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Suh J, Williams S, Fann JR, Fogarty J, Bauer AM, Hsieh G. Parallel Journeys of Patients with Cancer and Depression: Challenges and Opportunities for Technology-Enabled Collaborative Care. ACTA ACUST UNITED AC 2020; 4. [PMID: 32656502 DOI: 10.1145/3392843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Depression is common but under-treated in patients with cancer, despite being a major modifiable contributor to morbidity and early mortality. Integrating psychosocial care into cancer services through the team-based Collaborative Care Management (CoCM) model has been proven to be effective in improving patient outcomes in cancer centers. However, there is currently a gap in understanding the challenges that patients and their care team encounter in managing co-morbid cancer and depression in integrated psycho-oncology care settings. Our formative study examines the challenges and needs of CoCM in cancer settings with perspectives from patients, care managers, oncologists, psychiatrists, and administrators, with a focus on technology opportunities to support CoCM. We find that: (1) patients with co-morbid cancer and depression struggle to navigate between their cancer and psychosocial care journeys, and (2) conceptualizing co-morbidities as separate and independent care journeys is insufficient for characterizing this complex care context. We then propose the parallel journeys framework as a conceptual design framework for characterizing challenges that patients and their care team encounter when cancer and psychosocial care journeys interact. We use the challenges discovered through the lens of this framework to highlight and prioritize technology design opportunities for supporting whole-person care for patients with co-morbid cancer and depression.
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Affiliation(s)
- Jina Suh
- University of Washington, USA and Microsoft Research, USA
| | | | - Jesse R Fann
- University of Washington, USA and Seattle Cancer Care Alliance, USA
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102
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Akambase JA, Miller NE, Garrison GM, Stadem P, Talley H, Angstman KB. Depression Outcomes in Smokers and Nonsmokers: Comparison of Collaborative Care Management Versus Usual Care. J Prim Care Community Health 2020; 10:2150132719861265. [PMID: 31303098 PMCID: PMC6628524 DOI: 10.1177/2150132719861265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Depression is common in the primary care setting and tobacco use is more prevalent among individuals with depression. Recent research has linked smoking to poorer outcomes of depression treatment. We hypothesized that in adult primary care patients with the diagnosis of depression, current smoking would have a negative impact on clinical outcomes, regardless of treatment type (usual primary care [UC] vs collaborative care management [CCM]). Methods: A retrospective chart review study of 5155 adult primary care patients with depression in a primary care practice in southeast Minnesota was completed. Variables obtained included age, gender, marital status, race, smoking status, initial Patient Health Questionnaire-9 (PHQ-9), and 6-month PHQ-9. Clinical remission (CR) was defined as 6-month PHQ-9 <5. Persistent depressive symptoms (PDS) were defined as PHQ-9 ≥10 at 6 months. Treatment in both CCM and UC were compared. Results: Using intention to treat analysis, depressed smokers treated with CCM were 4.60 times as likely (95% CI 3.24-6.52, P < .001) to reach CR and were significantly less likely to have PDS at 6 months (adjusted odds ratio [AOR] 0.19, 95% CI 0.14-0.25, P < .001) compared with smokers in UC. After a 6-month follow-up, depressed smokers treated with CCM were 1.75 times as likely (95% CI 1.18-2.59, P = .006) to reach CR and were significantly less likely to have PDS (AOR 0.45, 95% CI 0.31-0.64, P < .001) compared with smokers in UC. Conclusions: CCM significantly improved depression outcomes for smokers at 6 months compared with UC. However, in the UC group, smoking outcomes were not statistically different at 6 months for either remission or PDS. Also, nonsmokers in CCM had the best clinical outcomes at 6 months in both achieving clinical remission and reduction of PDS when compared with smokers in UC as the reference group.
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Affiliation(s)
| | | | | | - Paul Stadem
- 2 University of Minnesota Twin Cities, Minneapolis, MN, USA
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103
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Pirl WF, Greer JA, Gregorio SWD, Deshields T, Irwin S, Fasciano K, Wiener L, Courtnage T, Padgett LS, Fann JR. Framework for planning the delivery of psychosocial oncology services: An American psychosocial oncology society task force report. Psychooncology 2020; 29:1982-1987. [PMID: 32390322 DOI: 10.1002/pon.5409] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE While screening for psychosocial distress is now the standard of care in oncology, little guidance is available on how best to deliver services in response to identified needs. The American Psychosocial Oncology Society (APOS) convened a task force with the goal of creating a framework that could aid in planning services and justifying requests for resources. METHODS Ten experts from multiple disciplines within psychosocial oncology served on the task force, first meeting together as a larger group over 2 days to set an agenda and then subsequently working in smaller teams to execute the goals. The task force used consensus methods for developing recommendations. RESULTS Three principles were identified for the framework. First, psychosocial oncology is a key component of population health, and population-based approaches to care delivery are required. Second, several key parameters shape psychosocial oncology services: resources, aims, and scope. To guide resource allocation, example priorities were identified for the aims and scope of services. Finally, cancer care centers should strive to ensure the delivery of high-quality psychosocial oncology care across all components of care. A range of practices was ranked by their potential contributions to achieving that goal. CONCLUSIONS This framework may aid in planning, evaluating, and refining the delivery of responsive psychosocial oncology services.
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Affiliation(s)
- William F Pirl
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph A Greer
- Harvard Medical School, Boston, Massachusetts, USA.,Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Teresa Deshields
- Supportive Oncology, Rush University Cancer Center, Chicago, Illinois, USA
| | - Scott Irwin
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Health System, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California, USA
| | - Karen Fasciano
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, Bethesda, Maryland, USA
| | - Tiffany Courtnage
- Psychosocial Oncology, Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Lynne S Padgett
- Department of Psychology, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Jesse R Fann
- Psychosocial Oncology, Seattle Cancer Care Alliance, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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104
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Roberts K, Dowell A, Nie JB. Utilising acupuncture for mental health; a mixed-methods approach to understanding the awareness and experience of general practitioners and acupuncturists. Complement Ther Clin Pract 2020; 39:101114. [PMID: 32379653 DOI: 10.1016/j.ctcp.2020.101114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Mental health presents a significant burden of disease and a large, and increasing, number of patients are self-selecting forms of CAM, including acupuncture, as an adjunct, or standalone treatment for the management of their mental health. General practitioners (GPs) play an important role in integrated care management of primary mental health, and in most cases act as the primary provider and access point for further services. However, the interaction and collaboration between GPs and acupuncturists in relation to shared mental health care has not been investigated. This research explores interprofessional communication between GPs and acupuncturists in New Zealand concerning mental health care. The aim of this research was to understand the barriers to communication, and to facilitate collaboration between the two participant groups. METHODS The project utilised a mixed methods multiphase design, with both qualitative and quantitative inquiry, and involving the convergence of data and analyses. A nationwide survey of 400 GPs and 250 acupuncturists was conducted. Univariate data was analysed using descriptive statistics, which included frequencies and percentages for categorical data. This was followed by individual semi-structured interviews of 13 purposively sampled acupuncturists, and 14 GPs which was analysed using thematic analysis. This design consisted of three distinct phases: quantitative, qualitative, implementation and reflection. RESULTS Both provider groups acknowledged the complexities of working within mental health care, and supported the development of specific mental health competencies in light of the recognition of the limitations surrounding current mental health care. The unfamiliarity of acupuncture's evidence-base to both provider groups was an identified barrier, yet both groups acknowledged that while practice is informed by the evidence, there are many other factors that also inform clinical practice. CONCLUSIONS This study is the first in New Zealand to seek quantitative data and qualitative views regarding alignment about mental health management approaches and the use of acupuncture. This has the potential of improving healthcare outcomes through better inter professional communication and by contributing to better trans-cultural understandings on healthcare issues. The results of this research, whilst looking at the communication model between acupuncture and primary health care, will have easily generalizable findings for other necessary interprofessional communication strategies. This is the first time that the role and potential of the relatively untapped resource base of acupuncture within the health sector has been investigated within a New Zealand context.
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Affiliation(s)
- Kate Roberts
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand.
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand.
| | - Jing-Bao Nie
- Bioethics Centre, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
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Yonek J, Lee CM, Harrison A, Mangurian C, Tolou-Shams M. Key Components of Effective Pediatric Integrated Mental Health Care Models: A Systematic Review. JAMA Pediatr 2020; 174:487-498. [PMID: 32150257 PMCID: PMC7483725 DOI: 10.1001/jamapediatrics.2020.0023] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Emerging evidence suggests that integrated care models are associated with improved mental health care access and outcomes for youths (children ≤12 years and adolescents 12-21 years) served in pediatric primary care settings. However, the key components of these complex models remain unexamined. OBJECTIVE To identify and describe the key components of effective pediatric integrated mental health care models. EVIDENCE REVIEW The PubMed, Embase, PsycINFO, and Cochrane Controlled Register of Trials electronic databases were searched for relevant peer-reviewed articles published between January 1, 1985, and April 30, 2019. Articles were restricted to those published in the English language. Eligible articles reported original data on youths 17 years or younger, implemented an integrated mental health care model in a pediatric primary care setting, and assessed the model's association with primary outcomes (eg, mental health symptom severity) and secondary outcomes (eg, functional impairment and patient satisfaction). Articles that specified some degree of systematic coordination or collaboration between primary care and mental health professionals were included in the final review. Two independent reviewers extracted data on study design, model type, model components, level of integration, and outcomes. Study quality was assessed using the Jadad scale. Data were analyzed between January 1, 2018, and May 31, 2019. FINDINGS Eleven randomized clinical trials involving 2190 participants were included. Three studies focused on youths with depression, 3 on youths with attention-deficit/hyperactivity disorder, and 5 on youths with behavioral disorders. Most studies (9 of 11) implemented either the collaborative care model (n = 3), a slightly modified version of the collaborative care model (n = 2), or colocated care (n = 4). The most commonly reported components of effective pediatric integrated mental health care models were population-based care, measurement-based care, and delivery of evidence-based mental health services; all 3 components were present in studies reporting clinical improvement of mental health symptoms. Other model components, such as treatment-to-target or team-based care, were common in studies reporting specific outcomes, such as functional impairment. CONCLUSIONS AND RELEVANCE This review is the first to date to systematically search and qualitatively synthesize information on the key components of effective pediatric integrated mental health care models. This knowledge may be especially useful for pediatric primary care administrators in the selection of an integrated care model for their setting.
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Affiliation(s)
- Juliet Yonek
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco,Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco
| | - Chuan-Mei Lee
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco,Clinical Excellence Research Center, Stanford University, Stanford, California
| | - Anna Harrison
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco,Mental Health Service, San Francisco VA Medical Center San Francisco, San Francisco, California
| | - Christina Mangurian
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco,Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco
| | - Marina Tolou-Shams
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco,Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco
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106
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Jiratchayaporn K, Sindhu S, Seeherunwong A, Panitrat R, Viwatwongkasem C. Changes in health-related quality of life scores in patients with depression in the Thai health care delivery system. JOURNAL OF HEALTH RESEARCH 2020. [DOI: 10.1108/jhr-06-2019-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeAlthough health-related quality of life (HRQOL) has become an important outcome, specifically in regard to the impact of illness and treatment in patients with depression, few studies have explored the HRQOL of patients from different types of hospitals. This study aimed at examining a change in HRQOL of patients from various types of hospitalsDesign/methodology/approachA repeated measure was used in this study. Thirty participants in psychiatric outpatient units per center from the different types of hospitals, including a psychiatric hospital, regional hospital, general hospital and community hospital, were assessed with the Thai version of the World Health Organization Quality of Life Brief (WHOQOL-BREF-THAI) questionnaire at the first visit, and after the 6th and 12th weeks of the treatment course.FindingsThe HRQOL scores for the participants were increased in each type of hospital from their first visit to the 6th week and 12th week (p < 0.001; except for the 6th week in the regional hospital, p < 0.01).Originality/valueThe findings reflected HRQOL in patients with depression in terms of the resources available in different types of hospitals that could be used as baseline data for the development of Thai mental health service systems.
