scholarly journals 1106 Associations Between Severe Mental Illness and Positive Airway Adherence in a Veteran Cohort

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A420-A421
Author(s):  
A M May ◽  
K Gandotra ◽  
G E Jaskiw
Keyword(s):  
United States ◽  
Mental Illness ◽  
Major Depression ◽  
The United States ◽  
Veterans Affairs ◽  
Sensitivity Analyses ◽  
United States Government ◽  
Department Of Veterans Affairs ◽  
Targeted Interventions ◽  
Improve Health

Abstract Introduction Serious mental illness (SMI) is associated with excess morbidity and mortality irrespective of healthcare access. Adherence differences may contribute to this health disparity. In those with sleep disorders, adherence to positive airway pressure (PAP) can improve health outcomes. We hypothesized that SMI is associated with lower PAP adherence. Methods In this retrospective cohort study, 5047 veterans receiving a PAP machine from the VANEOHS (1/1/2010 - 6/31/2015) were evaluated for 90-day PAP adherence (% days used ≥4 hours). A composite variable of any billing diagnosis of psychotic spectrum disorder, bipolar disorder, post-traumatic stress disorder (PTSD), or major depression was examined via linear regression. Analyses were adjusted for demographics, comorbidities, and medications. We conducted sensitivity analyses of 30-day adherence as well as subset analyses of associations between each disorder and adherence. Results The group was 38.8 ± 11.9 years old, 3.9% female with 52.6% with major depression, 25.0% with PTSD. 58.4% of the cohort had at least one psychiatric disorder. PTSD with depression was the most common comorbidity in those with two or more psychiatric diagnoses. Unadjusted analyses showed worse adherence in those with any SMI (β = -7.5%, 95% CI: -9.8% -5.3%), which was mitigated in adjusted analyses (β = -1.6%, 95% CI: -5.1%, 1.9%). All individual SMIs were negatively associated with adherence, but only PTSD was associated with less adherence in adjusted analyses (β = -6.4%, 95%CI: -11.2%, -1.6%). Sensitivity analyses of 30-day adherence were similar to primary analyses. Conclusion In this large cohort of veterans, broadly defined SMI was associated with lower 30- and 90-day adherence in unadjusted but not adjusted analyses. Replication and refinement of the link between SMI, particularly PTSD, and adherence may provide opportunities for targeted interventions and improve health disparities. Support This work was supported in part by Career Development Award IK2CX001882 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research and Development Service. The contents of this work do not represent the views of the Department of Veterans Affairs or the United States government.

453 Cost-Effectiveness of Requalifying for Positive Airway Pressure Treatment After Initial Nonadherence

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A179-A179
Author(s):  
Anna May ◽  
Lu Wang ◽  
Mendel Singer
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Cost Effective ◽  
The United States ◽  
Veterans Affairs ◽  
United States Government ◽  
Department Of Veterans Affairs ◽  
Current Policy

Abstract Introduction Obstructive sleep apnea (OSA) is effectively treated with continuous positive airway pressure (CPAP). However, many people are not able to become adherent in the initial 90-day trial window for this therapy. Medicare requires a polysomnography and repeat trial documenting adherence before continuing payment for these services. Oral appliance therapy (OAT) is also an OSA first-line therapy but is less effective than CPAP. Methods We created a decision tree to model 4 strategies over a 5-year time horizon: (1) current policy, (2) direct referral for CPAP equipment, (3) OAT followed by CPAP under current policy, and (4) OAT followed by direct CPAP referral in a the Medicare population with mild-moderate OSA and nonadherence to a first attempt at CPAP therapy. Medicare fee schedules in 2020 defined costs. Incremental cost-effectiveness (ICER) was used to identify the supreme strategy Results The current policy was the most expensive. Both the current policy and direct DME referral were dominated by starting with OAT. OAT followed by titration was the most cost-effective strategy with an ICER of $42,586.47. The ICER was sensitive to adherence in the direct CPAP strategy and probability of getting CPAP equipment (vs. lost to follow-up). Conclusion Starting with OAT therapy in those that were CPAP nonadherent on first attempt is cost-effective. Despite decreased effectiveness, the increase adherence to OAT make it an attractive option for retrial of OSA therapy. If OAT therapy fails, the current policy is more cost-effective than direct CPAP referral. Support (if any) This study was supported Career Development Award IK2CX001882 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research and Development Service. The contents of this work do not represent the views of the Department of Veterans Affairs or the United States government.

Transformation of the US Veterans Health Administration

2006 ◽  
Vol 1 (2) ◽  
pp. 99-105 ◽  
Author(s):  
Jonathan B. Perlin
Keyword(s):  
United States ◽  
Health Care ◽  
Veterans Health Administration ◽  
The United States ◽  
Veterans Affairs ◽  
United States Department ◽  
Veterans Health ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
The Us

Ten years ago, it would have been hard to imagine the publication of an issue of a scholarly journal dedicated to applying lessons from the transformation of the United States Department of Veterans Affairs Health System to the renewal of other countries' national health systems. Yet, with the recent publication of a dedicated edition of the Canadian journal Healthcare Papers (2005), this actually happened. Veterans Affairs health care also has been similarly lauded this past year in the lay press, being described as ‘the best care anywhere’ in the Washington Monthly, and described as ‘top-notch healthcare’ in US News and World Report's annual health care issue enumerating the ‘Top 100 Hospitals’ in the United States (Longman, 2005; Gearon, 2005).

Advocating for minority Veterans in the United States: Principles for equitable public policy

2021 ◽  
pp. e20210024
Author(s):  
Kai River Blevins ◽  
Andy L. Blevins
Keyword(s):  
United States ◽  
Public Policy ◽  
The United States ◽  
Multiple Identities ◽  
Veterans Affairs ◽  
Department Of Veterans Affairs ◽  
Intersectionality Theory ◽  
Minority Veterans ◽  
Policies And Programs ◽  
The U.S

LAY SUMMARY Minority Veterans in the United States are often excluded, whether intentionally or not, from public policy initiatives, leading to approaches that attempt to account for, or include, minority Veterans after the policy process has begun rather than at the foundational stages. This leads to policies and programs that do not adequately serve or that may harm minority Veteran communities. Drawing on their work with the U.S. Senate and House Veterans’ Affairs Committees and the U.S. Department of Veterans Affairs, the authors outline four principles for equitable Veteran public policy to better support minority Veterans and their communities. These principles are grounded in intersectionality theory, a framework that starts from the recognition that everyone has multiple identities and that these identities relate to the inequalities one experiences personally and systemically. The authors hope these principles contribute to more equitable public policy analyses and practices to better serve minority Veterans and lessen instances of inequality or injustice.

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