Disease Management 307459301.2.3 Pass 3 Community Care Collaborative Integrated Behavioral Health Intervention for Chronic Disease Management 307459301.2.3 Pass 3 Provider: The Community Care Collaborative (CCC) is a new multi-institution, multi-provider,

More information

Lessons on the Integration of Medicine and Psychiatry

Lessons on the Integration of Medicine and Psychiatry Lessons on the Integration of Medicine and Psychiatry Edward Post, MD, PhD Associate Professor of Internal Medicine, University of Michigan VA Health Services Research & Development Center of Excellence,

More information

Results of a Peer Mentoring Intervention in Older Patients with Diabetes: The Care Companion Program

Results of a Peer Mentoring Intervention in Older Patients with Diabetes: The Care Companion Program Results of a Peer Mentoring Intervention in Older Patients with Diabetes: The Care Companion Program Deborah Graham, MSPH AAFP National Research Network Cynthia Henderson, RN, CCM WellMed Medical Management

More information

Do Patients of Racial/Ethnic Minority and Lower SES Use Depression Care Management Differently?

Do Patients of Racial/Ethnic Minority and Lower SES Use Depression Care Management Differently? Do Patients of Racial/Ethnic Minority and Lower SES Use Depression Care Management Differently? Yuhua Bao, Ph.D. Division of Health Policy, Department of Public Health Weill Cornell Medical College 2009

More information

Co-Occurring Disorder-Related Quick Facts: ELDERLY

Co-Occurring Disorder-Related Quick Facts: ELDERLY Co-Occurring Disorder-Related Quick Facts: ELDERLY Elderly: In 2004, persons over the age of 65 reached a total of 36.3 million in the United States, an increase of approximately nine percent over the

More information

Depression often coexists with other chronic conditions

Depression often coexists with other chronic conditions Depression A treatable disease PROPORTION OF PATIENTS WHO ARE DEPRESSED, BY CHRONIC CONDITION Diabetes 33% Parkinson s Disease % Recent Stroke % Hospitalized with Cancer 42% Recent Heart Attack 45% SOURCE:

More information

Self-management for people with chronic health conditions Innovation Community

Self-management for people with chronic health conditions Innovation Community Self-management for people with chronic health conditions Innovation Community Presenter Kate Lorig, DrPH Stanford Patient Education Research Center 1000 Welch Road, Suite 204 Palo Alto CA 94304 USA 650-723-7935

More information

Breaking Down the Barriers - Masterclass training package and modules

Breaking Down the Barriers - Masterclass training package and modules Breaking Down the Barriers - Masterclass training package and modules Assessment of a patient with urgent mental health needs in an emergency department Module 1 Module 2 Mental health awareness training

More information

Barriers to Healthcare Services for People with Mental Disorders. Cardiovascular disorders and diabetes in people with severe mental illness

Barriers to Healthcare Services for People with Mental Disorders. Cardiovascular disorders and diabetes in people with severe mental illness Barriers to Healthcare Services for People with Mental Disorders Cardiovascular disorders and diabetes in people with severe mental illness Dr. med. J. Cordes LVR- Klinikum Düsseldorf Kliniken der Heinrich-Heine-Universität

More information

Collaborative Care: Evidence-Based Mental Health Care in Primary Care Settings

Collaborative Care: Evidence-Based Mental Health Care in Primary Care Settings Collaborative Care: Evidence-Based Mental Health Care in Primary Care Settings Anna Ratzliff, MD, PhD Assistant Professor Associate Director for Education, Division of Integrated Care & Public Health Department

More information

Major Depressive Disorders Questions submitted for consideration by workshop participants

Major Depressive Disorders Questions submitted for consideration by workshop participants Major Depressive Disorders Questions submitted for consideration by workshop participants Prioritizing Comparative Effectiveness Research Questions: PCORI Stakeholder Workshops June 9, 2015 Patient-Centered