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107
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Hu J, Wu T, Damodaran S, Tabb KM, Bauer A, Huang H. The Effectiveness of Collaborative Care on Depression Outcomes for Racial/Ethnic Minority Populations in Primary Care: A Systematic Review. PSYCHOSOMATICS 2020; 61:632-644. [PMID: 32381258 DOI: 10.1016/j.psym.2020.03.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Racial/ethnic minorities experience a greater burden of mental health problems than white adults in the United States. The collaborative care model is increasingly being adopted to improve access to services and to promote diagnosis and treatment of psychiatric diseases. OBJECTIVE This systematic review seeks to summarize what is known about collaborative care on depression outcomes for racial/ethnic minorities in the United States. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. Collaborative care studies were included if they comprised adults from at least one racial/ethnic minority group, were located in primary care clinics in the United States, and had depression outcome measures. Core principles described by the University of Washington Advancing Integrated Mental Health Solutions Center were used to define the components of collaborative care. RESULTS Of 398 titles screened, 169 full-length articles were assessed for eligibility, and 19 studies were included in our review (10 randomized controlled trials, 9 observational). Results show there is potential that collaborative care, with or without cultural/linguistic tailoring, is effective in improving depression for racial/ethnic minorities, including those from low socioeconomic backgrounds. CONCLUSIONS Collaborative care should be explored as an intervention for treating depression for racial/ethnic minority patients in primary care. Questions remain as to what elements of cultural adaptation are most helpful, factors behind the difficulty in recruiting minority patients for these studies, and how the inclusion of virtual components changes access to and delivery of care. Future research should also recruit individuals from less studied populations.
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Affiliation(s)
- Jennifer Hu
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA.
| | - Tina Wu
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA.
| | - Swathi Damodaran
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
| | - Karen M Tabb
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Amy Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Hsiang Huang
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
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108
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Arevian AC, Jones F, Tang L, Sherbourne CD, Jones L, Miranda J. Depression Remission From Community Coalitions Versus Individual Program Support for Services: Findings From Community Partners in Care, Los Angeles, California, 2010-2016. Am J Public Health 2020; 109:S205-S213. [PMID: 31242001 DOI: 10.2105/ajph.2019.305082] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To explore effects of coalitions (Community Engagement and Planning [CEP]) versus technical assistance (Resources for Services [RS]) for depression collaborative care and the effects of social determinants on long-term remission outcomes. Methods. We randomized 95 health care and community programs in Los Angeles County, California, to CEP or RS. In 2010, 1246 depressed (Patient Health Questionnaire [PHQ-8] ≥ 10) adults enrolled and were invited for baseline and 6-, 12-, and 36-month surveys. Of 598 3-year completers, 283 participated at 4 years (2016). We examined effects of CEP versus RS, social factors (e.g., family income, food insecurity) on time to and periods in clinical (PHQ-8 < 10) and community-defined (PHQ-8 < 10 or PHQ-2 < 3; mental health composite score [MCS-12] > 40, or mental wellness) remission during the course of 3 years, and at 4 years. Results. We found that CEP versus RS increased 4-year depression remission and, for women, community-defined remission outcomes during the course of 3 years. Social factors and clinical factors predicted remission. Conclusions. At 4 years, CEP was more effective than RS at increasing depression remission. Public Health Implications. Coalitions may improve 4-year depression remission, while addressing social and clinical factors associated with depression may hold potential to enhance remission.
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Affiliation(s)
- Armen C Arevian
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Felica Jones
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Lingqi Tang
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Cathy D Sherbourne
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Loretta Jones
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Jeanne Miranda
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
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- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
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109
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Babajide A, Ortin A, Wei C, Mufson L, Duarte CS. Transition Cliffs for Young Adults with Anxiety and Depression: Is Integrated Mental Health Care a Solution? J Behav Health Serv Res 2020; 47:275-292. [PMID: 31428923 PMCID: PMC7028507 DOI: 10.1007/s11414-019-09670-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Young adulthood is a major transition period, particularly challenging for those with mental disorders. Though the prevalence of depressive and anxiety disorders is especially high, young adults are less likely to receive mental health treatment than younger and older individuals. Reasons for this mental health treatment gap are multifold and range from individual- to system-level factors that must be taken into consideration when addressing young adult mental health needs. Studies in adults and adolescents have shown that integrated care in primary care settings is an effective model of treatment of mental disorders. After providing an overview of the mental health treatment gap in this developmental period, the argument is made for research focused on integrated care models specifically tailored for young adults that takes into consideration the various needs and challenges that they face and addresses the mental health treatment gap in young adulthood.
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Affiliation(s)
- Azeesat Babajide
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Ana Ortin
- Hunter College, City University of New York, 695 Park Avenue, New York, NY, 10065, USA
| | - Chiaying Wei
- New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY, 10032, USA
| | - Laura Mufson
- New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY, 10032, USA
| | - Cristiane S Duarte
- New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY, 10032, USA.
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110
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Affiliation(s)
- Jean Yoon
- VA Health Economics Resource Center, VA Palo Alto Healthcare System, Menlo Park, CA, USA. .,Department of General Internal Medicine, UCSF School of Medicine, San Francisco, CA, USA.
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111
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Menear M, Dugas M, Careau E, Chouinard MC, Dogba MJ, Gagnon MP, Gervais M, Gilbert M, Houle J, Kates N, Knowles S, Martin N, Nease DE, Zomahoun HTV, Légaré F. Strategies for engaging patients and families in collaborative care programs for depression and anxiety disorders: A systematic review. J Affect Disord 2020; 263:528-539. [PMID: 31744737 DOI: 10.1016/j.jad.2019.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/23/2019] [Accepted: 11/02/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients and families are often referred to as important partners in collaborative mental health care (CMHC). However, how to meaningfully engage them as partners remains unclear. We aimed to identify strategies for engaging patients and families in CMHC programs for depression and anxiety disorders. METHODS We updated a Cochrane review of CMHC programs for depression and anxiety disorders. Searches were conducted in Cochrane CCDAN and CINAHL, complemented by additional database searches, trial registry searches, and cluster searches for 'sibling' articles. Coding and data extraction of engagement strategies was an iterative process guided by a conceptual framework. We used narrative synthesis and descriptive statistics to report on findings. FINDINGS We found 148 unique CMCH programs, described in 578 articles. Most programs (96%) featured at least one strategy for engaging patients or families. Programs adopted 15 different strategies overall, with a median of two strategies per program (range 0-9 strategies). The most common strategies were patient education (87% of programs) and self-management supports (47% of programs). Personalized care planning, shared decision making, and family or peer supports were identified in fewer than one third of programs. LIMITATIONS Our search strategy was designed to capture programs evaluated in clinical trials and so other innovative programs not studied in trials were likely missed. CONCLUSION Most CMHC programs for depression and anxiety disorders adopted a limited number of strategies to engage patients and families in their care. However, this review identifies numerous strategies that can be used to strengthen the patient- and family-centeredness of collaborative care.
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Affiliation(s)
- Matthew Menear
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada; Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada.
| | - Michèle Dugas
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada
| | - Emmanuelle Careau
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada; Department of Rehabilitation, Laval University, Quebec, Canada
| | | | - Maman Joyce Dogba
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada; Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada
| | | | - Michel Gervais
- Centre intégré universitaire en santé et en services sociaux de la Capitale-Nationale, Quebec, Canada
| | - Michel Gilbert
- National Centre for Excellence in Mental Health, Quebec, Canada
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Nick Kates
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Sarah Knowles
- NIHR Collaboration for Leadership in Applied Health Research an Care (CLAHRC) Greater Manchester, University of Manchester, Manchester, UK
| | | | - Donald E Nease
- Department of Family Medicine, University of Colorado Denver, Denver, US
| | | | - France Légaré
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada; Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada
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Unützer J, Carlo AD, Collins PY. Leveraging collaborative care to improve access to mental health care on a global scale. World Psychiatry 2020; 19:36-37. [PMID: 31922696 PMCID: PMC6953542 DOI: 10.1002/wps.20696] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Washington, WA, USA
| | - Andrew D. Carlo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Washington, WA, USA
| | - Pamela Y. Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Washington, WA, USA,Department of Global Health, University of Washington, Washington, WA, USA
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Bowen DJ, Powers DM, Russo J, Arao R, LePoire E, Sutherland E, Ratzliff ADH. Implementing collaborative care to reduce depression for rural native American/Alaska native people. BMC Health Serv Res 2020; 20:34. [PMID: 31931791 PMCID: PMC6958691 DOI: 10.1186/s12913-019-4875-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/25/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify the effects of Collaborative Care on rural Native American and Alaska Native (AI/AN) patients. METHODS Collaborative Care was implemented in three AI/AN serving clinics. Clinic staff participated in training and coaching designed to facilitate practice change. We followed clinics for 2 years to observe improvements in depression treatment and to examine treatment outcomes for enrolled patients. Collaborative Care elements included universal screening for depression, evidence-based treatment to target, use of behavioral health care managers to deliver the intervention, use of psychiatric consultants to provide caseload consultation, and quality improvement tracking to improve and maintain outcomes. We used t-tests to evaluate the main effects of Collaborative Care and used multiple linear regression to better understand the predictors of success. We also collected qualitative data from members of the Collaborative Care clinical team about their experience. RESULTS The clinics participated in training and practice coaching to implement Collaborative Care for depressed patients. Depression response (50% or greater reduction in depression symptoms as measured by the PHQ-9) and remission (PHQ-9 score less than 5) rates were equivalent in AI/AN patients as compared with White patients in the same clinics. Significant predictors of positive treatment outcome include only one depression treatment episodes during the study and more follow-up visits per patient. Clinicians were overall positive about their experience and the effect on patient care in their clinic. CONCLUSIONS This project showed that it is possible to deliver Collaborative Care to AI/AN patients via primary care settings in rural areas.
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Affiliation(s)
- Deborah J. Bowen
- University of Washington, A204, 1959 NE Pacific Street, Seattle, WA 98195 USA
| | - Diane M. Powers
- University of Washington, A204, 1959 NE Pacific Street, Seattle, WA 98195 USA
| | - Joan Russo
- University of Washington, A204, 1959 NE Pacific Street, Seattle, WA 98195 USA
| | - Robert Arao
- University of Washington, A204, 1959 NE Pacific Street, Seattle, WA 98195 USA
| | - Erin LePoire
- University of Washington, A204, 1959 NE Pacific Street, Seattle, WA 98195 USA
| | - Earl Sutherland
- Bighorn Valley Health Center, 10 4th Street W, Hardin, MT USA
| | - Anna D. H. Ratzliff
- University of Washington, A204, 1959 NE Pacific Street, Seattle, WA 98195 USA
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Purtle J, Nelson KL, Counts NZ, Yudell M. Population-Based Approaches to Mental Health: History, Strategies, and Evidence. Annu Rev Public Health 2020; 41:201-221. [PMID: 31905323 PMCID: PMC8896325 DOI: 10.1146/annurev-publhealth-040119-094247] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
There is growing recognition in the fields of public health and mental health services research that the provision of clinical services to individuals is not a viable approach to meeting the mental health needs of a population. Despite enthusiasm for the notion of population-based approaches to mental health, concrete guidance about what such approaches entail is lacking, and evidence of their effectiveness has not been integrated. Drawing from research and scholarship across multiple disciplines, this review provides a concrete definition of population-based approaches to mental health, situates these approaches within their historical context in the United States, and summarizes the nature of these approaches and their evidence. These approaches span three domains: (a) social, economic, and environmental policy interventions that can be implemented by legislators and public agency directors, (b) public health practice interventions that can be implemented by public health department officials, and (c) health care system interventions that can be implemented by hospital and health care system leaders.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania 19104, USA;
| | - Katherine L Nelson
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania 19104, USA;
| | | | - Michael Yudell
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania 19104, USA
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Hamilton AB, Finley EP. Reprint of: Qualitative methods in implementation research: An introduction. Psychiatry Res 2020; 283:112629. [PMID: 31735374 DOI: 10.1016/j.psychres.2019.112629] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 01/12/2023]
Abstract
Qualitative methods are a valuable tool in implementation research because they help to answer complex questions such as how and why efforts to implement best practices may succeed or fail, and how patients and providers experience and make decisions in care. This article orients the novice implementation scientist to fundamentals of qualitative methods and their application in implementation research, describing: 1) implementation-related questions that can be addressed by qualitative methods; 2) qualitative methods commonly used in implementation research; 3) basic sampling and data collection procedures; and 4) recommended practices for data analysis and ensuring rigor. To illustrate qualitative methods decision-making, a case example is provided of a study examining implementation of a primary care-based collaborative care management model for women Veterans with anxiety, depression, and PTSD.
