Case Management

Boa prática aprovada pelo Fórum Permanente de Processualistas Civis (Brasília, 2022):
Acordo de cooperação entre a advocacia pública e tribunal com o objetivo de simplificar a análise de eventuais prescrições intercorrentes em execuções fiscais por meio do encaminhamento, sem carga, de lista de processos à advocacia pública para análise e indicação dos casos que permitem o reconhecimento da prescrição. (Grupo: Cooperação judiciária nacional - XI FPPC-Brasília)
Descrição. Consiste na fixação de um rito diferenciado para análise de prescrição intercorrente no âmbito das execuções fiscais promovidas pela PRFN5 perante os juízos federais vinculados ao TRF5.Trata-se de protocolo institucional sobre processos indeterminados, mas determináveis, atuais e futuros. A concertação se dá sem prazo denido,permanecendo vigente enquanto não houver resolução. O TRF5encaminhará à PRFN5, em 1° de setembro de cada ano, em meio virtual, alista de execuções fiscais que serão submetidas aos Projeto. A PRFN5 responderá diretamente às Varas Federais, informando as execuções fiscais passíveis de sujeição ao rito simplificado de análise de prescrição intercorrente, dispensando inmação prévia para se manifestar nos termos do art. 40, §4°, da LEF, e também a carga dos autos físicos por ocasião de sua intimação da sentença, nos casos em que, cumulativamente: I - não houver condenação ao pagamento de honorários advocatícios em razão do reconhecimento da prescrição intercorrente; II - não houver penhora de bens ou direitos; III - restar consignada a especificação dos créditos(número de inscrição) envolvidos; e IV - for certificado que a representação processual da exequente está sendo exercida, nos autos, pela Procuradoria-Geral da Fazenda Nacional.
Dispositivos normativos concretizados. art. 67 do CPC; art. 19,§12, da Lei n° 10.522/2002; arts. 15 e 16 da Resolução n° 350 do CNJ.
Órgãos envolvidos. PRFN5 e TRF5
Responsáveis pela prática. Bernardo Alves da Silva Júnior, Carlos Rebêlo Júnior e Vladimir Souza Carvalho.

El Código General del Proceso es la reforma procesal más importante en materia procesal civil de las últimas décadas en Colombia. Esta norma ha sido expedida en el contexto del movimiento de reforma judicial que tiene lugar en Latinoamérica que busca modernizar los sistemas judiciales. En la reforma intervienen una serie de actores locales e internacionales con diferentes ideologías sobre la función del proceso civil en la sociedad. En  este código se advierte la concurrencia de las ideologías publicista, liberal, eficientista y constitucionalista del proceso civil, las cuales se manifiestan paralelamente en la configuración del modelo procesal a partir de los diversos dispositivos procesales consagrados en la ley, generando así un cuerpo normativo contradictorio e incoherente desde sus finalidades y funciones así como un modelo procesal poco delineado.

Objective: The Finnish Medicines Agency (Fimea) initiated a programme in 2012 for enhancing interprofessional networking in the medication management of the aged. The goal is to develop national guidelines for interprofessional collaboration with respect to medication management. This study aims to explore the challenges and potential solutions experienced by existing health care teams in managing medication of the aged: (1) at the individual and team level (micro level), (2) organisational level (meso level) and (3) structural level (macro level). Design: Group discussions (n ¼ 10), pair (n ¼ 3) and individual interviews (n ¼ 2). Abductive content analysis combining data and theory was applied. Networking was used as a theoretical framework. Setting: Meetings (n ¼ 15) organised by Fimea in the formation phase of the interprofessional network in 2012. Subjects: Health care professionals (n ¼ 55). Main outcome measures: Challenges and solutions in the medication management of the aged at the micro, meso and macro levels. Results: Challenges in interprofessional collaboration, problems with patient record systems, and the organisation of work and lack of resources were present at all the levels contributing to patients' medication problems. Participants suggested multiple potential solutions to improve interprofessional collaboration, sharing of tasks and responsibilities, better exploitation of pharmaceutical knowledge and developing tools as being the most commonly mentioned. Conclusions: Optimising medication use of the aged requires new systemic solutions within and between different system levels. The main challenges can be solved by clarifying responsibilities, enhancing communication and applying operational models that involve pharmacists and the use of information technology in medication management. KEY POINTS An interprofessional team approach has been suggested as a solution to promote rational medicine use among the aged. Fragmented health care system and lack of coordinated patient care are reasons for medication related problems of the aged. Challenges in the implementation of interprofessional collaboration in medication management appear in legislation, information systems, operational models and individuals' attitudes. Optimising medications requires better interprofessional networking and new systemic solutions within and between macro, meso and micro levels.