More information

PAYMENT INNOVATIONS SUPPORTING BEHAVIORAL HEALTHCARE DELIVERY IMPROVEMENT. NGA July 2015

PAYMENT INNOVATIONS SUPPORTING BEHAVIORAL HEALTHCARE DELIVERY IMPROVEMENT. NGA July 2015 PAYMENT INNOVATIONS SUPPORTING BEHAVIORAL HEALTHCARE DELIVERY IMPROVEMENT NGA July 2015 My Background Medicaid Director Previously DMH Medical Director 20 years Practicing Psychiatrist CMHCs 10 years FQHC

More information

Oregon Statewide Performance Improvement Project: Diabetes Monitoring for People with Diabetes and Schizophrenia or Bipolar Disorder

Oregon Statewide Performance Improvement Project: Diabetes Monitoring for People with Diabetes and Schizophrenia or Bipolar Disorder Oregon Statewide Performance Improvement Project: Diabetes Monitoring for People with Diabetes and Schizophrenia or Bipolar Disorder November 14, 2013 Prepared by: Acumentra Health 1. Study Topic This

More information

Treating Depression in Older Adults: Challenges to Implementing the Recommendations of an Expert Panel

Treating Depression in Older Adults: Challenges to Implementing the Recommendations of an Expert Panel SPECIAL TOPIC Treating Depression in Older Adults: Challenges to Implementing the Recommendations of an Expert Panel Mark Snowden, MD, MPH, Lesley Steinman, MSW, MPH, John Frederick, MD Suggested citation

More information

CHARACTERISTICS & OUTCOMES OF INSURED PATIENTS TREATED WITH EXTENDED- RELEASE NALTREXONE (XR-NTX) OR ORAL ALCOHOL DEPENDENCE MEDICATIONS

CHARACTERISTICS & OUTCOMES OF INSURED PATIENTS TREATED WITH EXTENDED- RELEASE NALTREXONE (XR-NTX) OR ORAL ALCOHOL DEPENDENCE MEDICATIONS CHARACTERISTICS & OUTCOMES OF INSURED PATIENTS TREATED WITH EXTENDED- RELEASE NALTREXONE (XR-NTX) OR ORAL ALCOHOL DEPENDENCE MEDICATIONS TAMI L. MARK, PHD, MBA ACADEMY HEALTH ANNUAL MEETING JUNE 29, 2010

More information

DIABETES: Applying Evidence- Based Medicine in Telehealth George E. Dafoulas MD, MBA in HSM, PhDc e- trikala SA, Greece

DIABETES: Applying Evidence- Based Medicine in Telehealth George E. Dafoulas MD, MBA in HSM, PhDc e- trikala SA, Greece DIABETES: Applying Evidence- Based Medicine in Telehealth George E. Dafoulas MD, MBA in HSM, PhDc e- trikala SA, Greece www.united4health.eu Table of Contents Overview of current status and need for Evidence

More information

Gayle Curto, RN, BSN, CDE Clinical Coordinator

Gayle Curto, RN, BSN, CDE Clinical Coordinator Gayle Curto, RN, BSN, CDE Clinical Coordinator INTRODUCTION Historical Program Overview Leadership Team Mission Statement Diabetes Center Demographics for 2011 Older Adult Population HISTORICAL PROGRAM

More information

Profile: Incorporating Routine Behavioral Health Screenings Into the Patient-Centered Medical Home

Profile: Incorporating Routine Behavioral Health Screenings Into the Patient-Centered Medical Home 104 A LOOK TO THE FUTURE Profile: Incorporating Routine Behavioral Health Screenings Into the Patient-Centered Medical Home Background Management of chronic diseases can be challenging in primary care,

More information

With Depression Without Depression 8.0% 1.8% Alcohol Disorder Drug Disorder Alcohol or Drug Disorder