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Affiliation(s)
- Alison B Hamilton
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Erin P Finley
- South Texas Veterans Health Care System, San Antonio, TX, USA; UT Health San Antonio, San Antonio, TX, USA
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Lyon AR, Whitaker K, Richardson LP, French WP, McCauley E. Collaborative Care to Improve Access and Quality in School-Based Behavioral Health. THE JOURNAL OF SCHOOL HEALTH 2019; 89:1013-1023. [PMID: 31612501 DOI: 10.1111/josh.12843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/27/2018] [Accepted: 08/12/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND Collaborative care (CC) is a well-established approach for the delivery of accessible behavioral health services in integrated health care settings. Substantial evidence supports its effectiveness in improving the quality and outcomes of adult services, and growing research indicates utility with child and adolescent populations. METHODS To date, studies examining CC models for youth have focused exclusively on primary-care settings. Nevertheless, as the most common integrated service delivery setting for youth, the education sector is an equally important context for improving access to behavioral health services for children and adolescents. RESULTS We provide a narrative review of the literature on CC, describes the relevance of CC to schools, and details its alignment with contemporary movements in education and school-based behavioral health. CONCLUSIONS Potential adaptations of the CC model for use in schools are detailed to improve: (1) behavioral health service accessibility, (2) the capacity of schools to provide behavioral health services, and (3) school service effectiveness through use of evidence-based practices. Although little research has explored the applicability of CC in the education sector, the model holds potential promise to improve the quality and efficiency of school-based behavioral health services.
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Affiliation(s)
- Aaron R Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115
| | - Kelly Whitaker
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115
| | - Laura P Richardson
- University of Washington/Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, M/S CW8-6, Seattle, WA, 98121
| | - William P French
- University of Washington, 4800 Sand Point Way NE, M/S OA.5.154, PO Box 5371, Seattle, WA, 98145
| | - Elizabeth McCauley
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115
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Heddaeus D, Dirmaier J, Brettschneider C, Daubmann A, Grochtdreis T, von dem Knesebeck O, König HH, Löwe B, Maehder K, Porzelt S, Rosenkranz M, Schäfer I, Scherer M, Schulte B, Wegscheider K, Weigel A, Werner S, Zimmermann T, Härter M. Study protocol for the COMET study: a cluster-randomised, prospective, parallel-group, superiority trial to compare the effectiveness of a collaborative and stepped care model versus treatment as usual in patients with mental disorders in primary care. BMJ Open 2019; 9:e032408. [PMID: 31767595 PMCID: PMC6887029 DOI: 10.1136/bmjopen-2019-032408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/10/2019] [Accepted: 10/10/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Mental healthcare is one of the biggest challenges for healthcare systems. Comorbidities between different mental disorders are common, and patients suffer from a high burden of disease. While the effectiveness of collaborative and stepped care models has been shown for single disorders, comorbid mental disorders have rarely been addressed in such care models. The aim of the present study is to evaluate the effectiveness of a collaborative and stepped care model for depressive, anxiety, somatoform and alcohol use disorders within a multiprofessional network compared with treatment as usual. METHODS AND ANALYSIS In a cluster-randomised, prospective, parallel-group superiority trial, n=570 patients will be recruited from primary care practices (n=19 practices per group). The intervention is a newly developed collaborative and stepped care model in which patients will be treated using treatment options of various intensities within an integrated network of outpatient general practitioners, psychiatrists, psychotherapists and inpatient institutions. It will be compared with treatment as usual with regard to effectiveness, cost-effectiveness and feasibility, with the primary outcome being a change in mental health-related quality of life from baseline to 6 months. Patients in both groups will undergo an assessment at baseline, 3, 6 and 12 months after study inclusion. ETHICS AND DISSEMINATION The study has been approved by the ethics committee of the Hamburg Medical Association (No. PV5595) and will be carried out in accordance with the principles of the Declaration of Helsinki. For dissemination, the results will be published in peer-reviewed journals and presented at conferences. Within the superordinate research project Hamburg Network for Health Services Research, the results will be communicated to relevant stakeholders in mental healthcare. TRIAL REGISTRATION NUMBER NCT03226743.
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Affiliation(s)
- Daniela Heddaeus
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Brettschneider
- Institute of Health Economics and Health Care Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Daubmann
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Grochtdreis
- Institute of Health Economics and Health Care Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Institute of Health Economics and Health Care Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kerstin Maehder
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Porzelt
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Moritz Rosenkranz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Schulte
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angelika Weigel
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Werner
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Zimmermann
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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George MP, Garrison GM, Merten Z, Heredia D, Gonzales C, Angstman KB. Impact of Personality Disorder Cluster on Depression Outcomes Within Collaborative Care Management Model of Care. J Prim Care Community Health 2019; 9:2150132718776877. [PMID: 29785866 PMCID: PMC5967151 DOI: 10.1177/2150132718776877] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Previous studies have suggested that having a comorbid personality disorder (PD) along with major depression is associated with poorer depression outcomes relative to those without comorbid PD. However, few studies have examined the influence of specific PD cluster types. The purpose of the current study is to compare depression outcomes between cluster A, cluster B, and cluster C PD patients treated within a collaborative care management (CCM), relative to CCM patients without a PD diagnosis. The overarching goal was to identify cluster types that might confer a worse clinical prognosis. METHODS This retrospective chart review study examined 2826 adult patients with depression enrolled in CCM. The cohort was divided into 4 groups based on the presence of a comorbid PD diagnosis (cluster A/nonspecified, cluster B, cluster C, or no PD). Baseline clinical and demographic variables, along with 6-month follow-up Patient Health Questionnaire-9 (PHQ-9) scores were obtained for all groups. Depression remission was defined as a PHQ-9 score <5 at 6 months, and persistent depressive symptoms (PDS) was defined as a PHQ-9 score ≥10 at 6 months. Adjusted odds ratios (AORs) were determined for both remission and PDS using logistic regression modeling for the 6-month PHQ-9 outcome, while retaining all study variables. RESULTS A total of 59 patients (2.1%) had a cluster A or nonspecified PD diagnosis, 122 patients (4.3%) had a cluster B diagnosis, 35 patients (1.2%) had a cluster C diagnosis, and 2610 patients (92.4%) did not have any PD diagnosis. The presence of a cluster A/nonspecified PD diagnosis was associated with a 62% lower likelihood of remission at 6 months (AOR = 0.38; 95% CI 0.20-0.70). The presence of a cluster B PD diagnosis was associated with a 71% lower likelihood of remission at 6 months (AOR = 0.29; 95% CI 0.18-0.47). Conversely, having a cluster C diagnosis was not associated with a significantly lower likelihood of remission at 6 months (AOR = 0.83; 95% CI 0.42-1.65). Increased odds of having PDS at 6-month follow-up were seen with cluster A/nonspecified PD patients (AOR = 3.35; 95% CI 1.92-5.84) as well as cluster B patients (AOR = 3.66; 95% CI 2.45-5.47). However, cluster C patents did not have significantly increased odds of experiencing persistent depressive symptoms at 6-month follow-up (AOR = 0.95; 95% CI 0.45-2.00). CONCLUSIONS Out of the 3 clusters, the presence of a cluster B PD diagnosis was most significantly associated with poorer depression outcomes at 6-month follow-up, including reduced remission rates and increased risk for PDS. The cluster A/nonspecified PD group also showed poor outcomes; however, the heterogeneity of this subgroup with regard to PD features must be noted. The development of novel targeted interventions for at-risk clusters may be warranted in order to improve outcomes of these patients within the CCM model of care.
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Wulsin L, Pinkhasov A, Cunningham C, Miller L, Smith A, Oros S. Innovations for integrated care: The Association of Medicine and Psychiatry recognizes new models. Gen Hosp Psychiatry 2019; 61:90-95. [PMID: 31104827 DOI: 10.1016/j.genhosppsych.2019.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 04/12/2019] [Accepted: 04/12/2019] [Indexed: 11/18/2022]
Abstract
This editorial looks at the current state of the integration of medicine and psychiatry in clinical practice. We note selected recent triumphs and barriers to implementing integrated care, highlighting some gaps and priorities for future innovations. In contrast to the relatively more orderly culture of health services research, where some notable innovations in integrated care were funded, tested, and published, the health care marketplace can be a difficult place to identify and track the innovations that could shape health care reform. Recognizing the need to find, describe, and disseminate the most innovative models in integrated care, the Association of Medicine and Psychiatry (AMP) launched in 2016 the Innovative Models for Integrated Care Awards. Although many service innovations solve local problems, some can also act as models to be adopted in multiple settings. The projects that win AMP Innovative Models for Integrated Care Awards are selected for their innovativeness, their clinical importance, their generalizability, and their effectiveness. We briefly describe here the four models that earned these awards at the 2017 AMP Annual Meeting. They demonstrate innovations across a range of settings and populations: inpatient general hospital patients under constant observation in New York, severely mentally ill patients in a federally qualified health center in San Francisco, outpatients in a VA women's health center in Chicago, and HIV patients in an academic infectious disease clinic in Charleston, south Carolina. These model descriptions aim to encourage the implementation of innovative models that advance the integration of medicine and psychiatry.
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Affiliation(s)
| | - Aaron Pinkhasov
- NYU Winthrop Hospital, Stony Brook School of Medicine, New York, United States of America
| | | | - Laura Miller
- Hines Veterans Administration Medical Center, Chicago, United States of America
| | - Allison Smith
- Medical University of South Carolina, United States of America
| | - Sarah Oros
- Medical University of South Carolina, United States of America
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Hamilton AB, Finley EP. Qualitative methods in implementation research: An introduction. Psychiatry Res 2019; 280:112516. [PMID: 31437661 PMCID: PMC7023962 DOI: 10.1016/j.psychres.2019.112516] [Citation(s) in RCA: 378] [Impact Index Per Article: 75.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 11/22/2022]
Abstract
Qualitative methods are a valuable tool in implementation research because they help to answer complex questions such as how and why efforts to implement best practices may succeed or fail, and how patients and providers experience and make decisions in care. This article orients the novice implementation scientist to fundamentals of qualitative methods and their application in implementation research, describing: 1) implementation-related questions that can be addressed by qualitative methods; 2) qualitative methods commonly used in implementation research; 3) basic sampling and data collection procedures; and 4) recommended practices for data analysis and ensuring rigor. To illustrate qualitative methods decision-making, a case example is provided of a study examining implementation of a primary care-based collaborative care management model for women Veterans with anxiety, depression, and PTSD.