OBJECTIVES The goals of this study were to: (1) determine if management according to a standardized clinical management pathway/algorithm (compared with usual treatment) improves clinical outcomes by 6 weeks; and (2) assess the reliability and validity of a standardized clinical management pathway for chronic cough in children. METHODS: A total of 272 children (mean ± SD age: 4.5 ± 3.7 years) were enrolled in a pragmatic, multicenter, randomized controlled trial in 5 Australian centers. Children were randomly allocated to 1 of 2 arms: (1) early review and use of cough algorithm (“early-arm”); or (2) usual care until review and use of cough algorithm (“delayed-arm”). The primary outcomes were proportion of children whose cough resolved and cough-specific quality of life scores at week 6. Secondary measures included cough duration postrandomization and the algorithm’s reliability, validity, and feasibility. RESULTS: Cough resolution (at week 6) was significantly more likely in the ear...

Data on presentation, aetiology, and prognostic indicators of childhood pneumonia, which can help design strategies for controlling the disease, are generally scarce in developing countries. In this paper, the distribution of aetiologic agents, clinical presentation, and evolution of pneumonia cases are described, and the factors associated with duration of pneumonia episode and of hospital admission examined. During June 1994-June 1995, 472 children, aged 6-59 months, with clinical diagnosis of pneumonia, who were admitted to hospital or treated as outpatients, were investigated in Recife, Northeast Brazil. Pneumonia, in most cases, was confirmed by radiology. A combination of methods was used for investigating the aetiology of pneumonia. Data obtained on a large number of clinical, socioeconomic and biological variables were analyzed to determine the prognostic factors for the severity and outcome of pneumonia. Bacteria were identified in 26.7% of the cases, while viruses and mixe...

The purpose behind this article is to describe the features of Ftklipse, an extendable platform for computer forensics. This document designed to provide a detailed specification for the developers of Ftklipse. Ftklipse is a thick-client solution for forensics investigation. It is designed to collect and preserve evidence, to analyze it and to report on it. It supports chain of custody

The complex formed by chronic illness, episodes of acute illness, physiological disabilities, functional limitations, and cognitive problems is prevalent among frail elderly persons. These individuals rely on assistance from social and health care programs, which in ...

Aim. This paper presents the findings of a review and appraisal of the evidence for the effectiveness of nurse case management in improving health outcomes for patients living either with Diabetes, Chronic Obstructive Pulmonary Disease or Coronary Heart Disease. Background. Long term chronic health conditions provide some of the greatest challenges to western health care systems. In the UK, three of the most significant chronic conditions are Diabetes, Chronic Obstructive Pulmonary Disease and Coronary Heart Disease. Patients with these long term conditions are high users of health services who often receive unplanned, poorly coordinated, ad-hoc care in response to an exacerbation or crisis. To counter this, the nurse case manager is identified as a central aspect of improving care for these patients. However, the evidence for the effectiveness of nurse case management in improving health outcomes for the chronically ill is scarce. Design. A structured review of the literature. Method. The review was undertaken focussing on studies that evaluated nurse case management with one or all of the three major long term chronic conditions. A total of 108 papers were initially reviewed and filtered to leave 75 citations that were appraised. About 18 papers were finally included in the review and subject to thematic analysis based on the health outcomes evaluated in the studies. Results. Significantly positive results were reported for nurse case management impact on five health outcomes; 'objective clinical measurements', 'quality of life and functionality', 'patient satisfaction', 'adherence to treatment' and 'self care and service use'. Relevance to clinical practice. The evidence generated in this review suggests that nurse case managers have the potential to achieve improved health outcomes for patients with long term conditions. Further research is required to support role development and create a more targeted approach to the intervention.

