Laurel Copeland - Academia.edu (original) (raw)

Papers by Laurel Copeland

BMJ open, Jan 11, 2018

Efforts to promote the health and well-being of military veterans have been criticised for being ... more Efforts to promote the health and well-being of military veterans have been criticised for being inadequately informed of veterans' most pressing needs as they separate from military service, as well as the programmes that are most likely to meet these needs. The current article summarises limitations of the current literature and introduces The Veterans Metrics Initiative (TVMI) study, a longitudinal assessment of US veterans' well-being and programme use in the first three years after they separate from military service. Veterans were assessed within 3 months of military separation and will complete five additional assessments at 6-month intervals during the subsequent period. The TVMI study cohort consists of a national sample of 9566 newly separated US veterans that were recruited in the fall of 2016. The TVMI sample includes representation from all branches of service, men and women, and officers and enlisted personnel. Although representative of the larger population o...

American journal of infection control, Jan 22, 2017

Novel self-sanitizing copper oxide-impregnated solid surfaces have the potential to influence bio... more Novel self-sanitizing copper oxide-impregnated solid surfaces have the potential to influence bioburden levels, potentially lowering the risk of transmission of pathogens in patient care environments. Our study showed persistently lower microbial burden over a 30-hour sampling period on a copper-impregnated tray table compared with a standard noncopper surface in occupied patient rooms after thorough initial disinfection.

BMC health services research, Mar 14, 2017

Hospital readmissions are associated with higher resource utilization and worse patient outcomes.... more Hospital readmissions are associated with higher resource utilization and worse patient outcomes. Causes of unplanned readmission to the hospital are multiple with some being better targets for intervention than others. To understand risk factors for surgical readmission and their incremental contribution to current Veterans Health Administration (VA) surgical quality assessment, the study, Improving Surgical Quality: Readmission (ISQ-R), is being conducted to develop a readmission risk prediction tool, explore predisposing and enabling factors, and identify and rank reasons for readmission in terms of salience and mutability. Harnessing the rich VA enterprise data, predictive readmission models are being developed in data from patients who underwent surgical procedures within the VA 2007-2012. Prospective assessment of psychosocial determinants of readmission including patient self-efficacy, cognitive, affective and caregiver status are being obtained from a cohort having colorecta...

Military medicine, Oct 1, 2016

To compare the influence of various statistical analysis approaches while assessing the marginal ... more To compare the influence of various statistical analysis approaches while assessing the marginal effect of polypharmacy (prescription of multiple psychotropics including a first-line antidepressant) on all-cause hospital admission among veterans diagnosed with post-traumatic stress disorder. Data were obtained on 398 Iraq/Afghanistan veterans being followed in a southwestern U.S. health care system from October 2005 through September 2009, diagnosed with post-traumatic stress disorder and receiving first-line antidepressants (serotonin selective or serotonin norepinephrine reuptake inhibitors). High-dimensional propensity score (hd-PS) approaches were considered, examining both covariate adjustment per PS deciles and propensity weighting, with results compared to those of standard multivariable logistic regression. Veterans prescribed polypharmacy did not appear to have increased odds of admission in either the decile-adjusted hd-PS model (odds ratio [OR] = 2.1; 95% confidence inter...

Cardiovascular diagnosis and therapy, 2016

Over 1,000,000 cardiac catheterizations (CC) are performed annually in the United States. There i... more Over 1,000,000 cardiac catheterizations (CC) are performed annually in the United States. There is a small risk of complication that has persisted despite advances in technology. It is unknown whether daily CC procedural volume can influence this risk. In an effort to improve outcomes at our academic medical center, we investigated the relationship between daily CC volume and complication rates. We obtained data from both the National Cardiovascular Data Registry (NCDR) Cath-PCI and Lumedx© databases reviewing the records of patients undergoing scheduled, non-emergent CC at our facility between January 2005 to June 2013. Daily CC volume was analyzed as were complications including death, post-procedure MI, cardiogenic shock, heart failure, stroke, tamponade, bleeding, hematoma and acute kidney injury (AKI). 12,773 patients were identified who underwent 16,612 CCs on 2,118 days. The average age was 63 years (SD 12.4; range, 18-95). 61% were men. A total of 326 complications occurred ...

