Publication Type: Conference Paper/Unpublished Manuscript
Abstract: For some time it has been believed that supervision based programs have little if any effect on the recidivism rates of offenders participating in such programs. Recently, summative research on intensive supervision programs (ISP) has indicated that such programs have varying impacts on recidivism. Furthermore, ISPs, with a rehabilitative focus were determined to be more effective in reducing recidivism than those programs that were surveillance based. The current study adds to this knowledge base by creating a treatment score (rather than using simple categories of rehabilitative versus surveillance), for 66 ISP and other non-residential programs and investigating the relationship between these scores and the programs’ effectiveness in reducing recidivism.

Publication Type: Abstract
Abstract: Rationale: Copayment increases have been shown to affect health care demand in many settings, and adherence to essential medications may decrease when medication copayments rise. In 2002, the Veterans Administration (VA) increased medication copayments from $2.00 to $7.00 per 30-day prescription fill.

Objectives: To examine whether adherence to metformin by veterans with diabetes changed between 2001-2003 when medication copayments increased in 2002. A subset of veterans who were exempt from medication copayments were expected to have less price-elastic demand for medications than a subset of veterans who were required to pay medication copayments.

Methodology: VA data on demographic and risk characteristics of veterans were obtained from VA administrative data. Medication adherence was calculated based upon Pharmacy Benefits Management data that contain all prescriptions filled in VA pharmacies nation-wide. A cohort of 3,649 veterans being seen at the Ann Arbor, Hines, Little Rock and Seattle VA medical centers were included in the study. A generalized estimating equation was estimated for whether or not a veteran’s adherence changed after the copayment increased. Patient copayment “eligibility”, risk (via DCG), age, gender, race, marital status, hypertension status, number of diabetes medications, total number of medications, and site were controlled.

Results: Nearly 18% of the entire sample was required to pay the medication copayment between 2001-2003, and these veterans were younger and lower risk than veterans who were exempt from medication copayments due to significant military service-related disability or low income. Veterans who were required to pay medication copayments were less adherence to metformin after the copay increase. Medication adherence did not change significantly for veterans who were exempt from copayments.

Conclusions: Adherence to essential medications appears to be undermined by medication price increases. If medication non-adherence does result in higher downstream health care costs in other areas, increasing medication copayments may not be cost-effective for the VA system. Future VA copayment increases need to be considered very carefully.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: This study applied Rimal and Real’s (2003) Risk Perception Attitude (RPA) framework to examine the interaction effects between cancer risk and efficacy perceptions on individuals’ adherence for colon, prostate, and breast cancer screenings, intentions to get these screenings in the future, and intent to adopt health lifestyle behaviors in the next year. A national probability sample of 2,226 adults aged 40-70 were surveyed and the results offer partial support of RPA framework predictions. Overall, although an interaction effect was found between risk and efficacy on some outcomes, the nature of these interaction effects were not entirely consistent with the RPA framework. The findings have implications for health campaigns, particularly the need to increase efficacy beliefs about reducing cancer risks within the general population.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: The goal of this study was to understand how diabetes patients view and use information as they manage their disease. Through in-depth interviews, we queried patients about information sources and treatment adherence. Patients relied most heavily on their doctors for information, particularly upon initial diagnosis. As time passed, they began relying on other sources of information, with those who adhered to their treatment regimen relying on different sources than those who did not fully adhere.

Publication Type: Conference Paper/Unpublished Manuscript
Review Method: Peer Reviewed
Abstract: Representative payees manage disability funds of more than 1,000,000 adults with mental disorders. This paper examines whether improved treatment adherence and reduced violence are associated with proper implementation of payeeship (i.e., ensuring beneficiary’s basic needs are met and encouraging beneficiary input into financial decisions). Outpatients with psychiatric disabilities assigned payees (N=321) were interviewed. Multivariate analysis confirmed beneficiaries reporting having basic needs met were three times more likely to adhere to treatment adherent. Beneficiaries who perceived having more say over daily money decisions were less likely to report violence. Clinical and policy implications about implementing this prevalent legal mechanism are discussed.