As part of the Closing the Quality Gap: Revisiting the State of the Science series of the Agency for Healthcare Research and Quality (AHRQ), this systematic review sought to identify completed and ongoing evaluations of the comprehensive patient-centered medical home (PCMH), summarize current evidence for this model, and identify evidence gaps. We searched PubMed®, CINAHL®, and the Cochrane Database of Systematic Reviews for published English-language studies, and a wide variety of databases and Web resources to identify ongoing or recently completed studies. Two investigators per study screened abstracts and full-text articles for inclusion, abstracted data, and performed quality ratings and evidence grading. Our functional definition of PCMH was based on the definition used by AHRQ. We included studies that explicitly claimed to be evaluating PCMH and those that did not but which met our functional definition. Seventeen studies with comparison groups evaluated the effects of PCMH ...

Objective To assess the quality of care provided by Health Surveillance Assistants (HSAs)—a cadre of community-based health workers—as part of a national scale-up of community case management of childhood illness (CCM) in Malawi. Methods Trained research teams visited a random sample of HSAs (n 131) trained in CCM and provided with initial essential drug stocks in six districts, and observed the provision of sick child care. Trained clinicians conducted ‘gold-standard’ reassessments of the child. Members of the survey team also interviewed caregivers and HSAs and inspected drug stocks and patient registers. Findings HSAs provided correct treatment with antimalarials to 79 % of the 241 children presenting with uncomplicated fever, with oral rehydration salts to 69 % of the 93 children presenting with uncomplicated diarrhoea and with antibiotics to 52 % of 58 children presenting with suspected pneumonia (cough with fast breathing). About one in five children (18%) presented with dange...

A randomized experiment was conducted to test the effects of the Comprehensive Child Development Program (CCDP), a two-generation program that employed case management and home visiting to ensure multi-risk, low-income children and their parents a range of education, health, and social services to meet the complex needs of disadvantaged families. The evaluation of 21 CCDP projects, which followed 4,410 families for five years, found no statistically significant impact on CCDP families when they were compared with control families in either child outcomes (cognitive and socio-emotional development, and health) on parent outcomes (parenting, family economic self-sufficiency, or maternal life course). Since the intervention failed to change parenting behavior or family economic status, the two hypothesized pathways to affecting the well-being of the children, not unexpectedly there were no significant impacts of CCDP on children. The study suggests that the combination of case management and parenting education, delivered through home visits, is not an effective means of improving developmental outcomes for low-income children. Three linked hypotheses-that the child's early development lays the foundation for his or her long-term functioning, that early environmental influences have important effects on early development, and that poverty is associated with a variety of material and psychological deficits in children's early experiences-are widely accepted, supported by research evidence, and troubling in their implica

Compliance with antipsychotic treatment is a well-recognized concern in the ongoing management of individuals with schizophrenia. The present investigation incorporated the Medication Event Monitoring System (MEMS®) to evaluate compliance in a group of outpatients (N = 52) with schizophrenia or schizoaffective disorder. Evaluating compliance as a dichotomous variable and using a threshold of 80%, the rate of noncompliance as measured by MEMS® was 52%, considerably higher than self-report (3%), clinician rating (24%) and pill count (25%). The ability of treating clinicians to predict compliance/noncompliance was limited: 13 of 31 (42%) subjects they rated as compliant were noncompliant while 4 of 9 (44%) rated as noncompliant were actually compliant according to MEMS®. Factors most consistently associated with noncompliance were higher total symptom scores and dosing complexity i.e., greater than once daily. Based on MEMS® data, the overall mean level of compliance was 66%; however, it remains unclear as to what threshold is associated with a compromise in clinical response. More sophisticated measurement tools such as MEMS® may assist us in better understanding how level and pattern of antipsychotic noncompliance, factors that at present remain poorly understood, impact on symptom exacerbation.