Preventive medicine, Oct 3, 2016

Long-term prescription opioid use is associated both with new-onset and recurrence of depression.... more Long-term prescription opioid use is associated both with new-onset and recurrence of depression. Whether chronic opioid use interferes with depression management has not been reported, therefore we determined whether patients' longer duration of opioid use and higher opioid dose are associated with new-onset treatment resistant depression (TRD) after controlling for confounding from pain and other variables. Data was obtained from Veteran Health Administration (VHA) de-identified patient medical records. We used a retrospective cohort design from 2000-2012. Eligible subjects (n=6,169) were 18-80 years of age, free of cancer and HIV, diagnosed with depression and opioid-free for the 24-month interval prior to the observation period. Duration of a new prescription for opioid analgesic was categorized as 1-30 days, 31-90 days and >90 days. Morphine-equivalent dose (MED) during follow-up categorized as ≤50 mg versus >50 mg per day. Pain and other sources of confounding were c...

Medical Care, 2016

Veterans of the wars in Iraq and Afghanistan who receive care in the Veterans Health Administrati... more Veterans of the wars in Iraq and Afghanistan who receive care in the Veterans Health Administration (VA) have high disease burden. Distinct comorbidity patterns have been shown to be differentially associated with adverse outcomes, including death. This study determined correlates of 5-year mortality. VA demographic, military, homelessness, and clinical measures informed this retrospective analysis. Previously constructed comorbidity classifications over 3 years of care were entered into a Cox proportional hazards model of death. There were 164,933 veterans in the cohort, including African Americans (16%), Hispanics (11%), and whites (65%). Most were in their 20s at baseline (60%); 12% were women; 4% had attempted suicide; 4% had been homeless. Having clustered disorders of pain, posttraumatic stress disorder, and traumatic brain injury was associated with death [hazard ratio (HR)=2.0]. Mental disorders including substance abuse were similarly associated (HR=2.1). Prior suicide attempt (HR=2.2) or drug overdose (HR=3.0) considerably increased risk of death over 5 years. As congressional actions such as Veterans Choice Act offer more avenues to seek care outside of VA, coordination of care, and suicide prevention outreach for recent veterans may require innovative approaches to preserve life.

The journal of pain : official journal of the American Pain Society, Aug 1, 2016

The Journal of Nervous and Mental Disease, 2008

Insight into the perceived value of psychotherapy and pharmacological treatment may improve adher... more Insight into the perceived value of psychotherapy and pharmacological treatment may improve adherence to medication regimens among patients with bipolar disorder, because patients are more likely to take medication they believe will make them better. We conducted a cross-sectional survey of patients recruited into the Continuous Improvement for Veterans in Care-Mood Disorders (CIVIC-MD; July 2004-July 2006), assessing therapeutic insight and 2 measures of medication adherence: the Morisky scale of intrapersonal barriers and missing any doses the previous 4 days. Among 435 patients with bipolar disorder, 27% had poor adherence based on missed dose and 46% had poor adherence based on the Morisky. In multivariable models, greater insight into medication was negatively associated with both measures of poor adherence. Odds of poor adherence increased for women, African Americans, mania, and hazardous drinking. The association of mutable factors-hazardous drinking, manic symptoms, and insight-could represent an opportunity to improve adherence.

