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The American Journal of Managed Care Feb 2022The current study investigated mental health utilization review (UR) clinical service authorization requests, denials, and reasons for denial in a statewide Medicaid...
OBJECTIVES
The current study investigated mental health utilization review (UR) clinical service authorization requests, denials, and reasons for denial in a statewide Medicaid managed care organization (MMCO) program.
STUDY DESIGN
Retrospective analysis of utilization review data reported by MMCOs in New York State.
METHODS
Data from the utilization review practices of 15 MMCOs were collected and analyzed for calendar years 2017 and 2018. The data reported are specific to mental health services and include the number of authorization requests, number of clinical denials, and the reasons specified for each denial. Analyses were undertaken to determine the UR denial rates and most common reasons for denials.
RESULTS
A total of 264,901 requests for inpatient mental health service authorizations and 53,687 requests for outpatient mental health service authorizations were made in 2017 and 2018. Of these, 1.5% of inpatient authorization requests and 0.4% of outpatient authorization requests were denied for reasons related to medical necessity. The most common reason for inpatient mental health service denials was that the patient no longer met the standard for the requested level of care.
CONCLUSIONS
Low UR denial rates warrant further examination of the relationship between UR and both quality of care and patient outcomes in mental health care. With the substantial resources spent on UR, findings could point to areas of potential reforms to the system that may minimize these costs and improve care for patients with mental illness.
Topics: Humans; Managed Care Programs; Medicaid; Mental Health Services; Retrospective Studies; United States; Utilization Review
PubMed: 35139293
DOI: 10.37765/ajmc.2022.88824 -
Journal of Public Health (Oxford,... Sep 2021After more than a year of pandemic, SARS-CoV-2 (Severe acute respiratory syndrome coronavirus type 2) remains a relevant health care and society issue. Movements...
After more than a year of pandemic, SARS-CoV-2 (Severe acute respiratory syndrome coronavirus type 2) remains a relevant health care and society issue. Movements doubting the dangerousness or the existence of the virus have emerged and became a challenge to social cohesion. About 3487 individuals (434 Corona doubters and 3053 non-doubters) have participated in an online survey (predominat age group: 35-45 years). Particularly, COVID-19-related anxiety, generalized anxiety (Generalizied Anxiety Disorder Screener, GAD-7), depression (Patient Health Questionnaire, PHQ-2) and functional/adherent safety behaviour were assessed. COVID-19 doubters describe less functional safety behaviour. Fear of the virus is evident, similar to non-doubters. Generalized anxiety and depression were significantly higher in doubters. Repression and denial as psychological defence mechanisms could be the unconscious psychological strategy for coping with the distress variables. The results point out that public strategies may only be successful in managing opinions and beliefs if they address fears and worries.
Topics: Adult; Anxiety; COVID-19; Cross-Sectional Studies; Depression; Humans; Middle Aged; Pandemics; SARS-CoV-2; Stress, Psychological
PubMed: 34018564
DOI: 10.1093/pubmed/fdab168 -
Annual Review of Public Health Apr 2021Climate change presents a challenge at multiple levels: It challenges our cognitive abilities because the effect of the accumulation of emissions is difficult to... (Review)
Review
Climate change presents a challenge at multiple levels: It challenges our cognitive abilities because the effect of the accumulation of emissions is difficult to understand. Climate change also challenges many people's worldview because any climate mitigation regime will have economic and political implications that are incompatible with libertarian ideals of unregulated free markets. These political implications have created an environment of rhetorical adversity in which disinformation abounds, thus compounding the challenges for climate communicators. The existing literature on how to communicate climate change and dispel misinformation converges on several conclusions: First, providing information about climate change, in particular explanations of why it occurs, can enhance people's acceptance of science. Second, highlighting the scientific consensus can be an effective means to counter misinformation and raise public acceptance. Third, culturally aligned messages and messengers are more likely to be successful. Finally, climate misinformation is best defanged, through a process known as inoculation, before it is encountered, although debunking techniques can also be successful.
Topics: Climate Change; Communication; Humans
PubMed: 33355475
DOI: 10.1146/annurev-publhealth-090419-102409 -
BMC Women's Health Dec 2021Although associated with many successes, oocyte donation can lead to numerous psychological challenges in recipient women. The identification of these challenges during...