With Depression Without Depression 8.0% 1.8% Alcohol Disorder Drug Disorder Alcohol or Drug Disorder Minnesota Adults with Co-Occurring Substance Use and Mental Health Disorders By Eunkyung Park, Ph.D. Performance Measurement and Quality Improvement May 2006 In Brief Approximately 16% of Minnesota adults

More information

a major step toward population health management

a major step toward population health management Phyllis Floyd integrating physical and behavioral health a major step toward population health management Improved care coordination for patients requiring both physical and mental health services could

More information

Florida Alcohol and Drug Abuse Association. Presented to the Behavioral Health Quarterly Meeting Pensacola, Florida April 23, 2014

Florida Alcohol and Drug Abuse Association. Presented to the Behavioral Health Quarterly Meeting Pensacola, Florida April 23, 2014 Florida Alcohol and Drug Abuse Association Presented to the Behavioral Health Quarterly Meeting Pensacola, Florida April 23, 2014 Florida Alcohol and Drug Abuse Association Founded in 1981 Currently has

More information

Professional Reference Series Depression and Anxiety, Volume 1. Depression and Anxiety Prevention for Older Adults

Professional Reference Series Depression and Anxiety, Volume 1. Depression and Anxiety Prevention for Older Adults Professional Reference Series Depression and Anxiety, Volume 1 Depression and Anxiety Prevention for Older Adults TA C M I S S I O N The mission of the Older Americans Substance Abuse and Mental Health

More information

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource E-Resource March, 2015 DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource Depression affects approximately 20% of the general population

More information

Quality Improvement in Primary Care Settings

Quality Improvement in Primary Care Settings Quality Improvement in Primary Care Settings Eboni Price Haywood, MD, MPH Chief Medical Officer, Tulane Community Health Medical Director, Tulane Community Health @ Covenant House Team Approach to Quality

More information

RIGHT CARE RIGHT TIME RIGHT PLACE DEBORAH HARRIS-COBBINAH RN, MSN, CNS, NP, BC

RIGHT CARE RIGHT TIME RIGHT PLACE DEBORAH HARRIS-COBBINAH RN, MSN, CNS, NP, BC RIGHT CARE RIGHT TIME RIGHT PLACE DEBORAH HARRIS-COBBINAH RN, MSN, CNS, NP, BC Faculty Disclosure Deborah Harris-Cobbinah, MSN, ANP,MHCNS,BC Conflict of Interest: None Employer: Dept. of Veterans Affairs

More information

Viability and Impact of Telehealth-Based Depression Care in Home Care

Viability and Impact of Telehealth-Based Depression Care in Home Care Viability and Impact of Telehealth-Based Depression Care in Home Care Thomas Sheeran, PhD, ME Rhode Island Hospital Alpert Medical School of Brown University Funding: NIMH K01MH08757 Disclosures: None

More information

Evaluating Dimensions of

Evaluating Dimensions of Evaluating Dimensions of Geriatric Depression and Anxiety Joel E. Streim, MD Professor, Psychiatry Geriatric Psychiatry Section University of Pennsylvania VISN 4 MIRECC Philadelphia VA Medical Center Philadelphia,

More information

A SURVEY OF DIABETICS PATIENTS ATTENDING PUBLIC SECTOR POLYCLINICS IN BARBADOS. DEPRESSION AND TYPE 2 DIABETES MELLITUS

A SURVEY OF DIABETICS PATIENTS ATTENDING PUBLIC SECTOR POLYCLINICS IN BARBADOS. DEPRESSION AND TYPE 2 DIABETES MELLITUS A SURVEY OF DIABETICS PATIENTS ATTENDING PUBLIC SECTOR POLYCLINICS IN BARBADOS. DEPRESSION AND TYPE 2 DIABETES MELLITUS Dr. Tania Whitby-Best BSc, MB. BS, MSc, DM Family Medicine 78 th UWI/BAMP CME CONFERENCE

