Author
John A. Fleishman
Other affiliations: Harvard University, Johns Hopkins University, Charles R. Drew University of Medicine and Science ...read more
Bio: John A. Fleishman is an academic researcher from Agency for Healthcare Research and Quality. The author has contributed to research in topics: Acquired immunodeficiency syndrome (AIDS) & Population. The author has an hindex of 43, co-authored 87 publications receiving 8150 citations. Previous affiliations of John A. Fleishman include Harvard University & Johns Hopkins University.
Papers published on a yearly basis
Papers
More filters
••
Charles R. Drew University of Medicine and Science1, RAND Corporation2, University of California, Los Angeles3, Agency for Healthcare Research and Quality4, Kent State University5, University of Pennsylvania6, National Institutes of Health7, University of California, San Diego8, Michigan State University9
TL;DR: Clinicians may need to actively identify those at risk of psychiatric and/or drug dependence disorders and work with policymakers to ensure the availability of appropriate care for these treatable disorders.
Abstract: Background: There have been no previous nationally representative estimates of the prevalence of mental disorders and drug use among adults receiving care for human immunodeficiency virus (HIV) disease in the United States. It is also not known which clinical and sociodemographic factors are associated with these disorders. Subjects and Methods: We enrolled a nationally representative probability sample of 2864 adults receiving care for HIV in the United States in 1996. Participants were administered a brief structured psychiatric instrument that screened for psychiatric disorders (major depression, dysthymia, generalized anxiety disorders, and panic attacks) and drug use during the previous 12 months. Sociodemographic and clinical factors associated with screening positive for any psychiatric disorder and drug dependence were examined in multivariate logistic regression analyses. Results: Nearly half of the sample screened positive for a psychiatric disorder, nearly 40% reported using an illicit drug other than marijuana, and more than 12% screened positive for drug dependence during the previous 12 months. Factors independently associated with screening positive for a psychiatric disorder included number of HIV-related symptoms, illicit drug use, drug dependence, heavy alcohol use, and being unemployed or disabled. Factors independently associated with screening positive for drug dependence included having many HIV-related symptoms, being younger, being heterosexual, having frequent heavy alcohol use, and screening positive for a psychiatric disorder. Conclusions: Many people infected with HIV may also have psychiatric and/or drug dependence disorders. Clinicians may need to actively identify those at risk and work with policymakers to ensure the availability of appropriate care for these treatable disorders.
1,185 citations
••
TL;DR: The authors in this article examined variations in the care received by a national sample representative of the adult US population infected with HIV and found that not all individuals infected with human immunodeficiency virus (HIV) receive adequate care.
Abstract: ContextStudies of selected populations suggest that not all
persons infected with human immunodeficiency virus (HIV) receive
adequate care.ObjectiveTo examine variations in the care received by a national
sample representative of the adult US population infected with HIV.DesignCohort study that consisted of 3 interviews from January
1996 to January 1998 conducted by the HIV Cost and Services Utilization
Consortium.Patients and SettingMultistage probability sample of 2864
respondents (68% of those targeted for sampling), who represent the
231,400 persons at least 18 years old, with known HIV infection
receiving medical care in the 48 contiguous United States in early 1996
in facilities other than emergency departments, the military, or
prisons. The first follow-up consisted of 2466 respondents and the
second had 2267 (65% of all surviving sampled subjects).Main Outcome MeasuresService utilization (<2 ambulatory visits,
at least 1 emergency department visit that did not lead to
hospitalization, at least 1 hospitalization) and medication utilization
(receipt of antiretroviral therapy and prophylaxis against
Pneumocystis carinii pneumonia).ResultsInadequate HIV care was commonly reported at the time of
interviews conducted from early 1996 to early 1997 but declined to
varying degrees by late 1997. Twenty-three percent of patients
initially and 15% of patients subsequently had emergency department
visits that did not lead to hospitalization, 30% initially and 26%
subsequently of those who had CD4 cell counts below
0.20,×109/L did not receive P
carinii pneumonia prophylaxis, and 41% initially and 15%
subsequently of those who had CD4 cell counts below
0.50×109/L did not receive antiretroviral
therapy (protease inhibitor or nonnucleoside reverse transcriptase
inhibitor). Inferior patterns of care were seen for many of these
measures in blacks and Latinos compared with whites, the uninsured and
Medicaid-insured compared with the privately insured, women compared
with men, and other risk and/or exposure groups compared with men who
had sex with men even after CD4 cell count adjustment. With
multivariate adjustment, many differences remained statistically
significant. Even by early 1998, fewer blacks, women, and uninsured and
Medicaid-insured persons had started taking antiretroviral medication
(CD4 cell count adjusted P values <.001 to <.005).ConclusionsAccess to care improved from 1996 to 1998 but
remained suboptimal. Blacks, Latinos, women, the uninsured, and
Medicaid-insured all had less desirable patterns of care. Strategies to
ensure optimal care for patients with HIV requires identifying the
causes of deficiency and addressing these important shortcomings in
care.
746 citations
••
TL;DR: Changes in the U.S. population between 1990 and today make the old standard obsolete for the VR-12, so the updated standard developed here is widely available to serve as such a contemporary standard for future applications for health-related quality of life (HRQoL) assessments.