BACKGROUND
Although associated with many successes, oocyte donation can lead to numerous psychological challenges in recipient women. The identification of these challenges during the treatment process is crucial to improve recipient mental health. Thus, the aim of this study was to gain an understanding of the experiences of oocyte recipient women.
METHODS
This research was conducted using a qualitative approach and inductive content analysis method. The data collection tool was in-depth interviews. Twenty women with the experience of receiving donated oocyte were selected and entered the study using purposive sampling method and considering the maximum variation.
RESULTS
Three main categories of psychological challenges were extracted from patient interviews, specifically, distressing psychologic symptoms, social stigmatization, and negative coping mechanisms. The category of distressing psychologic symptoms was shaped based on the subcategories of self-esteem destruction, anxiety and stress, depression and spiritual discouragement. The category of social stigmatization included the subcategories of concern about disclosure, judgment of others, and conflict with religious teachings. And the category of negative coping mechanisms was formed based on the subcategories of aggression and denial.
CONCLUSION
The results indicated that the process of treatment with donated oocyte is followed by the experiences of distressing psychologic symptoms, social stigmatization, and negative coping mechanisms in recipient women. As such, paying attention to the socio-cultural factors which affect this process seems necessary to maintain the mental health of these women. Although associated with many successes, oocyte donation can lead to numerous psychological challenges in recipient women. The aim of this study was to gain an understanding of the experiences of oocyte recipient women. This research was conducted using a qualitative approach and inductive content analysis method. The data collection tool was in-depth interviews. Twenty women with the experience of receiving donated oocyte were selected and entered the study using purposive sampling method and considering the maximum variation. Three main categories of psychological challenges were extracted from patient interviews, specifically, distressing psychologic symptoms, social stigmatization, and negative coping mechanisms. The category of distressing psychologic symptoms was shaped based on the subcategories of self-esteem destruction, anxiety and stress, depression and spiritual discouragement. The category of social stigmatization included the subcategories of concern about disclosure, judgment of others, and conflict with religious teachings. And the category of negative coping mechanisms was formed based on the subcategories of aggression and denial. The results indicated that the process of treatment with donated oocyte is followed by experience of distressing psychologic symptoms, social stigmatization, and negative coping mechanisms in recipient women. As such, paying attention to the socio-cultural factors which affect this process seems necessary to maintain the mental health of these women.
Topics: Adaptation, Psychological; Disclosure; Female; Humans; Oocyte Donation; Oocytes; Qualitative Research
PubMed: 34886829
DOI: 10.1186/s12905-021-01562-4 -
Journal of the American Academy of... Mar 2023
Topics: Humans; Adaptation, Psychological; Patients
PubMed: 35341889
DOI: 10.1016/j.jaad.2022.03.035 -
International Journal of Nursing Studies Sep 2019To provide a comprehensive integrative review of research literature on 1) the coping strategies that are reported by adult family members following admission of their... (Review)
Review
OBJECTIVES
To provide a comprehensive integrative review of research literature on 1) the coping strategies that are reported by adult family members following admission of their adult loved ones to the intensive care unit (ICU), 2) identify which coping strategies are associated with psychological response during this stressful experience, and 3) the factors that are associated with coping strategies.
DATA SOURCES
Electronic databases: MEDLINE, PubMed, CINAHL, PsycINFO, and EMBASE; reference lists of journal publications.
REVIEW METHODS
A total of 643 citations or abstracts were initially screened for content relevance, 15 were included in the integrative review, including 7 quantitative, 3 qualitative and 5 mixed methods studies. Included studies were all conducted in the hospital intensive care unit.
RESULTS
Coping approaches such as self-distraction appear to be associated with lower psychological distress, and avoidant coping and denial associated with increased psychological distress including traumatic stress symptoms. Factors including social support, gender, age, relationship with the patient, decision maker role, and prior ICU experience can influence coping by family members. Uncertainty of the patient's prognosis and recovery heightens the intensity of the emotional response experienced by family members. Such family members appear at increased risk for experiencing depressive symptoms.
CONCLUSIONS
From the studies reviewed, it is unclear if coping approaches employed by family members mediate psychological responses such as anxiety and depressive symptoms, or whether coping is a response to psychological stress experienced following hospitalisation of their relative. Future research should focus on the relationship between coping and psychological, physiological and health related behaviours in family members following ICU admission that might contribute towards transient increased health risk during this time. Additionally, future research should explore potential interventions to modify coping and promote family well-being following hospitalisation.