More information

Integrated Health Care Models and Practices

Integrated Health Care Models and Practices Integrated Health Care Models and Practices The Greater Houston Behav io r al Health Affordable Care Act Initiative S e c o n d C o m m u n i t y E d u c a t i o n E v e n t I n t e g r a t e d H e a l

More information

Challenges in Glycemic Control in Adult and Geriatric Patients. Denyse Gallagher, APRN-BC, CDE Endocrinology Nurse Practitioner

Challenges in Glycemic Control in Adult and Geriatric Patients. Denyse Gallagher, APRN-BC, CDE Endocrinology Nurse Practitioner Challenges in Glycemic Control in Adult and Geriatric Patients Denyse Gallagher, APRN-BC, CDE Endocrinology Nurse Practitioner Provide an overview of diabetes prevalence; discuss challenges and barriers

More information

American Society of Addiction Medicine

American Society of Addiction Medicine American Society of Addiction Medicine Public Policy Statement on Core Benefit for Primary Care and Specialty Treatment and Prevention of Alcohol, Nicotine and Other Drug PREFACE Statement of the Problem:

More information

CHAPTER V DISCUSSION. normal life provided they keep their diabetes under control. Life style modifications

CHAPTER V DISCUSSION. normal life provided they keep their diabetes under control. Life style modifications CHAPTER V DISCUSSION Background Diabetes mellitus is a chronic condition but people with diabetes can lead a normal life provided they keep their diabetes under control. Life style modifications (LSM)

More information

Effective Care Management for Behavioral Health Integration

Effective Care Management for Behavioral Health Integration Effective Care Management for Behavioral Health Integration Title: Effective Care Management for Behavioral Health Integration A process improvement initiative focused on improving mental health outcomes

More information

The New Complex Patient. of Diabetes Clinical Programming

The New Complex Patient. of Diabetes Clinical Programming The New Complex Patient as Seen Through the Lens of Diabetes Clinical Programming 1 Valerie Garrett, M.D. Medical Director, Diabetes Center at Mission Health System Nov 6, 2014 Diabetes Health Burden High

More information

Impact of VA Home Based Primary Care: Access, Quality and Cost National Health Policy Forum

Impact of VA Home Based Primary Care: Access, Quality and Cost National Health Policy Forum Impact of VA Home Based Primary Care: Access, Quality and Cost National Health Policy Forum Thomas Edes, MD, MS Director, Geriatrics and Extended Care Office of Clinical Operations U.S. Department of Veterans

More information

Connecticut Diabetes Statistics

Connecticut Diabetes Statistics Connecticut Diabetes Statistics What is Diabetes? State Public Health Actions (1305, SHAPE) Grant March 2015 Page 1 of 16 Diabetes is a disease in which blood glucose levels are above normal. Blood glucose

More information

Population Health Management Program

Population Health Management Program Population Health Management Program Program (formerly Disease Management) is dedicated to improving our members health and quality of life. Our Population Health Management Programs aim to improve care

More information

Mental Health Care Services by Family Physicians (Position Paper)

Mental Health Care Services by Family Physicians (Position Paper) Background Mental Health Care Services by Family Physicians (Position Paper) Mental health services are an essential element of the health care services continuum. Promotion of mental health and the diagnosis

More information

Office ID Location: City State Date / / PRIMARY CARE SURVEY

Office ID Location: City State Date / / PRIMARY CARE SURVEY A. Organizational Characteristics PRIMARY CARE SURVEY We want to learn more about the general features of your office. A1. What health-related services does your office provide (check all that apply)?

