Thursday, June 02, 2005

The Use of Oregon's Evidence-Based Reviews for Medicaid Pharmacy Policies: Experiences in Four States A report, in Adobe Acrobat format, from the Kaiser Commission on Medicaid and the Unisured that "explores how four state Medicaid programs — Washington, Wyoming, Minnesota, and North Carolina — differ in their use of Oregon’s Drug Effectiveness Review Project (DERP) to manage their prescription drug benefit." See also the related press release from the NMHA, KFF Paper on Evidence-Based Reviews for Medicaid Pharmacy Policies Reiterates Concerns of NMHA and Other Health Advocates - "In the face of budget pressures, states are increasingly turning to “effectiveness research,” such as that provided by Oregon’s Drug Effectiveness Review Project (DERP), to help design pharmacy benefit policies. ... Despite the important issues inherent in DERP reports raised by KFF that require state decision-maker attention, the National Mental Health Association remains concerned about the potential misuse of these reports. NMHA has long held that research reviews can be an important part of pharmacy benefit management; however, states have a responsibility to use research reviews as only one component of a full spectrum of information necessary to design effective and fair policies that drive the quality of care for vulnerable Americans with chronic illnesses, like mental illness..."  
  

Community care has led to loss of staff from psychiatric wards (UK) May 28 British Medical Journal news story - "A new report indicates that the growing emphasis on caring for mental health patients in the community is having a serious effect on hospital care, leading to an exodus of staff and worsening conditions for inpatients. The survey, by the Sainsbury Centre for Mental Health, was commissioned by the National Institute for Mental Health in England and is one of the most detailed assessments of hospital care ever carried out in England, covering more than 50 trusts and 300 wards. Nearly a third of ward managers reported that their patients were now more severely ill and had higher levels of need..."  
  

Substance Use During Pregnancy: 2002 and 2003 Update  "This Short Report, The NSDUH Report: Substance Use During Pregnancy: 2002 and 2003 Update, is based on SAMHSA's National Survey on Drug Use and Health, formerly called the National Household Survey on Drug Abuse (NHSDA) conducted by the Office of Applied Studies (OAS) in the Substance Abuse and Mental Health Services Administration (SAMHSA). ... Annual averages based on SAMHSA's National Survey on Drug Use & Health conducted in 2002 and 2003 found that women aged 15 to 44 who were currently pregnant were less likely to currently use an illicit drug, smoke cigarettes, or drink alcohol then either recent mothers or nonpregnant women in this age group. Pregnant women aged 15 to 25 were more likely to have smoked cigarettes in the past month and to have used an illicit drug during the past month than pregnant women aged 26 to 44. Among pregnant women aged 15 to 44, 9.8% reported drinking alcohol during the past month, 4.1% reported binge alcohol use, and less than 1% reported heavy alcohol use..." The report is available in both HTML and PDF formats.  
  

Monthly Injections of Naltrexone Show Continued Benefit in Treating Alcoholism Medscape Medical News story - "Patients with alcohol dependence who continue taking naltrexone (Vivitrex) for a year or more continue to benefit from treatment, according to investigators who presented their findings here at the 2005 American Psychiatric Association Annual Meeting.'We were pleased to see that [naltrexone] led to a sustained reduction in heavy drinking over an extended-treatment period,' said principal investigator David Gastfriend, MD, in a presentation. The findings bode well for the treatment of alcoholism, which is a chronic disease characterized by relapses, Dr. Gastfriend said." [Viewing Medscape resources requires registration, which is free].  
  

Women With ADHD Less Likely to Be Diagnosed and More Symptomatic Than Men Medscape Medical News story - "Women with attention deficit/hyperactivity disorder (ADHD) have more severe symptoms and emotional impairment than male patients, although they respond at least as well to treatment, according to investigators who presented their findings here at the 2005 American Psychiatric Association Annual Meeting..." [Viewing Medscape resources requires registration, which is free].  
  

The Effect of Increase Cost Sharing in Medicaid Report from the Center on Budget and Policy Priorities - "Recent policy discussions concerning ways to change Medicaid often include the idea of letting states increase the amounts that low-income beneficiaries are charged in the form of cost-sharing (i.e., in premiums, deductibles, co-insurance, and co-payments). Proponents of increased cost-sharing maintain it would make Medicaid more like private health insurance and promote “personal responsibility,” by making people accountable for a larger share of the cost of their care. Medicaid already permits cost-sharing on a limited basis. Those who advocate increased cost-sharing generally seek flexibility to raise the amounts that can be charged and to apply cost-sharing to groups of beneficiaries that currently are exempted. Changes in Medicaid’s cost-sharing rules could mean charging higher copayments when a patient sees a doctor or picks up a prescription or charging monthly premiums to participate in Medicaid. This analysis highlights key research about the impact of cost-sharing on low-income families and individuals, including recent evidence about how cost-sharing has affected low-income Medicaid beneficiaries in states that have increased their cost-sharing levels..." The report is also available in PDF format.  
  