Topics: Adaptation, Psychological; Critical Illness; Family; Hospitalization; Humans; Inpatients
PubMed: 31132688
DOI: 10.1016/j.ijnurstu.2019.04.016 -
Orvosi Hetilap Sep 2021Összefoglaló. A primer Sjögren-szindróma (pSS) krónikus autoimmun betegség, melynek elsődleges tünetei az exokrin mirigyeket érintő autoimmun folyamat...
Összefoglaló. A primer Sjögren-szindróma (pSS) krónikus autoimmun betegség, melynek elsődleges tünetei az exokrin mirigyeket érintő autoimmun folyamat következtében létrejövő szem- és szájszárazság, szisztémás manifesztációi között pedig a leggyakoribbak a szellemi és fizikai fáradtság és az ízületi fájdalmak. A betegség lélektani vonatkozásait nagy érdeklődés övezi; közleményünk a vonatkozó kutatási eredményeket foglalja össze a hátterükben húzódó pszichoneuroimmunmodulációs háttér rövid bemutatásával. A pSS pszichológiai tényezői közt a legrégebben vizsgáltak a depresszió és a szorongás. Ezek jelentős hatással vannak a betegek életminőségére, jóllétére, kognitív funkcióira, sőt a betegség aktivitására is. Bemutatjuk továbbá a stressz és a megküzdési stratégiák jellegzetes mintázatait pSS-ben, amelyek közt a betegségre jellemző maladaptív stratégiák a legjelentősebbek a patogenezis megértése és a kezelés szempontjából. Ilyenek a tagadás, a hasítás és a helyettesítés. Kitérünk a Sjögren-szindrómát kísérő személyiségjellemzőkre is, amely ígéretes terület, de kevés adat áll rendelkezésünkre; az eddigi vizsgálatok alapján a neuroticismus a leginkább pSS-re jellemző tényező. A kognitív funkciók érintettségének összefoglalása és az egyéb pszichológiai tényezők (szellemi fáradtság, szexualitás, testképzavar, életminőség) összegzése után egyértelműen levonható a következtetés, hogy a Sjögren-szindróma nemcsak biológiai, hanem pszichés, pszichoszociális és szociális jelenségszinteken is okoz zavarokat, tüneteket. Ezért rendkívül fontos a betegség biopszichoszociális szemléletű kezelése, a betegek aktív, intencionális részvétele a pSS-sel való megküzdésben. Orv Hetil. 2021; 162(39): 1558-1566. Summary. Primary Sjögren syndrome (pSS) is a chronic, autoimmune disorder. Primary symptoms are ocular and oral dryness as a of an autoimmune process affecting the exocrine glands. The most common systemic manifestations of the disease are mental and physical fatigue and arthralgia. Psychological features of pSS are studied with great interest; the present publication reviews the results of the related investigations alongside with the possible psychoneuroimmunomodulatory background. Among psychological factors in pSS, depression and anxiety have been studied the longest. These impact significantly the quality of life, wellbeing, cognitive functions and disease activity of the patients. Afterwards, we introduce the characteristic patterns of stress and coping mechanisms in pSS, among which maladaptive strategies, typical for the disorder are the most important regarding the pathogenesis and the therapy. These pSS-linked maladaptive strategies are denial, disengagement and focus and venting of emotions. As next, we give a summary about personality characteristics in pSS, which is a promising field to study, and yet very few related data are available; based on them, neuroticism seems to be the most common personality factor in Sjögren's. After summarizing briefly cognitive functions and other psychological features (mental fatigue, sexuality, body image disturbance and quality of life), it is evident that pSS is determined not only by biological but also by psychological, psychosocial and social disturbances. Hence, treating pSS patients with a biopsychosocial perspective is crucial and so is the active and intentional participation of patients in their recovery. Orv Hetil. 2021; 162(39): 1558-1566.
