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Dive into the research topics where Elizabeth Merwin is active.

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Featured researches published by Elizabeth Merwin.


Journal of Health Care for the Poor and Underserved | 1995

DE FACTO MENTAL HEALTH SERVICES IN THE RURAL SOUTH

Jeanne C. Fox; Elizabeth Merwin; Michael B. Blank

Health care reform efforts highlighted the continuing scarcity of mental health services for the rural poor. Most mental health services are provided in the general medical sector, a concept first described by Regier and colleagues in 1978 as the de facto mental health service system, rather than through formal mental health specialist services. The de facto system combines specialty mental health services with general medical services such as primary care and nursing home care, ministers and counselors, self-help groups, families, and friends. The nature of the de facto system in rural areas with large minority populations remains largely unknown due to minimal available data. This article examines the availability, accessibility, and use of mental health services in the rural South and the applicability of the de facto model to rural areas. The critical need for data necessary to inform changes in health care relative to rural mental health service delivery is emphasized.


Family & Community Health | 2006

Rurality, Gender, and Mental Health Treatment

Emily J. Hauenstein; Stephen Petterson; Elizabeth Merwin; Virginia Rovnyak; Barbara Heise; Douglas P. Wagner

Mental health problems are common and costly, yet many individuals with these problems either do not receive care or receive care that is inadequate. Gender and place of residence contribute to disparities in the use of mental health services. The objective of this study was to identify the influence of gender and rurality on mental health services utilization by using more sensitive indices of rurality. Pooled data from 4 panels of the Medical Expenditure Panel Survey (1996–2000) yielded a sample of 32,219 respondents aged 18 through 64. Variables were stratified by residence using rural–urban continuum codes. We used logistic and linear regression to model effects of gender and rurality on treatment rates. We found that rural women are less likely to receive mental health treatment either through the general healthcare system or through specialty mental health systems when compared to women in metropolitan statistical areas (MSA) or urbanized non-MSA areas. Rural men receive less mental health treatment than do rural women and less specialty mental health treatment than do men in MSAs or least rural non-MSA areas. Reported mental health deteriorates as the level of rurality increases. There is a considerable unmet need for mental health services in most rural areas. The general health sector does not seem to contribute remarkably to mental health services for women in these areas.


Administration and Policy in Mental Health | 2007

Rurality and Mental Health Treatment

Emily J. Hauenstein; Stephen Petterson; Virginia Rovnyak; Elizabeth Merwin; Barbara Heise; Douglas P. Wagner

Diversity within rural areas renders rural–urban comparisons difficult. The association of mental health treatment rates with levels of rurality is investigated here using Rural–Urban Continuum Codes. Data from the 1996–1999 panels of the Medical Expenditure Panel Survey are aggregated to provide annual treatment rates for respondents reporting mental health problems. Data show that residents of the most rural areas receive less mental health treatment than those residing in metropolitan areas. The adjusted odds of receiving any mental health treatment are 47% higher for metropolitan residents than for those living in the most rural settings, and the adjusted odds for receiving specialized mental health treatment are 72% higher. Findings suggest rural community size and adjacency to metropolitan areas influence treatment rates.


Family & Community Health | 2006

Differential access to quality rural healthcare: professional and policy challenges.

Elizabeth Merwin; Audrey Snyder; Elizabeth Katz

Using a national dataset, the influence of the community and individual provider characteristics on the availability of healthcare resources in rural areas was evaluated. Disparities continue to exist in the availability of providers including organizational types of providers such as Community Health Centers and Community Mental Health Centers. A lower percentage of nonmetropolitan counties have such centers, and more rural counties within the general grouping of nonmetropolitan counties have fewer of these organizational resources. A case study on the Southwestern region of Virginia is presented to highlight the impact on health outcomes and an innovative community response to the lack of availability of needed healthcare services.


Community Mental Health Journal | 1995

Human resource issues in rural mental health services.

Elizabeth Merwin; Harold F. Goldsmith; Ronald W. Manderscheid

Human resource issues related to the provision of mental health care in rural areas under the proposed health care reform are addressed. Rural areas continue to utilize more non-specialty providers in the provision of mental health care. First, issues surrounding the training, recruitment, and retention of specialty mental health providers differ between urban and rural areas. Next, innovative strategies currently being used to attract and retain specialty providers to rural practice are presented. Finally, implications for expanding the knowledge base related to rural providers are explored.