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Affiliation(s)
- Alison B Hamilton
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Erin P Finley
- South Texas Veterans Health Care System, San Antonio, TX, USA; UT Health San Antonio, San Antonio, TX, USA
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Kryger MA, Crytzer TM, Fairman A, Quinby EJ, Karavolis M, Pramana G, Setiawan IMA, McKernan GP, Parmanto B, Dicianno BE. The Effect of the Interactive Mobile Health and Rehabilitation System on Health and Psychosocial Outcomes in Spinal Cord Injury: Randomized Controlled Trial. J Med Internet Res 2019; 21:e14305. [PMID: 31464189 PMCID: PMC6737885 DOI: 10.2196/14305] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/21/2019] [Accepted: 07/21/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Individuals with spinal cord injury (SCI) are at risk for secondary medical complications, such as urinary tract infections (UTIs) and pressure injuries, that could potentially be mitigated through improved self-management techniques. The Interactive Mobile Health and Rehabilitation (iMHere) mobile health (mHealth) system was developed to support self-management for individuals with disabilities. OBJECTIVE The main objective of this study was to determine if the use of iMHere would be associated with improved health outcomes over a 9-month period. A secondary objective was to determine if the use of iMHere would be associated with improved psychosocial outcomes. Phone usage, app usage, and training time data were also collected to analyze trends in iMHere use. METHODS Overall, 38 participants with SCI were randomized into either the intervention group who used the iMHere system and received standard care or the control group who received standard care without any technology intervention. Health outcomes were recorded for the year before entry into the study and during the 9 months of the study. Participants completed surveys at baseline and every 3 months to measure psychosocial outcomes. RESULTS The intervention group had a statistically significant reduction in UTIs (0.47 events per person; P=.03; number needed to treat=2.11). Although no psychosocial outcomes changed significantly, there was a nonsignificant trend toward a reduction in mood symptoms in the intervention group compared with the control group meeting the threshold for clinical significance. Approximately 34 min per participant per month were needed on average to manage the system and provide technical support through this mHealth system. CONCLUSIONS The use of the iMHere mHealth system may be a valuable tool in the prevention of UTIs or reductions in depressive symptoms. Given these findings, iMHere has potential scalability for larger populations. TRIAL REGISTRATION ClinicalTrials.gov NCT02592291; https://clinicaltrials.gov/ct2/show/NCT02592291.
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Affiliation(s)
- Michael Alan Kryger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Physical Medicine and Rehabilitation, Penn State University Milton Hershey Medical Center, Hershey, PA, United States
| | - Theresa M Crytzer
- Human Engineering Research Laboratories, Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Andrea Fairman
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, United States
| | - Eleanor J Quinby
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
| | - Meredith Karavolis
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gede Pramana
- Department of Health Information Management, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
| | - I Made Agus Setiawan
- Department of Health Information Management, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Computer Science, Udayana University, Badung, Indonesia
| | - Gina Pugliano McKernan
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
- Human Engineering Research Laboratories, Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Bambang Parmanto
- Human Engineering Research Laboratories, Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
- Department of Health Information Management, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
| | - Brad E Dicianno
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
- Human Engineering Research Laboratories, Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
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Cochran G, Cole ES, Warwick J, Donohue JM, Gordon AJ, Gellad WF, Bear T, Kelley D, DiDomenico E, Pringle J. Rural access to MAT in Pennsylvania (RAMP): a hybrid implementation study protocol for medication assisted treatment adoption among rural primary care providers. Addict Sci Clin Pract 2019; 14:25. [PMID: 31366408 PMCID: PMC6670171 DOI: 10.1186/s13722-019-0154-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 07/04/2019] [Indexed: 01/03/2023] Open
Abstract
Background The continued escalation of opioid use disorder (OUD) calls for heightened vigilance to implement evidence-based care across the US. Rural care providers and patients have limited resources, and a number of barriers exist that can impede necessary OUD treatment services. This paper reports the design and protocol of an implementation study seeking to advance availability of medication assisted treatment (MAT) for OUD in rural Pennsylvania counties for patients insured by Medicaid in primary care settings. Methods This project was a hybrid implementation study. Within a chronic care model paradigm, we employed the Framework for Systems Transformation to implement the American Society for Addiction Medicine care model for the use of medications in the treatment of OUD. In partnership with state leadership, Medicaid managed care organizations, local care management professionals, the Universities of Pittsburgh and Utah, primary care providers (PCP), and patients; the project team worked within 23 rural Pennsylvania counties to engage, recruit, train, and collaborate to implement the OUD service model in PCP practices from 2016 to 2019. Formative measures included practice-level metrics to monitor project implementation, and outcome measures involved employing Medicaid claims and encounter data to assess changes in provider/patient-level OUD-related metrics, such as MAT provider supply, prevalence of OUD, and MAT utilization. Descriptive statistics and repeated measures regression analyses were used to assess changes across the study period. Discussion There is an urgent need in the US to expand access to high quality, evidence-based OUD treatment—particularly in rural areas where capacity is limited for service delivery in order to improve patient health and protect lives. Importantly, this project leverages multiple partners to implement a theory- and practice-driven model of care for OUD. Results of this study will provide needed evidence in the field for appropriate methods for implementing MAT among a large number of rural primary care providers.
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Affiliation(s)
- Gerald Cochran
- Program for Addiction Research, Clinical Care, Education, and Advocacy, University of Utah School of Medicine, 30 N. 1900 E, Salt Lake City, UT, 84132, USA.
| | - Evan S Cole
- University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA, 15261, USA
| | - Jack Warwick
- University of Pittsburgh Program Evaluation Research Unit, 5631 Baum Blvd, Pittsburgh, PA, 15206, USA
| | - Julie M Donohue
- University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA, 15261, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Education, and Advocacy, University of Utah School of Medicine, 30 N. 1900 E, Salt Lake City, UT, 84132, USA
| | - Walid F Gellad
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA
| | - Todd Bear
- University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA, 15261, USA
| | - David Kelley
- Pennsylvania Department of Human Services, 625 Forster St, Harrisburg, PA, 17120, USA
| | - Ellen DiDomenico
- Pennsylvania Department of Human Services, 625 Forster St, Harrisburg, PA, 17120, USA
| | - Jan Pringle
- University of Pittsburgh Program Evaluation Research Unit, 5631 Baum Blvd, Pittsburgh, PA, 15206, USA.,University of Pittsburgh School of Pharmacy, 3501 Terrace St, Pittsburgh, PA, 15213, USA
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Udo C, Svenningsson I, Björkelund C, Hange D, Jerlock M, Petersson E. An interview study of the care manager function-Opening the door to continuity of care for patients with depression in primary care. Nurs Open 2019; 6:974-982. [PMID: 31367421 PMCID: PMC6650652 DOI: 10.1002/nop2.277] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 02/13/2019] [Accepted: 03/12/2019] [Indexed: 12/11/2022] Open
Abstract
AIM To explore experiences among patients with depression of contact with a care manager at a primary care centre. DESIGN A qualitative explorative study. METHODS During spring and summer 2016, 20 individual face-to-face interviews were conducted with patients with experience of care manager contact. The material was analysed using systematic text condensation. RESULTS The participants described that having contact with a care manager was a support in their recovery process. Care became more available, and the structured continuous contact and the care manager's availability contributed to a trusting relationship. Having someone to share their burden with was a relief. However, it was described as negative when the care manager was perceived as inflexible and not open to issues that the participants felt a need to discuss. For the care manager contact to be successful, there is a need for flexibility and individually tailored contact.
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Affiliation(s)
- Camilla Udo
- School of Education, Health and Social StudiesDalarna UniversityFalunSweden
- Center for Clinical Research DalarnaDalarnaSweden
| | - Irene Svenningsson
- Department of Primary Health Care, Institute of MedicineThe Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Närhälsan Research and Development, Primary Health Care RegionVästra GötalandSweden
| | - Cecilia Björkelund
- Department of Primary Health Care, Institute of MedicineThe Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Dominique Hange
- Department of Primary Health Care, Institute of MedicineThe Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Margareta Jerlock
- Department of Primary Health Care, Institute of MedicineThe Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Eva‐Lisa Petersson
- Department of Primary Health Care, Institute of MedicineThe Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Närhälsan Research and Development, Primary Health Care RegionVästra GötalandSweden
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124
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Celano CM, Huffman JC. Rethinking our approach to delirium: The potential of proactivity. J Psychosom Res 2019; 122:52-53. [PMID: 30987809 DOI: 10.1016/j.jpsychores.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Christopher M Celano
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Jeff C Huffman
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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125
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Abstract
Promoting population mental health and meeting the burdens of mental illness is a priority public health challenge of the 21st century. But too little attention has been placed on how to design and sustain the scope of strategies and commitments that credibly live up to the full breadth of that challenge. ThriveNYC is an effort by New York City to fill that gap, through a public health approach backed by investment in resources and leadership. ThriveNYC can by example help mobilize a larger community of investigators and policymakers to consider how to meet this challenge, to get to consensus on key elements for effective action and implementation, to reimagine who and what the mental health "system" includes, and, in doing so, to strengthen the social contract that underlies well-being.
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Affiliation(s)
- Gary Belkin
- Gary Belkin is with the Office of the Mayor, New York, NY. Chirlane McCray is First Lady of New York City
| | - Chirlane McCray
- Gary Belkin is with the Office of the Mayor, New York, NY. Chirlane McCray is First Lady of New York City
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126
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Aragonès E, Rambla C, López-Cortacans G, Tomé-Pires C, Sánchez-Rodríguez E, Caballero A, Miró J. Effectiveness of a collaborative care intervention for managing major depression and chronic musculoskeletal pain in primary care: A cluster-randomised controlled trial. J Affect Disord 2019; 252:221-229. [PMID: 30986737 DOI: 10.1016/j.jad.2019.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/07/2019] [Accepted: 04/06/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depression and chronic musculoskeletal pain commonly occur as comorbid conditions, which increases their negative effects on health outcomes. The objective of this study was to assess the effectiveness of the DROP (DepRessiOn and Pain) programme designed for the management of major depression and chronic musculoskeletal pain in primary care. METHODS A cluster-randomised controlled trial was carried out between June 2015 and December 2017 with 328 patients with major depression and chronic musculoskeletal pain, randomly allocated to either intervention arm or usual care arm. The intervention included care management, optimised management of depression, and a psychoeducational programme. Outcomes were monitored using blinded interviews over a 12-month period. TRIAL REGISTRATION NCT02605278 (ClinicalTrials.gov). RESULTS After 12 months, 274 patients were evaluated (83.5% participation). The severity of depression (Hopkins Symptom Checklist score) was 0.23 points lower in the intervention arm [1.11 vs. 1.34; CI95% = -0.42 to -0.04]. Intervention arm's response rate to antidepressant treatment was 18.9% higher [39.6% vs. 20.7%; OR = 2.74; CI95% = 1.12-6.67] and its remission rate for depression was 9.0% higher [20.1% vs. 11.1%; OR = 2.13; CI95% = 0.94-4.85] compared to the usual care arm. There were no significant differences between the two arms in terms of pain severity (Brief Pain Inventory severity score) [6.23 vs. 6.66; difference = -0.39; CI95% = -1.13-0.35] or pain response rate [18.7% vs. 18.5%; OR = 1.02; CI95% = 0.46-2.26]. LIMITATIONS This is a pragmatic study, and poor adherence to the programme by patients and physicians was a main limitation. CONCLUSION The programme improves clinical outcomes for depression, although no clinical benefits were seen for pain.
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Affiliation(s)
- Enric Aragonès
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain.
| | - Concepció Rambla
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Germán López-Cortacans
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Catarina Tomé-Pires
- Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain; Unit for the Study and Treatment of Pain - ALGOS, and Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain; Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
| | - Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain - ALGOS, and Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain; Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
| | - Antonia Caballero
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Jordi Miró
- Unit for the Study and Treatment of Pain - ALGOS, and Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain; Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
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127
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Duarte-Climents G, Sánchez-Gómez MB, Rodríguez-Gómez JÁ, Rodríguez-Álvarez C, Sierra-López A, Aguirre-Jaime A, Gómez-Salgado J. Impact of the Case Management Model through Community Liaison Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111894. [PMID: 31146341 PMCID: PMC6603531 DOI: 10.3390/ijerph16111894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 11/16/2022]
Abstract
The objective of the present study is to assess the model’s impact on patients and their families in terms of outcomes and the efficiency results for the health system in Tenerife, Canary Islands, selecting a period of eight years from the time interval 2002–2018. The employed indicators were collected on a monthly basis. They referred to home care and its impact on clinical outcomes and on the use of resources. The comparison between the indicators’ tendencies with and without the liaison nurse model was done with the F-test by Snedecor. All these tests are bilateral, with a level of significance of p < 0.05. In those areas with community liaison nurse (CLN), improvements have been found in indicators that describe: (1) the management of the clinical status of patients, (2) the efficiency of the use of resources, and (3) the quality and compliance with the process that also includes home visits and social risk detection and management. It can be said that in the basic areas of primary health care where the work of the CLN develops there are improvements in the management of the patients’ clinical condition as well as in the quality and efficiency of care.
