WICHE Center for Rural Mental Health Research

Publications

Alphabetical list. You can also view by publication date.

• Are Primary Care Services a Substitute or Complement for Specialty and Inpatient Services?
  Author(s): John C. Fortney, Diane E. Steffick, James F. Burgess Jr., Matt L. Maciejewski, Laura A. Petersen
  Citation: Health Services Research, 40(5, Part 1), 1422-42
  Date: 2005
  Topic: Health services
  Change in distance to primary care was a significant and substantial predictor of change in primary care visits. Analyses indicated that an increase in primary care service use was associated with increases in the use of all specialty outpatient services and inpatient services, as well as increases in inpatient and outpatient costs. Results provide evidence that health systems can implement strategies to encourage their members to use more primary care services without driving up physical health costs.
• Community-Level Risk Factors for Depression Hospitalizations
  Author(s): John Fortney, Gerard Rushton, Scott Wood, Lixun Zhang, Kathryn Rost
  Report Number: Working Paper
  Date: 09 / 2005
  Topics: Mental health, Rural statistics and demographics
  Examines the association between depression hospitalization rates and community-level socio-demographic, economic, and health care system characteristics.
• Community-Level Risk Factors for Depression Hospitalizations (Fact Sheet)
  Author(s): John Fortney, Gerard Rushton, Scott Wood, Lixun Zhang, Stan Xu, Fran Dong, Kathryn Rost
  Date: 09 / 2005
  Topics: Mental health, Rural statistics and demographics
  Overview of findings from a study to identify community-level risk factors for depression hospitalizations and geographic areas with elevated hospitalization rates.
• Differential Effectiveness of Depression Disease Management for Rural and Urban Primary Care Patients
  Author(s): Scott J. Adams, Stanley Xu, Fran Dong, John Fortney, Kathryn Rost
  Date: 09 / 2005
  Topic: Mental health
  Examined whether or not there is a differential impact of enhanced depression care on patient outcomes in rural versus urban primary care settings and whether differences any are mediated by receiving evidence-based care (pharmacotherapy and specialty care counseling). Findings indicate that enhanced care for depression improved mental health status over 18 months for urban primary care populations, but not rural patients. Full report available on request.
• Differential Effectiveness of Enhanced Depression Treatment for Rural and Urban Primary Care Patients
  Author(s): Scott J. Adams, Stanley Xu, Fran Dong, John Fortney, Kathryn Rost
  Citation: Journal of Rural Health, 22(4), 343-350
  Date: 2006
  Topic: Mental health
  Reports the results of a study that explored whether a depression disease management program has a comparable impact on clinical outcomes over 2 years in patients treated in rural and urban primary care practices and whether the impact is mediated by receiving evidence-based care (antidepressant medication and specialty care counseling). The study found that depression disease management improved the mental health status of urban patients over 18 months but not rural patients. Effects were not mediated by antidepressant medication or specialty care counseling in urban or rural patients.
• Does Improving Geographic Access to VA Primary Care Services Impact Patients' Patterns of Utilization and Costs?
  Author(s): John C. Fortney, Matt L. Maciejewski, J. Warren, James F. Burgess Jr.
  Citation: Inquiry, 42(1), 29-42
  Date: 2005
  Topics: Health services, Veterans
  The Department of Veterans Affairs (VA) has been establishing community-based outpatient clinics (CBOCs) across the country to improve veterans' access to and use of primary care services, thereby decreasing the need for costly specialty outpatient and inpatient care. Using a quasi-experimental, pre-post study design, the authors examined whether the establishment of CBOCs has affected access, use, and costs for VA patients residing in their catchment areas. Most patients residing in CBOC catchment areas did not receive care at CBOCs, resulting in only small increases in primary care utilization. While CBOCs improved veterans' access, they had little impact on overall patterns of utilization and cost.
• Identifying Community-Level Predictors of Depression Hospitalizations
  Author(s): John C. Fortney, T. Rushton, S. Wood, Kathryn Rost
  Date: 09 / 2005
  Topic: Mental health
  This investigation demonstrated that: (1) rural counties have lower rates of depression-related hospitalization than urban counties, (2) rurality fails to predict depression-related hospitalization in models that control for community-level demographic, economic and health system risk factors, (3) community-level risk factors explain a respectable ~30% of the variance in depression-related hospitalization rates, and (4) while these risk factors identify high risk areas in the 10 states we studied, they cannot be used to identify high risk areas in other states. Full report available on request. Executive summary available online.
• Mental Health and Rural America: 1994-2005
  Author(s): Dennis Mohatt, Scott J. Adams, Mimi M. Bradley, Chad A. Morris
  Date: 2006
  Topic: Mental health
  Provides a summary of the current knowledge base surrounding mental health issues in America's rural and frontier areas and an overview of the environment of mental health in rural areas over three decades. Includes an annotated bibliography.
• One Size Fits Some: the Impact of Patient Treatment Attitudes On the Cost-Effectiveness of a Depression Primary Care Intervention
  Author(s): Jeffrey M. Pyne, Kathryn M. Rost, Farah Farahati, Shanti P. Tripathi, Jeffrey Smith, D. Keith Williams, John Fortney, James C. Coyne
  Citation: Psychological Medicine, 35(6), 839-854
  Date: 2005
  Topic: Mental health
  Reports the results of a study that estimated the impact of patient receptivity to antidepressant medication on the cost-effectiveness of an evidence-based primary-care depression intervention.
• Preventing Hospitalization in Depressed Rural Patients
  Author(s): Scott J. Adams, Stanley Xu, Fran Dong , Kathryn Rost
  Date: 09 / 2005
  Topic: Mental health
  The purpose of this research was to investigate the substitution of higher cost hospitalization for lower cost outpatient specialty care for depression and the extent to which insurance barriers impact service substitution patterns of outpatient specialty care for depression in rural and urban areas. The study found that depressed rural patients were hospitalized more than their urban counterparts over two years, with statistically greater hospitalization rates at 6 months and statistically greater length of stays at 12 months. These differential hospitalization rates/lengths were not explained by previous outpatient specialty care treatment, which was comparable for rural and urban patients. Insurance barriers predict reduced use of specialty care in depressed urban patients, but not in depressed rural patients. Full report available on request.
• Role of Social Support and Stressful Life Events in the Effectiveness of Collaborative Care for Depression: A Rural-Urban Comparison
  Author(s): K. Albright, John C. Fortney, Scott J. Adams, Stanley Xu, F. Dong
  Date: 2005
  Topic: Mental health
  