Journal of Nursing Scholarship | 2009

Factors That Influence the Presence of a Hospice in a Rural Community

Cathy L. Campbell; Elizabeth Merwin; Guofen Yan

PURPOSE The purpose of this study was to identify socioeconomic, physician-related, and rural-urban factors that may influence the presence of a Medicare-certified hospice in three rural-urban areas. DESIGN This was secondary analysis of selected socioeconomic, physician-related, and rural-urban data from 3,140 counties using the 2005 Area Resource File, a county-level database. The county was the unit of analysis. METHODS Descriptive statistics were calculated for selected socioeconomic, physician, and rural-urban variables for the data set of 3,140 counties. Logistic regression was used to identify variables that influenced the presence of a Medicare-certified hospice across three rural-urban areas. FINDINGS As the rural-urban classification progressed from metropolitan (least rural) to rural-nonadjacent (most rural), the physician rate, racial-ethnic diversity, and number of counties with at least one Medicare-certified hospice decreased. However, in all three rural-urban areas only the physician rate was consistently significantly associated with the presence of a Medicare-certified hospice. CONCLUSIONS Given the increasing numbers of patients and families who will be facing end-of-life care issues across the globe, access to hospice care is a significant end-of-life outcome. The most rural communities are least likely to have a Medicare-certified hospice. The higher the physician rate, the more likely a county is to have a Medicare-certified hospice. The Medicare Hospice Benefits regulations requiring a physicians certification of terminal illness may be creating a barrier to hospice care, especially in rural communities. In this study, racial-ethnic diversity decreased as the rural-urban classification progressed from metropolitan (least rural) to rural-adjacent to metro to rural-nonadjacent (the most rural). The availability of Medicare-certified hospices in the metro and rural nonadjacent counties was influenced by the minority composition of the county. More research is needed on how the interaction of rurality, race-ethnicity, and physician access may affect access to hospice in rural communities. CLINICAL RELEVANCE Increasing numbers of patients and their families across the globe will be facing end-of-life care. One of the most common barriers to end-of-life care in rural communities all over the world is physician availability. People living in rural communities with few physicians may experience less access to the comprehensive services of hospice than people living in metropolitan communities and therefore not realize important end-of-life outcomes such as symptom management, improved quality of life, financial support, and bereavement support.


Archives of Psychiatric Nursing | 1995

Psychiatric Nursing Outcome Research: The State of the Science

Elizabeth Merwin; Anne Mauck

A review of the nursing literature from 1989 to 1994 indicates that few psychiatric nursing studies are published in the major nursing research journals. The psychiatric specialization literature includes a large number of studies that are classified as either outcome studies or could serve as building blocks for future outcome studies. Few studies build on prior research, resulting in a weak scientific basis for evaluating the outcomes of psychiatric nursing care. Strategies for increasing the quantity and quality of psychiatric nursing outcome research are presented.


Policy, Politics, & Nursing Practice | 2010

Health Care Reform and the Federal Transformation Initiatives: Capitalizing on the Potential of Advanced Practice Psychiatric Nurses

Nancy P. Hanrahan; Kathleen R. Delaney; Elizabeth Merwin

In the last decade the US federal government proposed a transformation vision of mental health service delivery; patient-centered, evidence-based and recovery oriented treatment models. Health care reform brings additional expectations for innovation in mental/substance use service delivery, particularly the idea of creating systems where physical health, mental health and substance use treatment is fully integrated. Psychiatric nurses, as one of the four core US mental health professions, have the potential to play a significant role in the both the transformation initiative and health care reform vision. However, psychiatric nurses, particularly advanced practice psychiatric nurses, are an untapped resource due in part to significant state regulatory barriers that limit their scope of practice in many states. The purpose of this paper is to document what is currently known about advanced practice psychiatric nurses and discuss policy implications for tapping into the strengths of this workforce. Strategies for facilitating utilization of advanced practice psychiatric nurses discussed.


Journal of Health Care for the Poor and Underserved | 2009

Race and Ethnicity and Rural Mental Health Treatment

Stephen Petterson; Ishan C. Williams; Emily J. Hauenstein; Virginia Rovnyak; Elizabeth Merwin

Objective. Research has shown that there is less use of mental health services in rural areas even when availability, accessibility, demographic, and need factors are controlled. This study examined mental health treatment disparities by determining treatment rates across different racial/ethnic groups. Methods. Data from the first four panels of the Medical Expenditure Panel Survey (MEPS) were used for these analyses. The sample consisted of 36,288 respondents yielding 75,347 person-year observations. The Economic Research Service’s Rural-Urban Continuum was used as a measure of rurality. Results. Findings show that rural residence does little to contribute to existing treatment disparities for racial/ethnic minorities living in these areas. Conclusions. Findings suggest that characteristics of the rural environment may disadvantage all residents with respect to mental health treatment. In more populated areas where mental health services are more plentiful, complex racial and service system factors may play a greater role in evident ethnic/racial treatment disparities.


Archives of Psychiatric Nursing | 1997

Patient outcomes used by advanced practice psychiatric nurses to evaluate effectiveness of practice.

Lorna Mill Barrell; Elizabeth Merwin; Elizabeth C. Poster

Health care in the 1990s requires Advanced Practice Psychiatric Nurses (APPNs), like other health care providers, to identify and evaluate the outcomes of their practices. Many APPNs report that they are not currently engaging in outcome evaluation, and many report that they would like more resources on outcome measurement. This study identifies outcome evaluations currently in use, through an analysis of the responses of 364 Certified Clinical Nurse Specialists in a survey conducted by the Society for Education and Research in Psychiatric Nursing in 1994-1995. Specific tools that APPNs report using to assess outcomes are also identified and referenced.

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Kathleen R. Delaney

Rush University Medical Center

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