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Affiliation(s)
- Gonzalo Duarte-Climents
- University School of Nursing, Candelaria NS University Hospital, University of La Laguna, Canary Islands Health Service, 38010 Santa Cruz de Tenerife, Spain.
| | - María Begoña Sánchez-Gómez
- University School of Nursing, Candelaria NS University Hospital, University of La Laguna, Canary Islands Health Service, 38010 Santa Cruz de Tenerife, Spain.
| | - José Ángel Rodríguez-Gómez
- University School of Nursing and Physiotherapy, Health Sciences School, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain.
| | | | - Antonio Sierra-López
- Department of Preventive Medicine and Public Health, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain.
| | - Armando Aguirre-Jaime
- Research Support Unit for Primary Care Management and Candelaria NS University Hospital, 38010 Santa Cruz de Tenerife, Spain.
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain.
- Safety and Health Posgrade Program, Universidad Espíritu Santo, Guayaquil 091650, Ecuador.
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128
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Cochran GT, Hruschak V, Abdullah W, Krans E, Douaihy AB, Bobby S, Fusco R, Tarter R. Optimizing Pregnancy Treatment Interventions for Moms (OPTI-Mom): A Pilot Study. J Addict Med 2019; 12:72-79. [PMID: 29140822 PMCID: PMC5786468 DOI: 10.1097/adm.0000000000000370] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The public health burden of opioid use disorder (OUD) among pregnant women has significantly increased in recent years. The Optimizing Pregnancy Treatment Interventions for Moms study was a pilot project that examined the feasibility of a patient navigation (PN) intervention model to reduce substance use and improve mental health, quality of life, and to increase engagement with treatment services among pregnant women with OUD. METHODS A 1-group repeated-measures pilot study was conducted with treatment-seeking pregnant women with opioid dependence initiating buprenorphine maintenance treatment. Participants received the PN intervention delivered as 10 sessions before delivery and 4 sessions postpartum. Participants completed assessments at baseline and after the prenatal and postnatal portions of the intervention. Demographics were assessed using descriptive statistics, and general estimating equation analyses were employed to examine changes in health and service engagement across time. RESULTS in all, 21 women were enrolled and completed the PN intervention and follow-up assessments. Participants reported improvements in abstinence from illicit opioids (B = 0.15, 95% confidence interval [CI] 0.1-0.2), drug use (odds ratio [OR] 5.25, 95% CI 2.1-13.0), and depression (OR 7.70, 95% CI 2.4-25.1). Results also showed nonsignificant trends suggesting enhancements in general health (B = 0.17, 95% CI 0.0-0.3, P = 0.06) and increases in substance use treatment attendance (B = 2.15, 95% CI -0.2 to 4.5, P = 0.07). Most study participants achieved adequate or better prenatal care. CONCLUSIONS These findings provide support that PN is a feasible adjunctive intervention that shows promise for health improvements and service engagement among treatment-seeking pregnant women with opioid dependence initiating buprenorphine.
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Affiliation(s)
- Gerald T Cochran
- University of Pittsburgh, School of Social Work, Pittsburgh, PA (GC, VH, RF); University of Pittsburgh, School of Medicine, Pittsburgh, PA (GC); UPMC, Magee-Womens Hospital, Pittsburgh, PA (WA); University of Pittsburgh, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, Pittsburgh, PA (EK); University of Pittsburgh, School of Medicine, Pittsburgh, PA (ABD); Pregnancy Recovery Center, UPMC, Magee-Womens Hospital, Pittsburgh, PA (SB); University of Pittsburgh, School of Pharmacy, Pittsburgh, PA (RT)
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129
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Van Wyngaarden JJ, Noehren B, Archer KR. Assessing psychosocial profile in the physical therapy setting. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/jabr.12165] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | - Kristin R. Archer
- Department of Orthopaedic Surgery, Department of Physical Medicine and Rehabilitation Vanderbilt University Medical Center Nashville Tennessee
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130
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Fletcher S, Chondros P, Palmer VJ, Chatterton ML, Spittal MJ, Mihalopoulos C, Wood A, Harris M, Burgess P, Bassilios B, Pirkis J, Gunn J. Link-me: Protocol for a randomised controlled trial of a systematic approach to stepped mental health care in primary care. Contemp Clin Trials 2019; 78:63-75. [PMID: 30593884 DOI: 10.1016/j.cct.2018.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/12/2018] [Accepted: 12/25/2018] [Indexed: 11/16/2022]
Abstract
Primary care in Australia is undergoing significant reform, with a particular focus on cost-effective tailoring of mental health care to individual needs. Link-me is testing whether a patient-completed Decision Support Tool (DST), which predicts future severity of depression and anxiety symptoms and triages individuals into care accordingly, is clinically effective and cost-effective relative to usual care. The trial is set in general practices, with English-speaking patients invited to complete eligibility screening in their general practitioner's waiting room. Eligible and consenting patients will then complete the DST assessment and are randomised and stratified according to predicted symptom severity. Participants allocated to the intervention arm will receive feedback on DST responses, select treatment priorities, assess motivation to change, and receive a severity-matched treatment recommendation (information about and links to low intensity services for those with mild symptoms, or assistance from a specially trained health professional (care navigator) for those with severe symptoms). All patients allocated to the comparison arm will receive usual GP care plus attention control. Primary (psychological distress) and secondary (depression, anxiety, quality of life, days out of role) outcomes will be assessed at 6 and 12 months. Differences in outcome means between trial arms both across and within symptom severity group will be examined using intention-to-treat analyses. Within trial and modelled economic evaluations will be conducted to determine the value for money of credentials of Link-me. Findings will be reported to the Federal Government to inform how mental health services across Australia are funded and delivered in the future.
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Affiliation(s)
- Susan Fletcher
- The Department of General Practice, Melbourne Medical School, University of Melbourne.
| | - Patty Chondros
- The Department of General Practice, Melbourne Medical School, University of Melbourne
| | - Victoria J Palmer
- The Department of General Practice, Melbourne Medical School, University of Melbourne
| | | | - Matthew J Spittal
- Melbourne School of Population and Global Health, University of Melbourne
| | | | - Anna Wood
- The Department of General Practice, Melbourne Medical School, University of Melbourne
| | | | | | - Bridget Bassilios
- Melbourne School of Population and Global Health, University of Melbourne
| | - Jane Pirkis
- Melbourne School of Population and Global Health, University of Melbourne
| | - Jane Gunn
- The Department of General Practice, Melbourne Medical School, University of Melbourne
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131
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Heddaeus D, Dirmaier J, Daubmann A, Grochtdreis T, König HH, Löwe B, Maehder K, Porzelt S, Rosenkranz M, Schäfer I, Scherer M, Schulte B, von dem Knesebeck O, Wegscheider K, Weigel A, Werner S, Zimmermann T, Härter M. [Clinical trial of a stepped and collaborative care model for mental illnesses and comorbidities in the Hamburg Network for Health Services Research]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:205-213. [PMID: 30607447 DOI: 10.1007/s00103-018-2865-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Healthcare for mental disorders is a big challenge for the German healthcare system. In cases of comorbid mental diseases, patients suffer from an especially high burden of disease. So far, innovative care models for collaborative and stepped care have only been investigated with respect to their effectiveness for single mental disorders.The project "Collaborative and Stepped Care in Mental Health by Overcoming Treatment Sector Barriers" (COMET), which is being carried out by the Hamburg Network for Health Services Research (HAM-NET) from 2017 until 2020, examines an innovative, guideline-based healthcare model for the improvement of healthcare for patients with mental illnesses and their potential comorbidities. In this article this new stepped and collaborative care model for patients in primary care that integrates general practitioners, psychiatrists, psychotherapists, and hospitals is presented. For the implementation and facilitation of the model, guideline-based treatment pathways, a tablet-based computer program for screening, diagnostic and guideline-based treatment recommendations, as well as a web-based transferal platform were developed.The results of this project on the effectiveness and efficacy of the model can help determine if the model can be implemented in routine healthcare. This could represent a major step towards more integrated and cross-sectoral healthcare for patients with mental illnesses.
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Affiliation(s)
- Daniela Heddaeus
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Jörg Dirmaier
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Anne Daubmann
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Thomas Grochtdreis
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Hans-Helmut König
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Bernd Löwe
- Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Kerstin Maehder
- Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Sarah Porzelt
- Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Moritz Rosenkranz
- Zentrum für interdisziplinäre Suchtforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Ingo Schäfer
- Zentrum für interdisziplinäre Suchtforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Martin Scherer
- Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Bernd Schulte
- Zentrum für interdisziplinäre Suchtforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Olaf von dem Knesebeck
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Karl Wegscheider
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Angelika Weigel
- Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Silke Werner
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Thomas Zimmermann
- Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Martin Härter
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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Swar S, Rimal P, Gauchan B, Maru D, Yang Y, Acharya B. Delivering Collaborative Care in Rural Settings: Integrating Remote Teleconsultation and Local Supervision in Rural Nepal. Psychiatr Serv 2019; 70:78-81. [PMID: 30220241 PMCID: PMC7718719 DOI: 10.1176/appi.ps.201800273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The collaborative care model can deliver high-quality mental health care. In rural regions, clinical supervision is conducted remotely rather than in person. The authors implemented a remote teleconsultation model in rural Nepal, where the consulting psychiatrist is over 30 hours away. This column describes strategies for several challenges: poor mental health competencies and high turnover among primary care providers; need for urgent consultations; psychiatrist discomfort with lack of direct patient contact; unreliable electricity, technological tools, documentation, and delivery of treatment recommendations; on-site clinicians' low motivation to accept psychiatrist recommendations; and mismatch between the psychiatrist's recommendations and the site's capacity to implement them.