Health Education Amp Behavior, Jun 1, 2003

The objective of the study was to estimate the effect of a brief alcohol-reduction intervention o... more The objective of the study was to estimate the effect of a brief alcohol-reduction intervention on health care use. Male veterans aged 55 years and older drinking more than guideline limits participated in an effective primary care-based randomized clinical trial to reduce drinking. Repeated measures ANCOVA assessed short-term and long-term changes in both inpatient and outpatient utilization. Stage of change (SOC) was assessed in a subsample to test for interaction between SOC and the intervention. Veterans exposed to the intervention used more outpatient medical services in the short term. Long-term effects on inpatient/outpatient use were not observed. SOC did not moderate the effect of the intervention but was associated with differential use of health care services. A cost-effective brief intervention to reduce drinking may spur increased efforts to seek health care. Early detection and management of alcohol-related or other illnesses might be expected to accrue savings in later years.

Data Revues 01966553 V42i6ss S0196655314003423, May 19, 2014

Circulation Cardiovascular Quality and Outcomes, May 1, 2015

Circulation, Mar 10, 2015

Neuromodulation : journal of the International Neuromodulation Society, Jan 29, 2016

Spinal Cord Stimulator (SCS) is a surgically implanted device for patients with certain types of ... more Spinal Cord Stimulator (SCS) is a surgically implanted device for patients with certain types of chronic pain. While some studies show the value of psychological screening of potential SCS candidates, no consensus exists. This single-site study analyzed the association of SCS success with psychological assessments (e.g., Millon Behavioral Medicine Diagnostic), beliefs regarding SCS efficacy, self-reported pain and quality of life (QOL) among patients approved for SCS. Potential SCS candidates (N = 200) were contacted 3-7 years after initial psychological and medical clearance for SCS; 59 consented to a structured telephone interview. Thirty-four of the 59 had received a SCS; 25 had not received a SCS. Of the 34 that had received a SCS, 22 were approved by routine psychological evaluation while 12 went through in-depth psychological testing. The majority of respondents (62%) reported effective pain reduction, and 64% of SCS recipients reported improved QOL. Younger patients reported ...

Pharmacoepidemiology and drug safety, May 22, 2016

Longer duration of prescription opioid use is associated with risk of major depression after cont... more Longer duration of prescription opioid use is associated with risk of major depression after controlling for daily morphine equivalent dose and pain. It is not known if risk of depression varies as a function of the type of opioid prescribed. A retrospective cohort design was used to model onset of new depression diagnosis among 11 462 Veterans Health Administration (VA) patients who were prescribed only codeine, only hydrocodone or only oxycodone for >30 days. Patients were free of prevalent opioid use and depression at baseline (2000-2001). Follow-up was 2002-2012. Propensity scores and weighting were used to balance covariates across opioid type. Cox-proportional hazard models were computed, using weighted data and additional adjustment for morphine equivalent dose (MED), duration of use, and pain after opioid initiation, to estimate the risk of new depression diagnosis among patients prescribed only codeine, only oxycodone vs. those prescribed only hydrocodone. After controll...

Psychiatric Services, Sep 1, 2008

This brief report describes patterns of psychiatric comorbidities among patients with epilepsy an... more This brief report describes patterns of psychiatric comorbidities among patients with epilepsy and their relationship with health care utilization. The study identified psychiatric comorbid conditions in a cohort of veterans identified as having epilepsy in fiscal year 1999. From these diagnoses, nine psychiatric disease burden profiles were created. Logistic regression examined variation in emergency, neurology, and primary care for groups having different profiles and compared them with those with only epilepsy. Of the 23,752 individuals identified, 48% had comorbid psychiatric conditions; most had multiple psychiatric diagnoses. Compared with patients with epilepsy only, those with comorbid psychiatric conditions were more likely to have emergency care and high primary care utilization; those with serious mental illness (psychotic disorders) were less likely to receive neurology care. Multiple co-occurring psychiatric diseases are common among patients with epilepsy. Addressing the mental health and medical needs of these patients, particularly those with serious mental illness, represents a challenge for health organizations.