Out-Of-Pocket Medical Expenses for Medicaid Beneficiaries Are Substantial and Growing Report from the Center on Budget and Policy Priorities - "Federal and state officials are discussing possible ways to reduce Medicaid expenditures. One commonly mentioned proposal is to increase the copayments that poor Medicaid beneficiaries must pay when receiving medical care. A related proposal would reduce the benefits that Medicaid covers for some groups. A rationale offered for these changes is that Medicaid policies are outdated and have not kept pace with changes in the private market. Many assume that because cost-sharing in Medicaid is limited, low-income Medicaid beneficiaries pay almost nothing and bear little financial responsibility for their health care. The analysis presented here shows, however, that the amounts that Medicaid beneficiaries pay out-of-pocket for medical care already are substantial and are growing twice as fast as their incomes. The data also indicate that out-of-pocket expenses have been growing significantly faster for poor adults on Medicaid than for people with private health insurance..." The report is also available in PDF format.  
  

Governors Back Away From Medicaid Cuts Panel AP story in the Las Vegas Sun - "Governors working on proposals to improve Medicaid decided Wednesday they won't join a federal commission that's supposed to recommend how to trim $10 billion from the joint federal-state health care program for the poor. The executive committee of the National Governors Association unanimously agreed that governors would continue their Medicaid work independently of the commission being set up by Michael Leavitt, secretary of the Health and Human Services Department. Association staff would assist the commission, however. Congressional Democrats last week announced they wouldn't be part of the commission being set up by Leavitt at the behest of Congress. Democratic leaders said they were opposed to the $10 billion reduction in spending..."  
  

Grand jury: Mental health services the elephant in the room (California) Ukiah Daily Journal story - " 'Mental illness is, both literally and figuratively, the member of the family many of us prefer to ignore. We find it scary. There is no easy fix for it." So speaks the Mendocino County Grand Jury in its latest report called 'The elephant in the county: A report on mental health services.' ... According to the grand jury, it is unreasonable to think that one county department - the Mental Health Department - can possibly take all the responsibility for caring for the mentally ill in this county. They also believe that there are many hidden costs of caring for the mentally ill in other departments throughout the county and that private and non-profit organizations are also carrying a heavy burden of responsibility as well."  
  

Blanco administration officials disagree on scope of mental health cuts (Louisiana) Beauregard Daily News story - "Eight rural mental health clinics face closure next year, according to Gov. Kathleen Blanco's state health department secretary in testimony rebutted Tuesday by the governor's financial analyst, who insisted those clinics could remain open under the budget proposal. The two disagreed at a Senate panel hearing, leaving senators to question whether they needed to shift dollars for mental health services in the budget for next year, and if so, how much was needed."  
  

Debate at standstill over closing remaining mental health institutions (Massachusetts) Milford Daily News story - "...Gov. Mitt Romney wants to close down state developmental centers such as Wrentham and move patients into smaller, privately run facilities. He has allies among activists opposed to the notion of "warehousing" the developmentally disabled. But another set of patient advocates, made up mostly of patient families, oppose the plan. They contend the closure of state facilities and the privatization of care hurts the profoundly developmentally disabled. "  
  

WHO launches first-ever international forum on community mental health services WHO press release - "In an effort to reduce the huge global burden of disease linked to mental disorders around the world, the World Health Organization (WHO) is launching the first ever global forum about community-based psychosocial rehabilitation services. These rehabilitation services represent an alternative to psychiatric hospitals, and aim to provide local care to people with severe mental health disorders, including medication, psychological support, and rehabilitation activities. Services can include protected apartments where patients can live, and opportunities for them to work. An estimated 450 million people worldwide are affected by mental disorders. WHO is inviting people to write the Organization about community-based psychosocial rehabilitation projects that have worked well and about those which have not been successful."  
  

Codey to sign order on mental health task force recommendations (New Jersey) AP story at Newsday - "Inspection of boarding homes that house mental patients would become the duty of the state Department of Community Affairs instead of Health and Senior Services under an executive order acting Gov. Richard J. Codey plans to sign, according to an umbrella group for mental health organizations in New Jersey. Codey's office on Wednesday declined to reveal the specific focus of the executive order, releasing only a planning advisory that said it would implement several key recommendations from a report by a mental health task force. But Dan Seymour, a spokesman with the New Jersey Association of Mental Health Agencies, said Codey's order would shift the inspection duties and expand the state Division of Mental Health's referral hotline to a round-the-clock, seven-day-a-week operation. The order would also create a governor's council on mental health stigma and elevate the state mental health division director to a special assistant commissioner who reports directly to the chief of the state Department of Human Services."