• Rural-Urban Difference in Health Care Benefits of Community-Based Sample of At-Risk Drinkers
  Author(s): John C. Fortney, Brenda M. Booth, JoAnn E. Kirchner, Xiaotong Han
  Citation: Journal of Rural Health, 19(3), 292-298
  Date: 2003
  Topic: Substance abuse
  Compares the cost-containment strategies used by health plans of insured at-risk drinkers residing in rural and urban areas.
• Stakeholder Benefit From Depression Disease Management: Differences by Rurality?
  Author(s): Kathryn Rost, Stanley Xu, Fran Dong, L. Miriam Dickinson
  Citation: Manuscript currently in review. Copies may be requested from Dr. Rost at Kathryn.Rost@med.fsu.edu, telephone 850.645.7367, fax 850.645.1773
  Date: 2006
  Topic: Mental health
  Background: Despite increasing consensus about the value of depression disease management programs, the field has not identified which stakeholders should absorb the relatively small additional costs associated with these programs. Aims of Study: This paper investigates whether two stakeholder groups (health plans and employer purchasers) in two delivery systems (rural and urban) economically benefit from improved depression treatment by testing whether depression care management results in: (1) a greater reduction of utilization costs in insured rural patients than their urban counterparts (health plan stakeholders), and (2) a greater reduction in work costs in employed urban patients than their rural counterparts (employer purchaser stakeholders). Methods: We examined the main and differential effects of intervention on utilization and work costs over 24 months in a pre-planned secondary analysis of 479 depressed patients from rural and urban primary care practices who participated in a randomized controlled trial of depression disease management. Results: Reductions in work costs were observable in both the rural and urban cohort, while reductions in utilization costs were observable in the urban cohort. Discussion with Limitations: While our small sample size limits definitive conclusions, the economic incentives to assure improved depression treatment may differ across stakeholders in rural and urban delivery systems. Implications for Health Policy: Employers may have more consistent economic incentives than health plans to assure improve depression treatment across rural and urban delivery systems.