Background Effective case management is central to reducing malaria mortality and morbidity worldwide, but only a minority of those affected by malaria, have access to prompt effective treatment. In Kenya, the Division of Malaria Control is committed to ensuring that 80 percent of childhood fevers are treated with effective anti-malarial medicines within 24 hours of fever onset, but this target is largely unmet. This review aimed to document evidence on access to effective malaria treatment in Kenya, identify factors that influence access, and make recommendations on how to improve prompt access to effective malaria treatment. Since treatment-seeking patterns for malaria are similar in many settings in sub-Saharan Africa, the findings presented in this review have important lessons for other malaria endemic countries. Methods Internet searches were conducted in PUBMED (MEDLINE) and HINARI databases using specific search terms and strategies. Grey literature was obtained by soliciting reports from individual researchers working in the treatment-seeking field, from websites of major organizations involved in malaria control and from international reports. Results The review indicated that malaria treatment-seeking occurs mostly in the informal sector; that most fevers are treated, but treatment is often ineffective. Irrational drug use was identified as a problem in most studies, but determinants of this behaviour were not documented. Availability of non-recommended medicines over-the-counter and the presence of substandard anti-malarials in the market are well documented. Demand side determinants of access include perception of illness causes, severity and timing of treatment, perceptions of treatment efficacy, simplicity of regimens and ability to pay. Supply side determinants include distance to health facilities, availability of medicines, prescribing and dispensing practices and quality of medicines. Policy level factors are around the complexity and unclear messages regarding drug policy changes. Conclusion Kenya, like many other African countries, is still far from achieving the Abuja targets. The government, with support from donors, should invest adequately in mechanisms that promote access to effective treatment. Such approaches should focus on factors influencing multiple dimensions of access and will require the cooperation of all stakeholders working in malaria control.

MORE was a mobile outreach drug abuse prevention and HIV harm reduction program primarily for ex-offenders who are active drug users. Through case management, clients were provided substance abuse education, counseling and referral. A long-term goal of these services was to reduce their drug use and re-incarceration for drug related crimes. From

The choice of palliative treatment and the prognostic factors in unresectable head and neck cancer cases continue to be controversial. In the present study we compared the survival rates of untreated stage IV head and neck cancer patients with cases managed prospectively at A.C. Camargo Hospital for Cancer with neoadjuvant chemotherapy, concomitant chemotherapy or radiotherapy alone. Previous results had shown that while the type of treatment did not influence survival rates (P = 0.706), tumor response to treatment (whether complete, partial or none) significantly influenced survival (P = 0.00002). In the present study we compared the survival rates in the groups with untreated patients (who remained untreated until death) with the same demographic and clinical characteristics of patients receiving treatment. We found that there was a significant difference between the survival rates of the untreated group and those of the treated groups that was independent of the type of treatment performed (P < 0.00001) or the tumor response to treatment (P < 0.0001).

To review a series of tears of the posterior cruciate ligament (PCL) in order to understand its healing process, as well as to identify prognostic factors. Type of Study: Prospective study. Methods: Eighteen patients with isolated or combined PCL tears were evaluated and followed-up for 1 year after their initial injury. Magnetic resonance imaging (MRI) scans and stress radiographs were obtained serially at the time of injury, at 6 months, and at 12 months. Results: Twelve of 18 PCL tears were found to have regained continuity at the 1-year follow-up. These patients complained of an isolated or combined PCL/medial collateral ligament injury at time 0 and all presented a posterior subluxation of less than 8 mm, detected with stress radiographs. The remaining 6 patients had posterior subluxations greater than 12 mm and presented with combined posterolateral corner injuries. Conclusions: This study underlines the importance of a complete MRI evaluation used in combination with stress radiography to adequately assess the healing process. The results obtained suggest that complete PCL tears with greater than 12 mm of posterior subluxation, as well as combined PLC injuries, are less likely to heal completely. These factors could further aid the surgeon in deciding the need and timing for surgical intervention in the acute setting of a PCL tear. Level of Evidence: Level II.