More information

Depression, anxiety and long term conditions. Linda Gask Professor of Primary Care Psychiatry University of Manchester

Depression, anxiety and long term conditions. Linda Gask Professor of Primary Care Psychiatry University of Manchester Depression, anxiety and long term conditions Linda Gask Professor of Primary Care Psychiatry University of Manchester Depression and LTCs People with LTCs are twice as likely than other adults to suffer

More information

The State of Mental Health and Aging in America

The State of Mental Health and Aging in America Issue Brief #1: What Do the Data Tell Us? In recognition of the essential role mental health plays in overall health, the Healthy Aging Program at the Centers for Disease Control and Prevention (CDC) and

More information

HealthCare Partners of Nevada. Heart Failure

HealthCare Partners of Nevada. Heart Failure HealthCare Partners of Nevada Heart Failure Disease Management Program 2010 HF DISEASE MANAGEMENT PROGRAM The HealthCare Partners of Nevada (HCPNV) offers a Disease Management program for members with

More information

The role of t he Depart ment of Veterans Affairs (VA) as

The role of t he Depart ment of Veterans Affairs (VA) as The VA Health Care System: An Unrecognized National Safety Net Veterans who use the VA health care system have a higher level of illness than the general population, and 60 percent have no private or Medigap

More information

Integrating Primary Care and Behavioral Health Services: A Compass and A Horizon

Integrating Primary Care and Behavioral Health Services: A Compass and A Horizon Integrating Primary Care and Behavioral Health Services: A Compass and A Horizon A curriculum for community health centers Developed for the Bureau of Primary Health Care Managed Care Technical Assistance

More information

American Diabetes Association Education Recognition Program Overview

American Diabetes Association Education Recognition Program Overview American Diabetes Association Education Recognition Program Overview A brief history of the National Standards for Diabetes Self-Management Education and Support and a walk through the 10 DSME/S standards

More information

Nutrition. Type 2 Diabetes: A Growing Challenge in the Healthcare Setting NAME OF STUDENT

Nutrition. Type 2 Diabetes: A Growing Challenge in the Healthcare Setting NAME OF STUDENT 1 Nutrition Type 2 Diabetes: A Growing Challenge in the Healthcare Setting NAME OF STUDENT 2 Type 2 Diabetes: A Growing Challenge in the Healthcare Setting Introduction and background of type 2 diabetes:

More information

Depression and Older Adults: Key Issues. The Treatment of Depression in Older Adults

Depression and Older Adults: Key Issues. The Treatment of Depression in Older Adults Depression and Older Adults: Key Issues The Treatment of Depression in Older Adults Depression and Older Adults: Key Issues The Treatment of Depression in Older Adults U.S. Department of Health and Human

More information

Chronic Illness and Emotional Distress- It takes a Village

Chronic Illness and Emotional Distress- It takes a Village Chronic Illness and Emotional Distress- It takes a Village William Gunn, PhD Director of Primary Care Behavioral Health NH Dartmouth Family Medicine Residency May 12, 2015 Learning Objectives Part 1 Identify

More information

Using a Flow Sheet to Improve Performance in Treatment of Elderly Patients With Type 2 Diabetes

Using a Flow Sheet to Improve Performance in Treatment of Elderly Patients With Type 2 Diabetes Special Series: AAFP Award-winning Research Papers Vol. 31, No. 5 331 Using a Flow Sheet to Improve Performance in Treatment of Elderly Patients With Type 2 Diabetes Gary Ruoff, MD; Lynn S. Gray, MD, MPH

More information

Massachusetts Population

Massachusetts Population Massachusetts October 2012 POLICY ACADEMY STATE PROFILE Massachusetts Population MASSACHUSETTS POPULATION (IN 1,000S) AGE GROUP Massachusetts is home to more than 6.5 million people. Of these, more than

More information

The Cost of Pain and Economic Burden of Prescription Misuse, Abuse and Diversion. Angela Huskey, PharmD, CPE

The Cost of Pain and Economic Burden of Prescription Misuse, Abuse and Diversion. Angela Huskey, PharmD, CPE The Cost of Pain and Economic Burden of Prescription Misuse, Abuse and Diversion Angela Huskey, PharmD, CPE Case Bill is a 47 year old man with a history of low back pain and spinal stenosis Not a real

