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Special Report
Preventive Interventions
Under Managed Care: Mental Health
and Substance Abuse Services
Method (DRGs)
Preparation of this literature review involved extensive searches
for two kinds of documents. The first set addressed policy,
projects, and issues related to prevention in general; the prevention
of substance abuse and mental health problems specifically; and
the availability of preventive behavioral health services to enrollees of
managed care organizations. Information from the review of these documents
is included in earlier chapters and in Appendices A and B.
The second set of documents included
evaluations of preventive interventions with
a link to substance use (alcohol, tobacco,
and drugs) or mental health that have been
published in peer-reviewed journals, including
those addressing the cost impact of the
interventions. This component of the search
focused on identifying intervention studies
that met the following criteria:
The intervention fit within the definition
of primary prevention, secondary prevention
or one of the three classifications in
the IOM’s Model of Prevention (universal,
selective, or indicated interventions).
The study evaluated or reviewed one or
more interventions designed to prevent a
substance abuse (i.e., alcohol, tobacco, or
drug) problem or a mental health problem,
or a behavioral health intervention
designed to prevent an associated health
problem, such as a low birthweight baby
resulting from use of tobacco.
The intervention was implemented with
human subjects; or an intervention model
was applied to a hypothetical group of
human subjects.
The intervention was implemented in a
medical care or referral setting.
The intervention was shown to result in
cost savings, cost offset, or neutral impact
on the cost of care; or the intervention
was shown to be effective with the potential
to result in cost savings, cost offset, or
no negative impact on the cost of care.
The study was published in 1964 through
1999 in the English language and in a
peer-reviewed journal.
The majority of the studies obtained for
this review were located through Internet
Grateful Med V2.3.2, which includes 11
databases: MEDLINE, HealthSTAR,
PREMEDLINE, AIDSLINE, AIDSDRUGS,
AIDSTRIALS, DIRLINE, HISTLINE,
HSRPROJ, OLDMEDLINE, and SDILINE.
The following search terms were used:
behavior, cost-benefit analysis, cost-effectiveness,
cost savings, evaluation studies,
health education, health maintenance organizations
(HMOs), health promotion, intervention
studies, managed care programs, mental
health, patient education, prevention, preventive
health services, preventive medicine, primary prevention/economics, and substance
abuse.
The search also included SAMHSA’s
National Clearinghouse for Alcohol and
Drug Information, SAMHSA's National Mental Health Information Center, and the Web site of the Agency
for Healthcare Research and Quality. In
addition, published articles were recommended
for review and bibliographies were
provided by staff of the CMHS and CSAP
Offices of Managed Care. Additional studies
were contributed from the files of the
author. Finally, some researchers who made
relevant presentations at conferences were
contacted by telephone or electronic mail to
solicit published articles.
From the numerous titles identified and
screened through these search methods, 78
articles were obtained and evaluated. Criteria
for inclusion in the literature review were
met by 54 of those articles. Appendix C
includes detailed summaries of these studies
organized by the developmental stage of the
research subjects (prenatal/pregnancy,
infants, children ages 1 to 12, adolescents
ages 13 to 17, families, adults ages 18 to 64,
and adults age 65 and over). In each developmental
stage, studies that address cost
impact are listed separately from those with
no cost data. Within those subsections, studies
are listed alphabetically by author. Every
literature summary is structured identically:
Reference (number and full citation);
Study question;
Description of study population;
Description of intervention;
Design;
Effectiveness of intervention;
Cost impact of intervention.
Information such as costs incurred in
delivering an intervention, the percentage of
eligible individuals that participated in an
intervention, and the type of personnel
involved in service delivery is included if provided
in the article cited.
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