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Affiliation(s)
- Sikhar Swar
- Possible, Achham, Nepal (Swar, Rimal, Gauchan, Maru, Acharya); Department of Psychiatry, Kathmandu Medical College, Duwakot, Nepal (Swar); Department of Health Systems and Global Health, Icahn School of Medicine at Mt. Sinai, New York City (Maru); Department of Psychiatry, University of Calfornia, San Francisco (Acharya); Department of Medical Psychology, Public Health College, Harbin Medical University, Harbin, China (Yang)
| | - Pragya Rimal
- Possible, Achham, Nepal (Swar, Rimal, Gauchan, Maru, Acharya); Department of Psychiatry, Kathmandu Medical College, Duwakot, Nepal (Swar); Department of Health Systems and Global Health, Icahn School of Medicine at Mt. Sinai, New York City (Maru); Department of Psychiatry, University of Calfornia, San Francisco (Acharya); Department of Medical Psychology, Public Health College, Harbin Medical University, Harbin, China (Yang)
| | - Bikash Gauchan
- Possible, Achham, Nepal (Swar, Rimal, Gauchan, Maru, Acharya); Department of Psychiatry, Kathmandu Medical College, Duwakot, Nepal (Swar); Department of Health Systems and Global Health, Icahn School of Medicine at Mt. Sinai, New York City (Maru); Department of Psychiatry, University of Calfornia, San Francisco (Acharya); Department of Medical Psychology, Public Health College, Harbin Medical University, Harbin, China (Yang)
| | - Duncan Maru
- Possible, Achham, Nepal (Swar, Rimal, Gauchan, Maru, Acharya); Department of Psychiatry, Kathmandu Medical College, Duwakot, Nepal (Swar); Department of Health Systems and Global Health, Icahn School of Medicine at Mt. Sinai, New York City (Maru); Department of Psychiatry, University of Calfornia, San Francisco (Acharya); Department of Medical Psychology, Public Health College, Harbin Medical University, Harbin, China (Yang)
| | - Yanjie Yang
- Possible, Achham, Nepal (Swar, Rimal, Gauchan, Maru, Acharya); Department of Psychiatry, Kathmandu Medical College, Duwakot, Nepal (Swar); Department of Health Systems and Global Health, Icahn School of Medicine at Mt. Sinai, New York City (Maru); Department of Psychiatry, University of Calfornia, San Francisco (Acharya); Department of Medical Psychology, Public Health College, Harbin Medical University, Harbin, China (Yang)
| | - Bibhav Acharya
- Possible, Achham, Nepal (Swar, Rimal, Gauchan, Maru, Acharya); Department of Psychiatry, Kathmandu Medical College, Duwakot, Nepal (Swar); Department of Health Systems and Global Health, Icahn School of Medicine at Mt. Sinai, New York City (Maru); Department of Psychiatry, University of Calfornia, San Francisco (Acharya); Department of Medical Psychology, Public Health College, Harbin Medical University, Harbin, China (Yang)
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A Leiferman J, Farewell CV, E Lee-Winn A, Jewell J, Ulrickson C, Huberty J, Paulson J. Management of Prenatal Depression: Effectiveness of an Online Training Module Across Health Care Disciplines. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2019; 39:178-184. [PMID: 31464821 DOI: 10.1097/ceh.0000000000000263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Maternal depression is associated with numerous deleterious maternal and child health outcomes. Although there are several treatment options for prenatal depression, many depressed women remain untreated. This study tested the effects of a low-intensity online training module on providers' attitudes, beliefs, and management practices of prenatal depression across a diverse group of providers. METHODS Health care providers who were providing care to pregnant women completed a 64-item survey consisting of items from the Management of Maternal Depression Inventory. Upon completion of the survey, providers were randomized into the intervention or the active control arm (wait-listed). The intervention consisted of an online training, which targeted knowledge and skills related to providing guidance on prenatal mood disorders. Approximately 6 to 8 weeks after randomization, all providers completed the survey again, and a general linear model framework was used to test change from baseline. RESULTS The final sample was comprised 74 compliant providers (intervention arm: n = 41; control arm: n = 33). Providers in the intervention arm reported significant increases in the sense of responsibility and self-efficacy when compared with their counterparts in the active control arm (all P < .001). Providers in the intervention arm also reported an increase in satisfaction related to communication with mental health specialists when compared with their counterparts in the active control arm (P = .05). DISCUSSION Our findings suggest that a brief, online training improved the attitudes, confidence, and communication of diverse providers related to the management of prenatal depression. Provider online training may help encourage patient-provider dialogue and in turn, enhance the management of prenatal depression.
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Affiliation(s)
- Jenn A Leiferman
- Dr. Leiferman: Associate Professor, Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO. Dr. Farewell: Senior Research Instructor, Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO. Dr. Lee-Winn: Assistant Professor, Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO. Ms. Jewell: DrPH Student, Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO. Ms. Ulrickson: Research Coordinator, Denver Health and Hospital Authority, Denver, CO. Dr. Huberty: Associate Professor, Arizona State University, Phoenix, AZ. Dr. Paulson: Associate Professor Old Dominion University, Norfolk, VA
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Martínez P, Rojas G, Martínez V, Marín R, Cornejo JP, Gómez V. Measuring Primary Health Care Clinicians' Skills for Depression Management. Front Psychiatry 2019; 10:570. [PMID: 31474886 PMCID: PMC6703131 DOI: 10.3389/fpsyt.2019.00570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/22/2019] [Indexed: 12/12/2022] Open
Abstract
Introduction: Primary health care clinicians play an important role in the management of depression. Thus, it is very important to have a valid and reliable assessment of the competences needed to manage depression in primary health care, with the use of clinical simulation providing such an opportunity. Objective: The present study describes the assessment of primary health care clinicians' depression-related skills through a series of objective structured clinical examination stations. Material and Methods: Clinicians from multi-professional teams for the management of depression at two primary health care clinics in Santiago, Chile, went through seven objective structured clinical examination stations, lasting 10 to 20 min each, to assess their depression-related skills. The clinical and communicative skills measured were in accordance with clinical guidelines. Standardized patients portrayed cases usually encountered in clinical practice, while expert raters evaluated clinicians' performance with standardized checklists. Results: Psychosocial clinicians performed better than biomedical clinicians in the assessed skills. The most notable results were as follows: a high level of accomplishment in the relationship with patient, medical anamnesis, health checkup, and lab test requests; heterogeneous performance in patient management according to screening results, feedback to the patient, and registration in clinical records; and major deficiencies in the differential diagnosis of bipolar disorder. Discussion: The objective structured clinical examinations administered provided an opportunity to perform an in-depth examination of the depression-related skills of primary health care clinicians, where flaws in the screening and diagnosis procedures used by biomedical clinicians were detected. Given the significant involvement of these types of clinicians in depression management, undergraduate-level and continuing health education opportunities are needed.
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Affiliation(s)
- Pablo Martínez
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile.,Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile.,Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile.,Escuela de Psicología, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile
| | - Graciela Rojas
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile.,Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile.,Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
| | - Vania Martínez
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile.,Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile.,Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (CEMERA), Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Rigoberto Marín
- Departamento de Educación en Ciencias de la Salud, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | | | - Víctor Gómez
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile.,Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
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135
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Adams EG. Treatment of Depression in Integrated Care: Implementation of the Nurse Care Manager. SAGE Open Nurs 2019; 5:2377960819861862. [PMID: 33415247 PMCID: PMC7774405 DOI: 10.1177/2377960819861862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 06/02/2019] [Accepted: 06/08/2019] [Indexed: 12/16/2022] Open
Abstract
The collaborative care model is an effective model for improving depression symptoms in patients in a primary care (PC) setting. An essential role in this model is the care manager (CM), and nurses have been effective in this role. However, there remains a question of how to best design, train, and implement this nurse CM role in PC. The purpose of this review is to provide readers with a critical description of what processes for training and implementation of a collaborative nurse CM role have been be successful in the literature, specifically as it pertains to supporting patients with depression and chronic medical illnesses in an integrated PC setting. A literature review of PubMed, CINAHL, PsychINFO, Scopus, and the Cochrane Collaborative was conducted in October 2018. Successful nurse CM interventions have included regular patient follow-up, symptom check-in, treatment monitoring, goal setting, and education. Psychological support techniques such as Problem-Solving Therapy, behavioral activation, and motivational interviewing have been useful in supporting patient care-plan engagement and goal achievement. Nurse CM training should support the successful implementation of the designed role. Nurse CMs have an opportunity to significantly impact depressive outcomes of patients with depression and long-term health conditions. Further research is needed to explore the potential that this nursing role has as well as how to best operationalize this role.
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136
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Shen N, Sockalingam S, Charow R, Bailey S, Bernier T, Freeland A, Hawa A, Sur D, Wiljer D. Education programs for medical psychiatry collaborative care: A scoping review. Gen Hosp Psychiatry 2018; 55:51-59. [PMID: 30384004 DOI: 10.1016/j.genhosppsych.2018.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/25/2018] [Accepted: 08/29/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To understand the current state of collaborative care education programs reported in the literature. METHODS Following Arksey and O'Malley methodology for scoping reviews, data was abstracted in following domains: article details, program details, program outcomes, and implementation factors. Numerical summaries were calculated where necessary. Implementation factors underwent a qualitative thematic analysis. RESULTS This review identified 40 unique collaborative care education programs. Most programs (n = 25; 62.5%) were delivered to a multi-disciplinary group of learners through didactic (n = 34; 85.0%) and/or in vivo (n = 32; 80.0%) training methods. The majority of programs focused on clinical knowledge/skill acquisition (n = 38; 95.0%) as opposed to attitudes towards mental health and collaboration (n = 27; 67.5%). Implementation factors fell within four themes: program development, supportive environment, necessary resources, and clinical change agents/leaders. CONCLUSION Despite the growing evidence for collaborative care, few collaborative care education programs are reported in the literature. Key elements of collaborative care education programs include: routine multi-disciplinary interaction, curriculum focus on attitudes; clinical change agents and leaders to accelerate implementation; and a user-centred design development process. Future implementations can learn from these experiences to avoid potential barriers and focus on enabling successful programs to enhance care.
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Affiliation(s)
- Nelson Shen
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6, Canada; University Health Network, 200 Elizabeth Street, 8 Eaton South, Toronto, Ontario M5G 2C4, Canada; Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.
| | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada; Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.
| | - Rebecca Charow
- University Health Network, 200 Elizabeth Street, 8 Eaton South, Toronto, Ontario M5G 2C4, Canada.
| | - Sharon Bailey
- Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.
| | - Thérèse Bernier
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6, Canada.
| | - Alison Freeland
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada; Trillium Health Partners, 100 Queensway W, Mississauga, Ontario L5B 1B8, Canada.
| | - Aceel Hawa
- Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada
| | - Deepy Sur
- Trillium Health Partners, 100 Queensway W, Mississauga, Ontario L5B 1B8, Canada.
| | - David Wiljer
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada; University Health Network, 200 Elizabeth Street, 8 Eaton South, Toronto, Ontario M5G 2C4, Canada; Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.
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Ghesquiere AR, Pepin R, Kinsey J, Bartels SJ, Bruce ML. Factors associated with depression detection in a New Hampshire mental health outreach program. Aging Ment Health 2018; 22:1471-1476. [PMID: 28812372 PMCID: PMC5815953 DOI: 10.1080/13607863.2017.1364346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES For mental health outreach programs for older adults, accurately detecting depression is key to quality service provision. Multiple factors, including gender, cognitive impairment, or recent bereavement may affect depression detection, but this is under-studied. Therefore, we sought to both establish rates of depressive symptom detection and to examine factors associated with inaccuracies of detecting depression among participants in a mental health outreach program serving older adults. METHOD We conducted a chart review of 1126 cases in an older adult-focused mental health outreach program in New Hampshire, the Referral Education Assistance & Prevention (REAP) program. Accuracy of depression detection was identified by comparing screen-positive scores for depressive symptoms on the 15-item Geriatric Depression Scale (GDS) to depression identification by counselors on a 'presenting concerns' list. RESULTS Inaccurate depression detection (positive on the GDS but depression not identified by counselors) occurred in 27.6% of cases. Multivariate regression analyses indicated that anxiety, cognitive concerns, and rurality were all associated with detection innaccuracy. CONCLUSION This study appears to be the first to examine factors influencing depression detection in a mental health outreach program. Future efforts should help ensure that all older mental health outreach clients have depression detected at optimal rates.
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Affiliation(s)
- Angela R Ghesquiere
- a Brookdale Center for Healthy Aging, Hunter College , City University of New York , NY , USA
| | - Renee Pepin
- b Dartmouth Centers for Health and Aging , Lebanon , NH , USA
| | | | - Stephen J Bartels
- d The Dartmouth Institute, Geisel School of Medicine at Dartmouth, and Dartmouth Centers for Health and Aging , Lebanon , NH , USA
| | - Martha L Bruce
- d The Dartmouth Institute, Geisel School of Medicine at Dartmouth, and Dartmouth Centers for Health and Aging , Lebanon , NH , USA
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138
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Moise N, Falzon L, Obi M, Ye S, Patel S, Gonzalez C, Bryant K, Kronish IM. Interventions to Increase Depression Treatment Initiation in Primary Care Patients: a Systematic Review. J Gen Intern Med 2018; 33:1978-1989. [PMID: 30109586 PMCID: PMC6206350 DOI: 10.1007/s11606-018-4554-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/26/2018] [Accepted: 06/25/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Nearly 50% of depressed primary care patients referred to mental health services do not initiate mental health treatment. The most promising interventions for increasing depression treatment initiation in primary care settings remain unclear. METHODS We performed a systematic search of publicly available databases from inception through August 2017 to identify interventions designed to increase depression treatment initiation. Two authors independently selected, extracted data, and rated risk of bias from included studies. Eligible studies used a randomized or pre-post design and assessed depression treatment initiation (i.e., ≥ 1 mental health visit or antidepressant fill) among adults, the majority of whom met criteria for depression. Interventions were classified as simple or complex and sub-classified into intervention strategies that were graded for strength of evidence. RESULTS Of 9516 articles identified, we included 14 unique studies representing 16 (4 simple and 12 complex) interventions and 8 treatment initiation strategies. We found low to moderate strength of evidence for collaborative/integrated care (3 studies), treatment preference matching (2 studies), and case management (2 studies) strategies. However, there was insufficient evidence to determine the benefit of cultural tailoring (2 studies), motivation (alone, with reminders or with cultural tailoring (5 studies)), education (1 study), and shared decision-making strategies (1 study). Overall, we found moderate strength of evidence for complex interventions (8 of 12 complex interventions demonstrated statistically significant effects on treatment initiation). DISCUSSION Collaborative/integrated care, preference treatment matching, and case management strategies had the best evidence for improving depression treatment initiation, but none of the strategies had high strength of evidence. While primary care settings can consider using some of these strategies when referring depressed patients to treatment, our review highlights the need for further rigorous research in this area.