More information

New Jersey Population

New Jersey Population New Jersey October 2012 POLICY ACADEMY STATE PROFILE New Jersey Population NEW JERSEY POPULATION (IN 1,000S) AGE GROUP New Jersey is home to nearly9 million people. Of these, more than 2.9 million (33.1

More information

Telemedicine in Physical Health and Behavioral Health

Telemedicine in Physical Health and Behavioral Health Telemedicine in Physical Health and Behavioral Health Collaborative Care Summit April 16, 2015 Shabana Khan, MD Assistant Professor of Psychiatry Western Psychiatric Institute and Clinic University of

More information

Kansas Behavioral Health Risk Bulletin

Kansas Behavioral Health Risk Bulletin Kansas Behavioral Health Risk Bulletin Kansas Department of Health and Environment November 7, 1995 Bureau of Chronic Disease and Health Promotion Vol. 1 No. 12 Diabetes Mellitus in Kansas Diabetes mellitus

More information

Substance Use Disorder Treatment: Challenges and the Future

Substance Use Disorder Treatment: Challenges and the Future County of Los Angeles-Department of Public Health Substance Abuse Prevention and Control Substance Use Disorder Treatment: Challenges and the Future Wesley L. Ford, MA, MPH Director 1 Outline Addiction-

More information

Chapter 8 - General Discussion

Chapter 8 - General Discussion Chapter 8 - General Discussion 101 As stated in the introduction, the goal of type 2 diabetes care is to offer patients an integrated set of interventions in relation to life style, blood pressure regulation,

More information

Florida Population POLICY ACADEMY STATE PROFILE. Florida FLORIDA POPULATION (IN 1,000S) AGE GROUP

Florida Population POLICY ACADEMY STATE PROFILE. Florida FLORIDA POPULATION (IN 1,000S) AGE GROUP Florida December 2012 POLICY ACADEMY STATE PROFILE Florida Population FLORIDA POPULATION (IN 1,000S) AGE GROUP Florida is home to more than 19 million people. Of these, more than 6.9 (36.9 percent) are

More information

The State of Mental Health and Aging in America

The State of Mental Health and Aging in America Issue Brief #2: Addressing Depression in Older Adults: Selected Evidence-Based Programs In recognition of the essential role mental health plays in overall health, the Healthy Aging Program at the Centers

More information

Diabetes. African Americans were disproportionately impacted by diabetes. Table 1 Diabetes deaths by race/ethnicity CHRONIC DISEASES

Diabetes. African Americans were disproportionately impacted by diabetes. Table 1 Diabetes deaths by race/ethnicity CHRONIC DISEASES Diabetes African Americans were disproportionately impacted by diabetes. African Americans were most likely to die of diabetes. People living in San Pablo, Pittsburg, Antioch and Richmond were more likely

More information

Integrated Behavioral Health within the Medical Home

Integrated Behavioral Health within the Medical Home Integrated Behavioral Health within the Medical Home Measurement-based care, Treatment to target, Accountable care: a statewide t P4P program Jürgen Unützer, MD, MPH, MA Jürgen Unützer, MD, MPH, MA Disclosures

More information

Antipsychotic Medications and the Risk of Diabetes and Cardiovascular Disease

Antipsychotic Medications and the Risk of Diabetes and Cardiovascular Disease Antipsychotic Medications and the Risk of Diabetes and Cardiovascular Disease Professional Tool #1: Screening and Monitoring in a High-Risk Population: Questions and Answers Overview of Cardiometabolic

More information

Effect of Anxiety or Depression on Cancer Screening among Hispanic Immigrants

Effect of Anxiety or Depression on Cancer Screening among Hispanic Immigrants Racial and Ethnic Disparities: Keeping Current Seminar Series Mental Health, Acculturation and Cancer Screening among Hispanics Wednesday, June 2nd from 12:00 1:00 pm Trustees Conference Room (Bulfinch