The American Journal of Managed Care, Mar 1, 2010

Objective: To assess the effect of a telephone intervention to improve quality of life among pati... more Objective: To assess the effect of a telephone intervention to improve quality of life among patients with congestive heart failure (CHF). Study design: Prospective randomized study. Methods: Single-site recruitment of 458 patients using Veterans Health Administration care into a randomized controlled trial with a 1-year preintervention data collection period and a 1-year intervention and follow-up period. To compensate for imbalanced study groups, propensity scores were included in adjusted models of quality of life, satisfaction with care, inpatient utilization, survival, and costs of care. Results: Patients aged 45 to 95 years participated in the study; 22% were of Hispanic race/ethnicity, and 7% were African American. All but 5 were male, consistent with the older population among veterans. At baseline, 40% were in Goldman Specific Activity Scale class I, 42% were in class III, 6% were in class II or IV, and 12% were unclassified. Patients scored a mean (SD) of 14 (1.5) points below the norm on the physical component score. After the yearlong intervention, no differences in clinical outcomes were noted between the intervention group and the control group. The CHF-related costs were higher for the intervention group, as were overall costs that included the cost of the intervention. Intervention group patients reported better compliance with weight monitoring and exercise recommendations. Conclusions: A risk-stratified intervention for patients with CHF resulted in potential behavioral improvements but no survival benefit. A high-cost high-intensity intervention may be required to improve survival for patients with CHF. Inclusion of the costs of interventions is recommended for future researchers.

Psychopharmacology bulletin

We determined the prevalence and correlates of complementary and alternative medicine (CAM) use a... more We determined the prevalence and correlates of complementary and alternative medicine (CAM) use among patients with bipolar disorder. Methods: Patients with bipolar disorder recruited from a large urban mental health facility from 2004 to 2006 completed a baseline questionnaire on CAM use, demographics, treatment perspectives, and behaviors. Additional data on current medications and clinical features were ascertained via chart review. Multivariable logistic regression was used to determine the patient sociodemographic, clinical, and treatment factors associated with use of different CAM practices. Results: Of 435 patients, the mean age was 49 years; 77% were white, 13% were black, and 10% other race/ethnicity. Patients reported a wide range of CAM use, including prayer/spiritual healing (54%), meditation (53%), vitamins or herbs (50%), and weight loss supplements (22%). Multivariable analyses controlling for sociodemographic, clinical, and treatment factors revealed that patients of other racial/ethnic groups (other than whites or Blacks), those diagnosed with bipolar spectrum disorders (other than bipolar I disorder), and those prescribed anticonvulsants (eg, valproic acid, carbamazepine), or atypical antipsychotics were most likely to use CAM. Conclusions: A substantial number of patients diagnosed with bipolar disorder is using CAM. CAM use may be popular among patients with this illness because conventional pharmacotherapy for managing bipolar symptoms can also disrupt quality of life. Mental health providers should be aware of CAM use among patients with bipolar disorder and assess the potential impact of CAM use on treatment course.

The Journal of family practice

Conduct disorder has been linked to substance use disorders in clinical populations. This study e... more Conduct disorder has been linked to substance use disorders in clinical populations. This study examined the relationships of conduct disorder and antisocial personality (ASP) disorder to substance use, substance abuse problems, depression, and demographic factors in primary care settings. As part of a larger clinical trial, a survey of 1898 patients in the offices of 64 primary care physicians was conducted using a self-administered health habits questionnaire. Childhood conduct disorder and adult antisocial personality disorder were assessed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Eight percent of men and 3.1% of women met criteria for a diagnosis of ASP disorder. The frequency of a history of childhood conduct disorders was higher, with 13.4% for men and 4% for women. Antisocial personality disorder was predicted by male sex, being unmarried (single, separated, divorced), lifetime history of depression, binge drinking, self-reported history of drug problems, current smoking, and younger age. The predictors of a history of child conduct disorder were similar to those of ASP. Primary care physicians treat many patients who have personality disorders and other conditions such as alcohol problems and depression. These patients need to be identified because of the high potential for comorbidity and the barriers to treatment inherent in these disorders.