Objective: The purpose of this study was to assess the need for incorporating perceived importance of service elements into client satisfaction measures. Method: A secondary analysis of client satisfaction data from 112 clients of an elderly case management setting was conducted. Results: This study found that the relationship between global client satisfaction and the composite of satisfaction with service elements differed significantly, depending on perceived importance of service elements. Conclusions: These results call into question the practice of simply adding or averaging scores from satisfaction items to produce global satisfaction scores without considering perceived importance of the service elements.

A life care plan sets out the full extent of the acquired impairments, likely complications, implications for independence, quality of life, and long-term care needs and then informs the parties about the rationale, including nature, extent, and frequency, for all the goods and services likely to be needed over a person's life span and associated costs. Whether from a clinical or litigation perspective, all life care plans should be founded in good science and preferably methodologically sound evidence-based medical practice. For patients with traumatic brain injury (TBI), a life care plan requires systematic and thorough consideration of multiple dimensions of central nervous system functioning, including not only the more obvious problems of motor, communication, cognitive, and neuropsychiatric impairment but also other issues, such as pain, fatigue, and psychological responses to trauma, impairment, and disability. Some of the major life care plan domains include home and/or facility care, medications, durable medical equipment, and vocational issues. Physicians and life care planners should be aware of common faux pas made in life care plans that can undermine the credibility of a plan as well as a professional's expert testimony. Clinicians-physicians or otherwise-involved either in the development of life care plans or in their critique should have a consistent methodology for reviewing the scientific credibility and foundation of such documents.

Suicide is a leading cause of deaths in the United States. Although the emergency department (ED) is an opportune setting for initiating suicide prevention efforts, ED-initiated suicide prevention interventions remain underdeveloped. To determine whether an ED-initiated intervention reduces subsequent suicidal behavior. This multicenter study of 8 EDs in the United States enrolled adults with a recent suicide attempt or ideation and was composed of 3 sequential phases: (1) a treatment as usual (TAU) phase from August 2010 to December 2011, (2) a universal screening (screening) phase from September 2011 to December 2012, and (3) a universal screening plus intervention (intervention) phase from July 2012 to November 2013. Screening consisted of universal suicide risk screening. The intervention phase consisted of universal screening plus an intervention, which included secondary suicide risk screening by the ED physician, discharge resources, and post-ED telephone calls focused on red...

At present, cloud computing extremely popular subject, which allows a service provider to provide seamless service/information over internet. Therefore, it eliminates the necessity for maintaining expensive computing resources. Testing cloud applications possesses its own challenges that demands for novel testing strategies and tools. Instead, cloud application also allows and provides options for the development of more beneficial and scalable software testing techniques. Because of this, an appropriate standard that really helps user to utilize application without any downtime is the need of the hour. Therefore, to ensure Geo-Red applications high quality, a number of test cases for geo redundancy are being proposed. Thus, this work is an extension of work already proposed as an effective testing framework (TF2Grace) that fulfills these types of needs. This paper provides the test environment setup and also describes the structural design and application experiment with proposed framework. It further provides an appropriate report and recommendation for the application under test.

Guidelines for treating various conditions can be helpful in setting practice standards, but the presence of several sets of guidelines from different countries, experts, and settings, written at different times, can also create confusion. Here we provide a “guideline of guidelines” for the treatment of schizophrenia, or “meta-guidelines,” which not only reconcile the various existing standards but also update them to include the use of several newer agents, most of which were marketed following the publication of existing standards.

An essential component of integrated schistosomiasis control as promoted by WHO is adequate clinical care for patients presenting at health care facilities. We evaluated the functioning of the Ghanaian health system for diagnosis and treatment of schistosomiasis by interviewing health workers from 70 health care facilities in 4 geographical areas in April and May 2000. Results from presentation of 4 hypothetical cases and a subsequent interview demonstrated that patients presenting with symptoms related to schistosomiasis have a small chance of receiving adequate treatment: often health workers do not recognize the symptoms, especially those of Schistosoma mansoni; patients are frequently referred for a diagnostic test or treatment with a large risk of non-compliance; and praziquantel was not available in 78% of the health care facilities with reported schistosomiasis in their coverage area. The overall cost of treatment is considerable: t~2.13 for S. haematobium and t~1.81 for S. mansoni patients, with drug costs contributing approximately 40% of the total cost. To better meet WHO recommendations for passive case detection as part of integrated schistosomiasis control, the Ghanaian health system needs to emphasize training of health workers in schistosomiasis case recognition and case management and increase the availability of praziquantel. Experience from other West African countries indicate that this is feasible.