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Affiliation(s)
- Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA.
| | - Louise Falzon
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Megan Obi
- Case Western Reserve University, Cleveland, OH, USA
| | - Siqin Ye
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Sapana Patel
- The New York State Psychiatric Institute, Research Foundation for Mental Hygiene, New York, NY, 10032, USA
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY, 10032, USA
| | | | | | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
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139
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Overbeck G, Brostrøm Kousgaard M, Davidsen AS. Enactments and experiences of 'enhanced interprofessional communication' in collaborative care - a qualitative study. J Interprof Care 2018; 33:519-527. [PMID: 30358462 DOI: 10.1080/13561820.2018.1538109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
One of the key components in collaborative care (CC) for anxiety and depression between general practitioners (GPs) and psychiatry is 'enhanced interprofessional communication'. However, the literature contains few detailed descriptions of the interprofessional roles and specific collaborative behaviours that are required to enhance communication. Using semi-structured interviews and observations, this study explores how interprofessional communication was enacted in a CC intervention in Denmark. Analysis was by Interpretative Phenomenological Analysis and interaction analysis. In the intervention the components of the enhanced communication were a) weekly meetings between care managers (CMs) and GPs and b) group supervision of GPs by a psychiatrist. This study showed that the meetings between CMs and GPs were enacted very differently across clinics, with communication ranging from monological 'giving report'-style to more dialogical 'peer-discussion'-style with development of new shared knowledge. The type of communication depended on the GP's professional style. The supervision element was not perceived as being meaningful and GPs reacted by non-attendance and non-response. Engagement of the GPs in a shared process requires a more dialogical model. However, the choice depends on whether a referral or a collaborative model is aimed at. A dialogical model would demand the teaching and guidance of the professionals.
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Affiliation(s)
- Gritt Overbeck
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen , Denmark
| | - Marius Brostrøm Kousgaard
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen , Denmark
| | - Annette Sofie Davidsen
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen , Denmark
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140
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van Grieken RA, van Tricht MJ, Koeter MWJ, van den Brink W, Schene AH. The use and helpfulness of self-management strategies for depression: The experiences of patients. PLoS One 2018; 13:e0206262. [PMID: 30359444 PMCID: PMC6201928 DOI: 10.1371/journal.pone.0206262] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/09/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To explore which of 50 self-management strategies are actually used and which are perceived as most helpful by patients in their day-to-day management of depression, in order to empower patients and promote active engagement in their own care. METHODS Retrospective study using an online self-report survey to assess the use and perceived helpfulness of 50 previously identified self-management strategies in 193 participants who recently recovered from a major depressive episode. RESULTS Forty-five of the 50 strategies were used by at least half of all participants and about one third of all participants perceived almost 50% of all strategies as (very) helpful. The most used strategies, such as 'finding strategies to create pleasurable distractions', 'engaging in leisure activities' or 'identifying the cause of the depression', were not always perceived as most helpful. In addition, the perceived most helpful strategies, such as 'completing treatment' and 'leaving the house regularly' were not always the most used ones. CONCLUSIONS Patients use and perceive a wide range of self-management strategies as helpful to recover from their depression. Patients use and perceive strategies about engagement in treatment and physical activities as being most helpful. These finding may contribute to the further development and implementation of self-management programs for the prevention or the rehabilitation of depression.
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Affiliation(s)
- Rosa A. van Grieken
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirjam J. van Tricht
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten W. J. Koeter
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Aart H. Schene
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
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Magaard JL, Liebherz S, Melchior H, Engels A, König HH, Kriston L, Schulz H, Jahed J, Brütt AL, Reber KC, Härter M. Collaborative mental health care program versus a general practitioner program and usual care for treatment of patients with mental or neurological disorders in Germany: protocol of a multiperspective evaluation study. BMC Psychiatry 2018; 18:347. [PMID: 30359248 PMCID: PMC6202836 DOI: 10.1186/s12888-018-1914-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 09/27/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND German statutory health insurances are pursuing the goal of improving treatment of chronically ill people by promoting networks of health care providers and supporting treatments that reflect the current medical knowledge. The so-called PNP program is a collaborative care program developed by a German statutory health insurance, which defines specific rules on psychiatric, neurological, psychosomatic, and psychotherapeutic treatment. It aims to strengthen provision of guideline-based outpatient treatment and collaboration between different health care providers. It includes the general practitioners' program, which aims to strengthen the coordinating role of GPs. This study aims to evaluate the PNP program. METHODS To evaluate the effectiveness of the PNP program, we will conduct a prospective non-randomized controlled trial with primary data comparing patients enrolled in the PNP program and in the general practitioner program (intervention group) to patients enrolled only in the general practitioner program and patients who receive usual care (control groups). To evaluate costs and level of detail of diagnoses in care of patients with PNP program, we will use routinely collected secondary administrative health data in a retrospective quasi-experimental design. Patients who are at least 18 years old, insured by the statutory health insurance AOK, and on sick leave due to one of the mental or neurological diagnoses (affective, anxiety, somatoform or adjustment disorders, alcohol use disorders, schizophrenia, multiple sclerosis) will be included. We will collect data at baseline and at 12-months follow-up. Health-related quality of life (primary data) and direct costs (secondary data) caused by outpatient and inpatient service utilization and medication will be the primary outcomes. We will analyze data using (generalized) linear mixed models and exploratory analyses. We will use entropy balancing to control for possible differences between the groups. We will use an exploratory sequential design including qualitative and descriptive statistical analyses to assess the structure and process quality of the PNP program among health care providers. DISCUSSION The results will help to develop a comprehensive picture of collaborative care programs for mental and neurological health care from the perspective of patients, health care providers, and health insurance companies. TRIAL REGISTRATION German Clinical Trial Register DRKS00013114.
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Affiliation(s)
- Julia Luise Magaard
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246 Hamburg, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246 Hamburg, Germany
| | - Hanne Melchior
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246 Hamburg, Germany
| | - Alexander Engels
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246 Hamburg, Germany
| | - Holger Schulz
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246 Hamburg, Germany
| | | | - Anna Levke Brütt
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246 Hamburg, Germany
- Department for Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Katrin Christiane Reber
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246 Hamburg, Germany
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Moise N, Shah RN, Essock S, Jones A, Carruthers J, Handley MA, Peccoralo L, Sederer L. Sustainability of collaborative care management for depression in primary care settings with academic affiliations across New York State. Implement Sci 2018; 13:128. [PMID: 30314522 PMCID: PMC6186053 DOI: 10.1186/s13012-018-0818-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 09/11/2018] [Indexed: 12/12/2022] Open
Abstract
Background In a large statewide initiative, New York State implemented collaborative care (CC) from 2012 to 2014 in 32 primary care settings where residents were trained and supported its sustainability through payment reforms implemented in 2015. Twenty-six clinics entered the sustainability phase and six opted out, providing an opportunity to examine factors predicting continued CC participation and fidelity. Methods We used descriptive statistics to assess implementation metrics in sustaining vs. opt-out clinics and trends in implementation fidelity 1 and 2 years into the sustainability phase among sustaining clinics. To characterize barriers and facilitators, we conducted 31 semi-structured interviews with psychiatrists, clinic administrators, primary care physicians, and depression care managers (24 at sustaining, 7 at opt-out clinics). Results At the end of the implementation phase, clinics opting to continue the program had significantly higher care manager full-time equivalents (FTEs) and achieved greater clinical improvement rates (46% vs. 7.5%, p = 0.004) than opt-out clinics. At 1 and 2 years into sustainability, the 26 sustaining clinics had steady rates of depression screening, staffing FTEs and treatment titration rates, significantly higher contacts/patient and improvement rates and fewer enrolled patients/FTE. During the sustainability phase, opt-out sites reported lower patient caseloads/FTE, psychiatry and care manager FTEs, and physician/psychiatrist CC involvement compared to sustaining clinics. Key barriers to sustainability noted by respondents included time/resources/personnel (71% of respondents from sustaining clinics vs. 86% from opt-out), patient engagement (67% vs. 43%), and staff/provider engagement (50% vs. 43%). Fewer respondents mentioned early implementation barriers such as leadership support, training, finance, and screening/referral logistics. Facilitators included engaging patients (e.g., warm handoffs) (79% vs. 86%) and staff/providers (71% vs. 100%), and hiring personnel (75% vs. 57%), particularly paraprofessionals for administrative tasks (67% vs. 0%). Conclusions Clinics that saw early clinical improvement and who invested in staffing FTEs were more likely to elect to enter the sustainability phase. Structural rules (e.g., payment reform) both encouraged participation in the sustainability phase and boosted long-term outcomes. While limited to settings with academic affiliations, these results demonstrate that patient and provider engagement and care manager resources are critical factors to ensuring sustainability. Electronic supplementary material The online version of this article (10.1186/s13012-018-0818-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nathalie Moise
- Center for Behavioral and Cardiovascular Health, Department of Medicine, Columbia University Medical Center, 622 W. 168th Street, PH9- Room 321, New York, NY, 10032, USA.
| | - Ravi N Shah
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Susan Essock
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Amy Jones
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Jay Carruthers
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Margaret A Handley
- Department of Epidemiology and Biostatistics and Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, USA
| | | | - Lloyd Sederer
- Columbia University Mailman School of Public Health, New York, NY, USA
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Sterling S, Chi F, Weisner C, Grant R, Pruzansky A, Bui S, Madvig P, Pearl R. Association of behavioral health factors and social determinants of health with high and persistently high healthcare costs. Prev Med Rep 2018; 11:154-159. [PMID: 30003015 PMCID: PMC6039851 DOI: 10.1016/j.pmedr.2018.06.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/23/2018] [Accepted: 06/25/2018] [Indexed: 01/27/2023] Open
Abstract
A high proportion of U.S. health care costs are attributable to a relatively small proportion of patients. Understanding behavioral and social factors that predict initial and persistent high costs for these "high utilizers" is critical for health policy-makers. This prospective observational study was conducted at Kaiser Permanente Northern California (KPNC), an integrated healthcare delivery system with 4.1 million members. A stratified random sample of high-cost vs. non-high-cost adult KPNC members matched by age, gender, race/ethnicity, type of health insurance, and medical severity (N = 378) was interviewed between 3/14/2013 and 3/20/2014. Data on health care costs and clinical diagnoses between 1/1/2008 and 12/31/2012 were derived from the electronic health record (EHR). Social-economic status, depression symptoms, adverse childhood experiences (ACEs), interpersonal violence, financial stressors, neighborhood environment, transportation access, and patient activation and engagement were obtained through telephone interviews. Initial and subsequent high-cost status were defined as being classified in top 20% cost levels over 1/1/2009-12/31/2011 and 1/1/2012-12/31/2012, respectively. Psychiatric diagnosis (OR 2.55, 95% CI 1.52-4.29, p < 0.001), financial stressors (OR 1.97, 95% CI 1.19-3.26, p = 0.009), and ACEs (OR 1.10, 95% CI 1.00-1.20, p = 0.051) predicted initial high-cost status. ACEs alone predicted persistent high-cost status in the subsequent year (OR 1.12, 95% CI 1.00-1.25, p = 0.050). Non-medical factors such as psychiatric problems, financial stressors and adverse childhood experiences contribute significantly to the likelihood of high medical utilization and cost. Efforts to predict and reduce high utilization must include measuring and potentially addressing these factors.