Topics: Adaptation, Psychological; Anxiety; Anxiety Disorders; Humans; Quality of Life; Sjogren's Syndrome
PubMed: 34570718
DOI: 10.1556/650.2021.32234 -
The American Journal of Medicine Apr 2021
Topics: Brazil; COVID-19; Communication; Denial, Psychological; Humans; Periodicals as Topic; SARS-CoV-2
PubMed: 33561430
DOI: 10.1016/j.amjmed.2021.01.003 -
Professional Case ManagementThe purpose of the inpatient psychiatric unit denials reduction project was to establish a taskforce to analyze denials data for root cause and identify an effective...
PURPOSE OF PROJECT
The purpose of the inpatient psychiatric unit denials reduction project was to establish a taskforce to analyze denials data for root cause and identify an effective solution to prevent denials through improved provider documentation.
PRIMARY PRACTICE SETTING
The development and implementation of the project occurred at Stanford Health Care, a nonprofit Level 1 trauma hospital, with a 29-bed inpatient psychiatric unit containing both open and secured levels of care. The project was led by the Utilization/Denials Management team, which is subteam within the Case Management Department. Team members are Nurse Case Managers specializing in the management of denials and appeals, data analysis and trending of denials, denial avoidance, and reduction of financial risk.
METHODOLOGY
Denials data analysis revealed the Psychiatry Service Line was responsible for over 70% of payer denials within the Length of Stay Write-offs category. In early 2019, the Utilization/Denials Management team initiated a quality improvement project using A3 Lean Approach methodology and evidence-based practice to guide the implementation. The partnership and collaboration included Case Management, Revenue Cycle, Clinical Documentation Improvement, Technology and Digital Solutions, and Psychiatry Service Line leadership that had an interest in reducing payer denials.
RESULTS
Outcomes measured for the project were based on denials data for (fiscal year) FY19, the preintervention period, compared to FY20 and FY21, the postintervention period. From FY19 to FY20, revenue loss decreased by 42%. The downward trend continued from FY20 to FY21 with a recorded decrease by 69%.
IMPLICATIONS FOR CASE MANAGEMENT PRACTICE
The most important implication of the project was improved physician documentation and medical necessity supporting the severity and intensity of inpatient psychiatric level of care, and medical justification for the inpatient stay not only to prevent medical necessity denials but to accurately reflect the care that was provided. High-quality documentation correlates to the high quality of care being provided. This project is far reaching not only for psychiatric units but also reproducible for other acute hospital service lines. Case Management is a multidisciplinary role, and this work is most meaningful for a Nurse Case Manager engaged in care coordination, including utilization and denials management.
Topics: Case Management; Delivery of Health Care; Documentation; Humans; Inpatients; Quality Improvement
PubMed: 36206122
DOI: 10.1097/NCM.0000000000000587 -
Journal of Occupational Health Jan 2022We aimed to synthesize published literature on seafarers' mental health and wellbeing during the COVID-19 pandemic. (Review)
Review
OBJECTIVES
We aimed to synthesize published literature on seafarers' mental health and wellbeing during the COVID-19 pandemic.
METHODS
This scoping review searched four electronic databases for literature on the mental health and wellbeing of seafarers during the COVID-19 pandemic.
RESULTS
Fourteen studies were included in the review. Few reported on the prevalence of mental health conditions. Only one compared mental health data gathered during the pandemic to pre-pandemic matched samples, suggesting symptoms of depression and anxiety were greater during the pandemic. There was some evidence that mental health worsened with longer stays on board during the pandemic and being on board longer than expected. Crew exchange difficulties forced many participants to extend their contracts or delay repatriation, often with little information as to when they might get to go home, leading them to feel they had no control over their lives and causing concern about fatigue and the potential for accidents and injuries. Participants described other challenges such as denial of shore leave; concerns about finances and future employment; loneliness and isolation; fears of COVID-19 infection; limited access to essential supplies; and feeling unsupported by management.
CONCLUSIONS
Maritime organizations must understand how best to support their staff in the aftermath of the COVID-19 pandemic and in any other prolonged crises that may arise in the future. Recommendations include ensuring that staff feel valued by their organization; enhancing work-related autonomy; ensuring that communication is accurate, consistent, and timely; and using lessons learned from the COVID-19 pandemic to inform emergency preparedness policies.
Topics: Anxiety; COVID-19; Humans; Mental Health; Occupations; Pandemics
PubMed: 36134469
DOI: 10.1002/1348-9585.12361