Study outcomes were enrollment into CITI and initiating antiretroviral treatment (ART). Factors associated with outcomes were estimated by logistic regressions with random effects. Results: Among the study participants, 54% enrolled into CITI and 23% initiated ART. CITI enrolment was associated with being married (adjusted odds ratio (AOR) = 1.17; 95%: 1.02-1.34); less than weekly compared to daily (AOR = 1.31; 95%: 1.13-1.52); less than 5 years of drug use compared to > 14 years (AOR = 1.73; 95%: 1.40-2.13), and having no criminal records (AOR = 1.30; 95%: 1.12-1.50). Factors of non-ART initiation were male gender (AOR = 1.33; 95%: 1.16-1.53); being single (AOR = 1.48; 95%: 1.21-1.82); drug use duration > 14 years compared to < 5 years (AOR = 1.38; 95%: 1.03-1.85), unemployment (AOR = 1.45; 95%: 1.15-1.83) and history of incarceration (AOR = 1.21; 95%: 1.003-1.45). Conclusion: Mobilizing the NGO community and PWID to engage in outreach HIV testing activity and harm reduction for key populations has succeeded in opening the gateway to prevention, care and ART for thousands of PWID in Ukraine.

One province in Canada, Ontario, is considering the use of drug tests for welfare recipients. Those with positive tests could be required to receive treatment and abstain from drug use or risk losing their benefits. Several experts from the Centre for Addiction and Mental Health (CAMH) reviewed the scientific strengths and weaknesses of this proposal. Strengths included possible increases in employment and reduced drug use among welfare recipients; however, the group concluded that drug testing of welfare recipients or removal of welfare benefits for people who refuse treatment or relapse is not advisable for several reasons. Drug testing cannot be used to determine substance abuse or dependence, could undermine the client case manager relationship and could be legally challenged as a violation of human rights. Other drawbacks of conditional welfare include possible negative societal consequences (i.e. increased crime and health problems) and disruptions to the treatment population. The whole process is expensive and will likely result in a very marginal increase in employment because drug dependence is not a major barrier to employment.

The rationale for the development of effective programs for parents with serious mental illness and their children is compelling. Using qualitative methods and a grounded theory approach with data obtained in site visits, seven existing programs for parents with mental illness and their children in the United States are described and compared across core components: target population, theory and assumptions, funding, community and agency contexts, essential services and intervention strategies, moderators, and outcomes. The diversity across programs is strongly complemented by shared characteristics, the identification of which provides the foundation for future testing and the development of an evidence base. Challenges in program implementation and sustainability are identified. Qualitative methods are useful, particularly when studying existing programs, in taking steps toward building the evidence base for effective programs for parents with serious mental illness and their chil...

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In the context of international debates about ways to reduce the harms related to the use of illicit drugs and their control, this article explores the specific issue of coerced treatment of people who use drugs. It uses established standards of human  rights and medical ethics to judge whether it is ethical to apply either of two types of coerced treatment (compulsory treatment and quasi-compulsory treatment, or QCT) to any of three groups of drug users (non-problematic users, dependent drug users and drug dependent offenders). It argues that compulsory treatment is
not ethical for any group, as it breaches the standard of informed consent. Quasi-compulsory treatment (i.e. treatment that is offered as an alternative to a punishment that is itself ethically justified) may be ethical (under specified conditions) for drug
dependent offenders who are facing a more restrictive penal sanction, but is not ethical for other people who use drugs. The article also briefly reviews evidence which suggests that QCT may be as effective as voluntary treatment.