Abstract: Purpose
The purpose of this project was to develop an updated U.S. population standard for the Veterans RAND 12-item Health Survey (VR-12).
436 citations
••
TL;DR: In this article, the authors used data from the HIV Cost and Services Utilization Study (HCSUS), a national probability survey of HIV-infected adults receiving medical care in the U.S. in early 1996 (N = 2,864: 2,017 men, 847 women), to estimate the prevalence of any alcohol consumption and heavy drinking.
Abstract: Objective: To establish population-based estimates of the prevalence of any alcohol consumption and heavy drinking among individuals who tested positive for human immunodeficiency virus (HIV) and to identify the factors associated with alcohol consumption and heavy drinking in this population. Method: Data from the HIV Cost and Services Utilization Study (HCSUS), a national probability survey of HIV-infected adults receiving medical care in the U.S. in early 1996 (N = 2,864: 2,017 men, 847 women), were used to estimate the prevalence of any alcohol consumption and heavy drinking. Logistic regression was used to identify independent influences of sociodemographic, health status, and substance use variables on alcohol consumption and heavy drinking. Results: Approximately 53% of persons in care for HIV reported drinking alcohol in the preceding month and 8% were classified as heavy drinkers. Of those who drank, 15% were heavy drinkers. The odds of heavy drinking were significantly higher among users of coca...
422 citations
••
TL;DR: There is substantial morbidity associated with HIV disease in adults and the variability in health-related quality of life according to disease progression is relevant for health policy and allocation of resources, and merits the attention of clinicians who treat patients with HIV Disease.
367 citations
Cited by
More filters
••
TL;DR: These Guidelines were developed by the Panel* on Clinical Practices for Treatment of HIV Infection convened by the Department of Health and Human Services and the Henry J. Kaiser Family Foundation.
Abstract: SUMMARY The availability of an increasing number of antiretroviral agents and the rapid evolution of new information has introduced extraordinary complexity into the treatment of HIV-infected persons. In 1996, the Department of Health and Human Services and the Henry J. Kaiser Family Foundation convened the Panel on Clinical Practices for the Treatment of HIV to develop guidelines for the clinical management of HIV-infected adults and adolescents. This report recommends that care should be supervised by an expert, and makes recommendations for laboratory monitoring including plasma HIV RNA, CD4 cell counts and HIV drug resistance testing. The report also provides guidelines for antiretroviral therapy, including when to start treatment, what drugs to initiate, when to change therapy, and therapeutic options when changing therapy. Special considerations are provided for adolescents and pregnant women. As with treatment of other chronic conditions, therapeutic decisions require a mutual understanding between the patient and the health care provider regarding the benefits and risks of treatment. Antiretroviral regimens are complex, have major side effects, pose difficulty with adherence, and carry serious potential consequences from the development of viral resistance due to non-adherence to the drug regimen or suboptimal levels of antiretroviral agents. Patient education and involvement in therapeutic
4,321 citations
••
TL;DR: The PHQ-8 is a useful depression measure for population-based studies, and either its diagnostic algorithm or a cutpoint > or = 10 can be used for defining current depression.
3,036 citations
••
TL;DR: Mental health affects progress towards the achievement of several Millennium Development Goals, such as promotion of gender equality and empowerment of women, reduction of child mortality, improvement of maternal health, and reversal of the spread of HIV/AIDS.
2,943 citations
••
TL;DR: In this article, the psychometric and pragmatic characteristics of the Patient Health Questionnaire (PHQ)-9 depression, generalized anxiety disorder (GAD)-7 anxiety and PHQ-15 somatic symptom scales are synthesized from two sources: (1) four multisite cross-sectional studies (three conducted in primary care and one in obstetric-gynecology practices) comprising 9740 patients, and (2) key studies from the literature that have studied these scales.
2,765 citations
•
TL;DR: Qualitative research in such mobile health clinics has found that patients value the informal, familiar environment in a convenient location, with staff who “are easy to talk to,” and that the staff’s “marriage of professional and personal discourses” provides patients the space to disclose information themselves.
Abstract: www.mobilehealthmap.org 617‐442‐3200 New research shows that mobile health clinics improve health outcomes for hard to reach populations in cost‐effective and culturally competent ways . A Harvard Medical School study determined that for every dollar invested in a mobile health clinic, the US healthcare system saves $30 on average. Mobile health clinics, which offer a range of services from preventive screenings to asthma treatment, leverage their mobility to treat people in the convenience of their own communities. For example, a mobile health clinic in Baltimore, MD, has documented savings of $3,500 per child seen due to reduced asthma‐related hospitalizations. The estimated 2,000 mobile health clinics across the country are providing similarly cost‐effective access to healthcare for a wide range of populations. Many successful mobile health clinics cite their ability to foster trusting relationships. Qualitative research in such mobile health clinics has found that patients value the informal, familiar environment in a convenient location, with staff who “are easy to talk to,” and that the staff’s “marriage of professional and personal discourses” provides patients the space to disclose information themselves. A communications academic argued that mobile health clinics’ unique use of space is important in facilitating these relationships. Mobile health clinics park in the heart of the community in familiar spaces, like shopping centers or bus stations, which lend themselves to the local community atmosphere.
2,003 citations