More information

Alcoholism and Aging

Alcoholism and Aging Alcoholism and Aging (See also: Prescription Drugs and Mental Health) The abuse of alcohol by older adults may be less prevalent than other age groups but according to most researchers it is more difficult

More information

Co-occurring MH/SA Disorders

Co-occurring MH/SA Disorders Maine Behavioral Health Data Forum Co-occurring MH/SA Disorders Data about Screening, Prevalence & Service Use January 5, 2012 Helen Hemminger, Quality Reporting Manager APS HealthCare 1 Introduction Introduction:

More information

Incidence of Type 2 Diabetes in Hispanics as Compared to the General Population in Massachusetts

Incidence of Type 2 Diabetes in Hispanics as Compared to the General Population in Massachusetts Incidence of Type 2 Diabetes in Hispanics as Compared to the General Population in Massachusetts By Isabelle Pierre Krystal Amaral, and Ardrianna Howard, 2014 SEP Participants 1 TYPE 2 DIABETES MELLITUS

More information

A Breakthrough Approach to Integrating Substance Use and Mental Health Treatment. Susan Whitley, MD Director of Chemical Dependency Services

A Breakthrough Approach to Integrating Substance Use and Mental Health Treatment. Susan Whitley, MD Director of Chemical Dependency Services A Breakthrough Approach to Integrating Substance Use and Mental Health Treatment Susan Whitley, MD Director of Chemical Dependency Services Date: September 17-21, 2012 In spite of the high percentage of

More information

Improving drug prescription in elderly diabetic patients. FRANCESC FORMIGA Hospital Universitari de Bellvitge

Improving drug prescription in elderly diabetic patients. FRANCESC FORMIGA Hospital Universitari de Bellvitge Improving drug prescription in elderly diabetic patients FRANCESC FORMIGA Hospital Universitari de Bellvitge High prevalence, but also increases the incidence. The older the patients, the higher the percentages

More information

Shaping our future: a call to action to tackle the diabetes epidemic and reduce its economic impact

Shaping our future: a call to action to tackle the diabetes epidemic and reduce its economic impact Shaping our future: a call to action to tackle the diabetes epidemic and reduce its economic impact Task Force for the National Conference on Diabetes: The Task Force is comprised of Taking Control of

More information

Feasibility of Engaging Underserved Diabetes Patients in a Web-based Personal Health Record to Facilitate Care Outcomes:

Feasibility of Engaging Underserved Diabetes Patients in a Web-based Personal Health Record to Facilitate Care Outcomes: Feasibility of Engaging Underserved Diabetes Patients in a Web-based Personal Health Record to Facilitate Care Outcomes: Michelle Magee, MD Carine Nassar, RD, MS, CDE MedStar Diabetes, Research and Innovation

More information

PRACTICE Matters. August, 2004 VOL. 9 ISSUE 2

PRACTICE Matters. August, 2004 VOL. 9 ISSUE 2 PRACTICE Matters August, 2004 VOL. 9 ISSUE 2 COLLABORATIVE TREATMENT FOR DEPRESSION Nearly 10% of the population, or about 18.8 million Americans suffer from a depressive disorder at some time in their

More information

Treating Patients with PRE-DIABETES David Doriguzzi, PA-C First Valley Medical Group. Learning Objectives. Background. CAPA 2015 Annual Conference

Treating Patients with PRE-DIABETES David Doriguzzi, PA-C First Valley Medical Group. Learning Objectives. Background. CAPA 2015 Annual Conference Treating Patients with PRE-DIABETES David Doriguzzi, PA-C First Valley Medical Group Learning Objectives To accurately make the diagnosis of pre-diabetes/metabolic syndrome To understand the prevalence

More information

Depression in Patients with Diabetes: Does It Impact Clinical Goals?