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Background: Continuity of care is widely acknowledged as a core value in family medicine. In this systematic review, we aimed to identify the instruments measuring continuity of care and to assess the quality of their measurement properties.

This article describes a randomized study to determine the effectiveness of a reentry modified therapeutic community (RMTC) for offenders with co-occurring substance use and mental disorders (co-occurring disorders or COD). Men with COD, approved for community corrections placement postrelease, were recruited from nine Colorado prisons and stratified according to the type of treatment received while incarcerated (i.e., a prison modified therapeutic community [MTC] program or standard care). When released, each offender was randomly assigned either to the experimental RMTC (E-RMTC) condition (n = 71) or to the control parole supervision and case management (PSCM) condition (n = 56). An intent-to-treat analysis 12 months postprison release showed that the E-RMTC participants were significantly less likely to be reincarcerated (19% vs. 38%), with the greatest reduction in recidivism found for participants who received MTC treatment in both settings. These findings support the RMTC as a stand-alone intervention and provide initial evidence for integrated MTC programs in prison and in aftercare for offenders with COD.

Background: Triply diagnosed patients, who live with HIV and diagnosed mental health and substance abuse disorders, account for at least 13% of all HIV patients. This vulnerable population has substantial gaps in their care, attributable in part to the need for treatment for three illnesses from three types of providers. Aims of the study: The HIV/AIDS Treatment Adherence, Health Outcomes and Cost study (HIV Cost Study) sought to evaluate the cost-effectiveness of integrated HIV primary care, mental health, and substance abuse services among triply diagnosed patients. The analysis was conducted from a health sector budget perspective. Methods: Patients from four sites were randomly assigned to intervention group or (n=232) or control group (n=199) that received care-as-usual. Health service costs were measured at baseline and three, six, nine and 12 months and included hospital stays, emergency room visits, outpatient visits, residential treatment, formal long-term care, case management, and both prescribed and over-the-counter medications. Costs for each service were the product of self-reported data on utilization and unit costs based on national data (2002 dollars). Quality of life was measured at baseline and six and 12 months using the SF-6D, as well as the SF-36 physical composite score (PCS) and mental composite score (MCS). Results: During the 12 months of the trial, total average monthly cost of health services for the intervention group decreased from $3235 to $3052 and for the control group decreased from $3556 to $3271, but the decreases were not significant. For both groups, the percentage attributable to hospital care decreased significantly. There were no significant differences in annual cost of health services, SF-6D, PCS or MCS between the intervention and control group. Implications for Health Care Provision and Use: The results of this randomized controlled trial did not demonstrate that the integrated interventions significantly affected the health service costs or quality of life of triply diagnosed patients. Professionals could pursue coordination or integration of care guided by the evidence that it does not increase the cost of care. The results do not however, provide an imperative to introduce multi-disciplinary care teams, adherence counseling, or personalized nursing services as implemented in this study. Implications for Health Policies: There is not enough evidence to either limit continued exploration of integration of care for triply diagnosed patients or adopt policies to encourage it, such as financial reimbursement, grants regulation or licensing. Implications for Further Research: Future trials with interventions with lower baseline levels of integration, longer duration and larger sample sizes may show improvement or slow the decline in quality of life. Future researchers should collect comprehensive cost data, because significant decreases in the cost of hospital care did not necessarily lead to significant decreases in the total cost of health services.

Housing problems present barriers to family unity and reunification among families in the child welfare system, yet few programs address both child welfare and housing needs. To date, the field lacks data for understanding families with dual vulnerabilities in these arenas and the programs that support them. This study aimed to address that gap by reporting the characteristics and outcomes of 1720 families referred to a Supportive Housing for Families (SHF) program over a 10-year period. This report describes client characteristics, progress, and outcomes at discharge. Positive shifts in employment and housing were evident across the entire sample. Clients who completed the program successfully had longer stays, were more likely to have a history of permanent housing and employment, and had higher initial and exit scores on a measure of environment of care. Higher client-staff involvement and service utilization were associated significantly with positive discharge, but not with procurement of permanent housing. This report provides initial endorsement for the SHF model and makes suggestions for program practice, future research, and policy. More research is critical if we are to understand the optimal mechanisms of support and change that lead to child safety and family self-sufficiency.

