Prevalence of HIV Viral Load Suppression Among Psychiatric Inpatients with Comorbid Substance Use Disorders.

A consistently suppressed viral load enables HIV (+) patients to live longer, healthier lives and reduces the probability of transmitting the virus. Since the prevalence of HIV is four times higher among those with psychiatric disorders than in the general population, it is likely that this group would also have greater difficulty remaining in care and achieving viral suppression. A secondary data analysis utilizing screening data from the Preventing AIDS Through Health (PATH) for Triples (PFT) Study were examined to assess HIV load suppression among 254 psychiatric inpatients with comorbid substance use disorders in Philadelphia. Viral load results from the past 12 months were obtained from medical records for 63 inpatients identified as HIV (+). The sample was predominately African American (76%), male (56%), and the average age was 43 years. Psychiatric disorders included depression (64%), schizophrenia (21%), and bipolar disorder (13%) with patients reporting use of alcohol (73%), cocaine (64%), cannabis (29%) and opioids (16%) prior to admission. Among this high risk sample of HIV (+) patients, about one-half (52%) achieved viral suppression, with recent opioid users six times more likely to have a detectable viral load than non-opioid users (OR 6.0; CI 1.1-31.7, p = .035). The 52% viral load suppression rate among psychiatric inpatient was higher than expected, given that the CDC's national suppression rate among those diagnosed with HIV in the general population is 58%. However, individuals with mental illness and substance use disorders require constant surveillance, monitoring, and supportive services to achieve viral suppression. Many of those who were virally suppressed were engaged in Philadelphia's extensive treatment network, whereas those who were detectable and enrolled in the PFT intervention were often homeless with unstable psychiatric symptoms and current substance use disorders, particularly opioid abuse.

Travel distance to HIV medical care: a geographic analysis of weighted survey data from the Medical Monitoring Project in Philadelphia, PA.

Decisions regarding where patients access HIV care are not well understood. The purpose of this analysis was to examine differences in travel distance to care among persons receiving care in Philadelphia. A multi-stage sampling design was utilized to identify 400 potential participants. 65 % (260/400) agreed to be interviewed. Participants were asked questions about medical care, supportive services, and geographic location. Distances were calculated between residence and care location. 46.3 % travelled more than three miles beyond the nearest facility. Uninsured travelled further (6.9 miles, 95 % CI 3.9-9.8) than persons with public insurance (3.3 miles, 2.9-3.6). In multivariate analyses, no insurance (20/260) was associated with increased distance (p = 0.0005) and Hispanic ethnicity was associated with decreased distance (p = 0.0462). Persons without insurance travel further but insurance status alone does not explain the variability in distance travelled to care. In Philadelphia, Hispanic populations, and providers that may be most accessible to them, are spatially contained.

Case manager follow-up to failed appointments and subsequent service utilization.

Case manager responses to failed appointments were monitored for 83 seriously mentally ill persons in a rural community mental health center. Case manager actions taken were grouped into four categories of follow-up from most intensive to least intensive: home visit, phone call, letter, and no follow-up. On the whole, case managers most frequently did not follow-up missed appointments (56.7%), followed up by letters (21.3%), and telephone calls (18.7%), and home visits (3.3%). Analyses revealed that home visits were most intensive and all clients who were visited following failed appointments did not fail the subsequent appointment. Clients who received telephone calls or letters were about equally likely to fail the subsequent appointment, but were much more likely to attend the subsequent appointment than were clients who received no follow-up to the failed appointment. Interestingly, clients who failed appointments and received no follow-up were much more likely to need emergency services rather than a regular appointment as their next contact with the clinic.

Critical issues in reforming rural mental health service delivery.

Critical issues in reforming rural mental health service delivery systems under health care reform are outlined. It is argued that the exclusive focus on health care financing reform fails to include obstacles to effective mental health service delivery in rural area, which should focus on issues of availability, accessibility, and acceptability, as well as financing and accountability. Characteristics of rural areas are delineated and three assumptions about the structure of rural communities which are shaping the dialogue on rural health and mental health service delivery are examined. These assumptions include the notion that rural communities are more closely knit than urban ones, that rural services can be effectively delivered through urban hubs, and that rural dwellers represent a low risk population which can be effectively served through existing facilities and by extending existing services.

Racial matching and service utilization among seriously mentally ill consumers in the rural South.

The authors examined racial matching between case manager and client for 677 seriously mentally ill consumers served through a rural community mental health center in the southeastern United States. Nonparametric statistics indicated that client-case manager dyads were more likely to be of the same race than of different races. Same-race dyads tended to have greater service utilization as indicated by a greater number of made appointments over the study period. An interaction was found for failed appointments where African Americans in same-race dyads were more likely to fail appointments, while caucasian consumers in same-race dyads were less likely to fail appointments.

Validation of scale measuring environmental barriers to diabetes-regimen adherence.

This study reports on the validation of a diabetes-specific measure of environmental barriers to regimen adherence. The reliability and validity of the environmental barriers to adherence scale (EBAS) were determined for a sample of 214 insulin-dependent and non-insulin-dependent diabetic patients. The scale was shown to be a valid measure of barriers to adherence as assessed by its relationship to the barriers to adherence questionnaire and the barriers to adherence portion of the diabetes-care profile. The medication, testing, exercise, and diet subscales of the EBAS were correlated with four corresponding and three noncorresponding measures of self-care behavior from the diabetes self-care behaviors scale. Each subscale correlated well with its corresponding self-care behavior. The internal consistency of the scale and the test-retest reliability were found to be good. The results suggest that the EBAS scale is a valid, reliable measure of barriers to diabetes-regimen adherence.

Psychologic distress of chronic pain sufferers and their spouses.

Recent research has begun to document the relationship between chronic pain and psychologic distress among pain patients, yet little attention has been given to the spouses' reaction to the chronic pain condition. The results of this research using the Symptom Checklist-90 (SCL-90) to assess the psychologic distress among both chronic pain sufferers and spouses (61 couples) reveal elevated distress scores among both groups when compared with the norms from a nonpatient sample. Patients and spouses present similar profiles according to the SCL-90 subscales, with patients' scores significantly higher on the somatization, hostility, and psychoticism subscales. No differences by sex were found.