Depression in Patients with Diabetes: Does It Impact Clinical Goals? Depression in Patients with Diabetes: Does It Impact Clinical Goals? William A. Rush, PhD, Robin R. Whitebird, PhD, Monica R. Rush, BS, Leif I. Solberg, MD, and Patrick J. O Connor, MD, MPH Introduction:

More information

Brief Research Report: Fountain House and Use of Healthcare Resources

Brief Research Report: Fountain House and Use of Healthcare Resources ! Brief Research Report: Fountain House and Use of Healthcare Resources Zachary Grinspan, MD MS Department of Healthcare Policy and Research Weill Cornell Medical College, New York, NY June 1, 2015 Fountain

More information

Unforeseen Benefits: Addiction Treatment Reduces Health Care Costs CLOSING THE ADDICTION TREATMENT GAP

Unforeseen Benefits: Addiction Treatment Reduces Health Care Costs CLOSING THE ADDICTION TREATMENT GAP Unforeseen Benefits: Addiction Treatment Reduces Health Care Costs CLOSING THE ADDICTION TREATMENT GAP Executive Summary Improving America s health care system, creating a healthier country, and containing

More information

Upstate New York adults with diagnosed type 1 and type 2 diabetes and estimated treatment costs

Upstate New York adults with diagnosed type 1 and type 2 diabetes and estimated treatment costs T H E F A C T S A B O U T Upstate New York adults with diagnosed type 1 and type 2 diabetes and estimated treatment costs Upstate New York Adults with diagnosed diabetes: 2003: 295,399 2008: 377,280 diagnosed

More information

echat: Screening & intervening for mental health & lifestyle issues

echat: Screening & intervening for mental health & lifestyle issues echat: Screening & intervening for mental health & lifestyle issues Felicity Goodyear-Smith Professor & Academic Head Dept of General Practice & Primary Health Care Faculty of Medicine & Health Science

More information

Oregon Standards for Certified Community Behavioral Health Clinics (CCBHCs)

Oregon Standards for Certified Community Behavioral Health Clinics (CCBHCs) Oregon Standards for Certified Community Behavioral Health Clinics (CCBHCs) Senate Bill 832 directed the Oregon Health Authority (OHA) to develop standards for achieving integration of behavioral health

More information

Diabetes Brief. Pre diabetes occurs when glucose levels are elevated in the blood, but are not as high as someone who has diabetes.

Diabetes Brief. Pre diabetes occurs when glucose levels are elevated in the blood, but are not as high as someone who has diabetes. Diabetes Brief What is Diabetes? Diabetes mellitus is a disease of abnormal carbohydrate metabolism in which the level of blood glucose, or blood sugar, is above normal. The disease occurs when the body

More information

METABOLIC SYNDROME IN A CORRECTIONS POPULATION TREATED WITH ANTIPSYCHOTICS

METABOLIC SYNDROME IN A CORRECTIONS POPULATION TREATED WITH ANTIPSYCHOTICS METABOLIC SYNDROME IN A CORRECTIONS POPULATION TREATED WITH ANTIPSYCHOTICS Andrew M. Cislo, PhD Megan J. Ehret, PharmD, MS, BCPP Robert L. Trestman, MD, PhD Kirsten Shea, MBA www.uchc.edu Background Metabolic

More information

Utilization of the Electronic Medical Record to Assess Morbidity and Mortality in Veterans Treated for Substance Use Disorders

Utilization of the Electronic Medical Record to Assess Morbidity and Mortality in Veterans Treated for Substance Use Disorders Utilization of the Electronic Medical Record to Assess Morbidity and Mortality in Veterans Treated for Substance Use Disorders Dr. Kathleen P. Decker, M.D. Staff Psychiatrist, Hampton VAMC Assistant Professor,

More information

Integrated Physical & Behavioral Health. A Business Opportunity for Employers

Integrated Physical & Behavioral Health. A Business Opportunity for Employers Integrated Physical & Behavioral Health A Business Opportunity for Employers About the Health and Health Costs of Your Employees 80% of employees with behavioral difficulties (~20% of employer covered

More information