This project evaluated whether clinical case managers (CCMs) could increase access and utilization of social services in the community; and thereby improve outcomes of addiction treatment. No case management (NoCM) -patients received standard, group-based, abstinence-oriented, outpatient drug abuse counseling, approximately twice weekly. Clinical case management (CCM)-patients were treated in the same programs but also were assigned a CCM who provided access to pre-contracted, support services such as drug free housing, medical care, legal referral, and parenting classes from community agencies. CCM patients received more alcohol, medical, employment, and legal services than NoCM patients during treatment. At 6 month follow-up CCM patients showed significantly more improvement in alcohol use, medical status, employment, family relations, and legal status than NoCM patients. We conclude that CCM was an effective method of improving outcomes for substance abuse patients in community treatment programs. Essential elements for successful implementation included extensive training to foster collaboration; and pre-contracting of services to assure availability.

Background: There are high rates of co-occurring depression among young people with substance use disorders. While there is preliminary evidence for the effectiveness of integrated cognitive behaviour therapy (CBT) in combination with antidepressants among alcohol and substance dependent adolescents and adults with co-existing depression, no studies have examined the effectiveness of integrated CBT interventions in the absence of pharmacotherapy.

OBJECTIVES: To study the feasibility and effectiveness of a discharge planning intervention.DESIGN: Quasi-experimental pre–post study design.SETTING: General medicine wards at three hospitals: an academic medical center, a community teaching hospital, and a community-based nonteaching hospital.PARTICIPANTS: All patients aged 65 and older admitted to the hospitalist services.INTERVENTION: The intervention toolkit had five core elements: admission form with geriatric cues, facsimile to the primary care provider, interdisciplinary worksheet to identify barriers to discharge, pharmacist–physician collaborative medication reconciliation, and predischarge planning appointments.MEASUREMENTS: Thirty-day readmission and return to emergency department rates and patient satisfaction with discharge. Odds ratios were determined, and site effects were examined accordig to interaction terms and Breslow Day statistics.RESULTS: Two hundred thirty-seven patients were followed during the preintervention period, and 185 were exposed to the intervention. Patients characteristics were similar across the two time periods. The proportion of patients with high-quality transitions home, measured according to Coleman's Care Transition Measures, increased from 68% to 89% (odds ratio (OR)=3.49, 95% confidence interval (CI)=2.06–5.92). Return to the emergency department within 3 days of discharge was lower in the intervention period (10% vs 3%, OR=0.25, 95% CI=0.10–0.62). At 30 days, there was a lower rate of readmission (22% vs 14%, OR=0.59, 95% CI=0.34–0.97) and fewer visits to the emergency department (21% vs 14%, OR=0.61, 95% CI=0.36–1.03) (P=.06).CONCLUSION: When hospitalized elderly patients are treated with consideration of their specific needs, healthcare outcomes can be improved.

Objective: To write a narrative review of the role of primary care physicians in the long-term care of people with dementia living at home, with a focus on psychosocial interventions, the provision of information and carer support, behavioural and psychological symptoms and case management. Methods: The systematic review carried out for the NICE/SCIE Guidelines was updated from January 2006, Cochrane Reviews were identified and other publications found by consultations with experts. Results: In primary care, the long-term care of people with dementia living at home can be structured around several key themes: reframing dementia with a focus on a social model of disability; active use of information sources; supporting carers (caregivers); the management of behavioural and psychological symptoms and a structured case management approach. Conclusions: Caring for people with dementia in primary care demands the same systematic approach as the management of other long-term conditions. The systematic follow-up of both people with dementia and their carers should be integrated into primary care. Reframing dementia, with an emphasis on abilities retained may allow people with dementia and their families to develop more effective coping strategies; an increase in skill mix within primary care is required to deliver this and may also improve the management of behavioural problems. The potential benefits of person-centred interventions, like advance care planning, and alternative models of service delivery, such as a structured, collaborative care approach which promotes integrated case management within primary care, require further evaluation.