RESUMO
This article describes the assertive community treatment model of comprehensive community-based psychiatric care for persons with severe mental illness and discusses issues pertaining to implementation of the model. The assertive community treatment model has been the subject of more than 25 randomized controlled trials. Research has shown that this type of program is effective in reducing hospitalization, is no more expensive than traditional care, and is more satisfactory to consumers and their families than standard care. Despite evidence of the efficacy of assertive community treatment, it is not uniformly available to the individuals who might benefit from it.
Assuntos
Serviços Comunitários de Saúde Mental/organização & administração , Assistência Integral à Saúde/organização & administração , Transtornos Mentais/reabilitação , Implementação de Plano de Saúde , Humanos , Modelos Organizacionais , Equipe de Assistência ao Paciente/organização & administração , Estados UnidosAssuntos
Doença de Alzheimer/tratamento farmacológico , Doença de Alzheimer/economia , Carbamatos/economia , Carbamatos/uso terapêutico , Inibidores da Colinesterase/economia , Inibidores da Colinesterase/uso terapêutico , Fármacos Neuroprotetores/economia , Fármacos Neuroprotetores/uso terapêutico , Fenilcarbamatos , Idoso , Redução de Custos , Humanos , RivastigminaRESUMO
For two decades, New Federalism, devolution, and other challenges to the federal role in domestic health and human services policy have fundamentally shaped the structure and delivery of long-term care in the United States. Devolution evokes crucial questions concerning the future of universal entitlement programs such as Social Security and Medicare and, with them, the future of aging and long-term care policy. This article examines the implications of the "devolution revolution" for long-term care in the context of the sociodemographics of aging and the managed care movement. Central issues are the extent to which state-level discretionary policy options (1) alter priorities, services, and benefits for the elderly and disabled: (2) foster a race to the bottom in long-term care; (3) promote generational, gender, racial and ethnic, and social class trade-offs; and (4) fundamentally alter the role and capacity of nonprofit sector services that comprise a significant part of the long-term care continuum.