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Affiliation(s)
- Stacy Sterling
- Division of Research, Kaiser Permanente Northern California, United States
| | - Felicia Chi
- Division of Research, Kaiser Permanente Northern California, United States
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, United States
- University of California, San Francisco, United States
| | - Richard Grant
- Division of Research, Kaiser Permanente Northern California, United States
| | | | - Sandy Bui
- The Permanente Medical Group, United States
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Thompson H. Capsule Commentary on Waitzfelder et al., Treatment Initiation for New Episodes of Depression in Primary Care Settings. J Gen Intern Med 2018; 33:1385. [PMID: 29855863 PMCID: PMC6082215 DOI: 10.1007/s11606-018-4319-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Hale Thompson
- Department of Psychiatry , Rush University Medical Center, Chicago, IL, USA.
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145
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Pedersen ER, Rubenstein L, Kandrack R, Danz M, Belsher B, Motala A, Booth M, Larkin J, Hempel S. Elusive search for effective provider interventions: a systematic review of provider interventions to increase adherence to evidence-based treatment for depression. Implement Sci 2018; 13:99. [PMID: 30029676 PMCID: PMC6053754 DOI: 10.1186/s13012-018-0788-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 06/29/2018] [Indexed: 12/11/2022] Open
Abstract
Background Depression is a common mental health disorder for which clinical practice guidelines have been developed. Prior systematic reviews have identified complex organizational interventions, such as collaborative care, as effective for guideline implementation; yet, many healthcare delivery organizations are interested in less resource-intensive methods to increase provider adherence to guidelines and guideline-concordant practices. The objective of this systematic review was to assess the effectiveness of healthcare provider interventions that aim to increase adherence to evidence-based treatment of depression in routine clinical practice. Methods We searched five databases through August 2017 using a comprehensive search strategy to identify English-language randomized controlled trials (RCTs) in the quality improvement, implementation science, and behavior change literature that evaluated outpatient provider interventions, in the absence of practice redesign efforts, to increase adherence to treatment guidelines or guideline-concordant practices for depression. We used meta-analysis to summarize odds ratios, standardized mean differences, and incidence rate ratios, and assessed quality of evidence (QoE) using the GRADE approach. Results Twenty-two RCTs promoting adherence to clinical practice guidelines or guideline-concordant practices met inclusion criteria. Studies evaluated diverse provider interventions, including distributing guidelines to providers, education/training such as academic detailing, and combinations of education with other components such as targeting implementation barriers. Results were heterogeneous and analyses comparing provider interventions with usual clinical practice did not indicate a statistically significant difference in guideline adherence across studies. There was some evidence that provider interventions improved individual outcomes such as medication prescribing and indirect comparisons indicated more complex provider interventions may be associated with more favorable outcomes. We did not identify types of provider interventions that were consistently associated with improvements across indicators of adherence and across studies. Effects on patients’ health in these RCTs were inconsistent across studies and outcomes. Conclusions Existing RCTs describe a range of provider interventions to increase adherence to depression guidelines. Low QoE and lack of replication of specific intervention strategies across studies limited conclusions that can be drawn from the existing research. Continued efforts are needed to identify successful strategies to maximize the impact of provider interventions on increasing adherence to evidence-based treatment for depression. Trial registration PROSPERO record CRD42017060460 on 3/29/17 Electronic supplementary material The online version of this article (10.1186/s13012-018-0788-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eric R Pedersen
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA.
| | - Lisa Rubenstein
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA.,David Geffen School of Medicine at UCLA, Los Angeles, USA.,UCLA Fielding School of Public Health, Los Angeles, USA
| | | | - Marjorie Danz
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
| | - Bradley Belsher
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, USA.,Uniformed Services University of the Health Sciences, Department of Psychiatry, Bethesda, USA
| | - Aneesa Motala
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
| | - Marika Booth
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
| | | | - Susanne Hempel
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
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146
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Bruce ML, Sirey JA. Integrated Care for Depression in Older Primary Care Patients. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:439-446. [PMID: 29495883 PMCID: PMC6099772 DOI: 10.1177/0706743718760292] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
For decades, depression in older adults was overlooked and not treated. Most treatment was by primary care providers and typically poorly managed. Recent interventions that integrate mental health services into primary care have increased the number of patients who are treated for depression and the quality of that treatment. The most effective models involve systematic depression screening and monitoring, multidisciplinary teams that include primary care providers and mental health specialists, a depression care manager to work directly with patients over time and the use of guideline-based depression treatment. The article reviews the challenges and opportunities for providing high-quality depression treatment in primary care; describes the 3 major integrated care interventions, PRISM-E, IMPACT, and PROSPECT; reviews the evidence of their effectiveness, and adaptations of the model for other conditions and settings; and explores strategies to increase their scalability into real world practice.
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Affiliation(s)
- Martha L. Bruce
- Dartmouth Centers for Health and Aging, Geisel School of Medicine, Hanover, NH, USA
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147
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Yiu KC, Rohwer A, Young T. Integration of care for hypertension and diabetes: a scoping review assessing the evidence from systematic reviews and evaluating reporting. BMC Health Serv Res 2018; 18:481. [PMID: 29925356 PMCID: PMC6011271 DOI: 10.1186/s12913-018-3290-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/11/2018] [Indexed: 12/26/2022] Open
Abstract
Background With the rise in pre-mature mortality rate from non-communicable disease (NCD), there is a need for evidence-based interventions. We evaluated existing systematic reviews on effectiveness of integration of healthcare services, in particular with focus on delivery of care designed to improve health and process outcomes in people with multi-morbidity, where at least one of the conditions was diabetes or hypertension. Methods We searched MEDLINE, EMBASE, Cochrane Library, and Health Evidence to November 8, 2016 and consulted experts. One review author screened titles, abstracts and two review authors independently screened short listed full-texts and selected reviews for inclusion. We considered systematic reviews evaluating integration of care, compared to usual care, for people with multi-morbidity. One review author extracted data and another author verified it. Two review authors independently evaluated risk of bias using ROBIS and AMSTAR. Inter-rater reliability was analysed for ROBIS and AMSTAR using Cohen’s kappa and percent agreement. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used to assess reporting. Results We identified five systematic reviews on integration of care. Four reviews focused on comorbid diabetes and depression and two covered hypertension and comorbidities of cardiovascular disease, depression, or diabetes. Interventions were poorly described. The health outcomes evaluated included risk of all-cause mortality, measures of depression, cholesterol levels, HbA1c levels, effect of depression on HbA1c levels, symptom improvement, systolic blood pressure, and hypertension control. Process outcomes included access and utilisation of healthcare services, costs, and quality of care. Overall, three reviews had a low and medium risk of bias according to ROBIS and AMSTAR respectively, while two reviews had high risk of bias as judged by both ROBIS and AMSTAR. Findings have demonstrated that collaborative care in general resulted in better health and process outcomes when compared to usual care for both depression and diabetes and hypertension and diabetes. Conclusions Several knowledge gaps were identified on integration of care for comorbidities with diabetes and/or hypertension: limited research on this topic for hypertension, limited reviews that included primary studies based in low-middle income countries, and limited reviews on collaborative care for communicable and NCDs. Electronic supplementary material The online version of this article (10.1186/s12913-018-3290-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kristy C Yiu
- McMaster University, 1280, Hamilton, ON, L8S 4L8, Canada
| | - Anke Rohwer
- Centre of Evidence Based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
| | - Taryn Young
- Centre of Evidence Based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa.
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148
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Härter M, Watzke B, Daubmann A, Wegscheider K, König HH, Brettschneider C, Liebherz S, Heddaeus D, Steinmann M. Guideline-based stepped and collaborative care for patients with depression in a cluster-randomised trial. Sci Rep 2018; 8:9389. [PMID: 29925893 PMCID: PMC6010425 DOI: 10.1038/s41598-018-27470-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/30/2018] [Indexed: 01/22/2023] Open
Abstract
Guidelines recommend stepped and collaborative care models (SCM) for depression. We aimed to evaluate the effectiveness of a complex guideline-based SCM for depressed patients. German primary care units were cluster-randomised into intervention (IG) or control group (CG) (3:1 ratio). Adult routine care patients with PHQ-9 ≥ 5 points could participate and received SCM in IG and treatment as usual (TAU) in CG. Primary outcome was change in PHQ-9 from baseline to 12 months (hypothesis: greater reduction in IG). A linear mixed model was calculated with group as fixed effect and practice as random effect, controlling for baseline PHQ-9 (intention-to-treat). 36 primary care units were randomised to IG and 13 to CG. 36 psychotherapists, 6 psychiatrists and 7 clinics participated in SCM. 737 patients were included (IG: n = 569 vs. CG: n = 168); data were available for 60% (IG) and 64% (CG) after 12 months. IG showed 2.4 points greater reduction [95% confidence interval (CI): -3.4 to -1.5, p < 0.001; Cohen's d = 0.45] (adjusted PHQ-9 mean change). Odds of response [odds ratio: 2.8; 95% CI: 1.6 to 4.7] and remission [odds ratio: 3.2; 95% CI: 1.58 to 6.26] were higher in IG. Guideline-based SCM can improve depression care.
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Affiliation(s)
- Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Birgit Watzke
- Clinical Psychology and Psychotherapy Research, Institute of Psychology, University of Zurich, Binzmühlestrasse 14/16, CH-8050, Zurich, Switzerland
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Daniela Heddaeus
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Maya Steinmann
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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149
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Bauer AM, Hodsdon S, Bechtel JM, Fortney JC. Applying the Principles for Digital Development: Case Study of a Smartphone App to Support Collaborative Care for Rural Patients With Posttraumatic Stress Disorder or Bipolar Disorder. J Med Internet Res 2018; 20:e10048. [PMID: 29875085 PMCID: PMC6010837 DOI: 10.2196/10048] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite a proliferation of patient-facing mobile apps for mental disorders, there is little literature guiding efforts to incorporate mobile tools into clinical care delivery and integrate patient-generated data into care processes for patients with complex psychiatric disorders. OBJECTIVE The aim of this study was to seek to gain an understanding of how to incorporate a patient-provider mobile health (mHealth) platform to support the delivery of integrated primary care-based mental health services (Collaborative Care) to rural patients with posttraumatic stress disorder and/or bipolar disorder. METHODS Using the Principles for Digital Development as a framework, we describe our experience designing, developing, and deploying a mobile system to support Collaborative Care. The system consists of a patient-facing smartphone app that integrates with a Web-based clinical patient registry used by behavioral health care managers and consulting psychiatrists. Throughout development, we engaged representatives from the system's two user types: (1) providers, who use the Web-based registry and (2) patients, who directly use the mobile app. We extracted mobile metadata to describe the early adoption and use of the system by care managers and patients and report preliminary results from an in-app patient feedback survey that includes a System Usability Scale (SUS). RESULTS Each of the nine Principles for Digital Development is illustrated with examples. The first 10 patients to use the smartphone app have completed symptom measures on average every 14 days over an average period of 20 weeks. The mean SUS score at week 8 among four patients who completed this measure was 91.9 (range 72.5-100). We present lessons learned about the technical and training requirements for integration into practice that can inform future efforts to incorporate health technologies to improve care for patients with psychiatric conditions. CONCLUSIONS Adhering to the Principles for Digital Development, we created and deployed an mHealth system to support Collaborative Care for patients with complex psychiatric conditions in rural health centers. Preliminary data among the initial users support high system usability and show promise for sustained use. On the basis of our experience, we propose five additional principles to extend this framework and inform future efforts to incorporate health technologies to improve care for patients with psychiatric conditions: design for public health impact, add value for all users, test the product and the process, acknowledge disruption, and anticipate variability.
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Affiliation(s)
- Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | | | - Jared M Bechtel
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
- Health Services Research and Development Service Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States
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150
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Turner A, Mulla A, Booth A, Aldridge S, Stevens S, Begum M, Malik A. The international knowledge base for new care models relevant to primary care-led integrated models: a realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [PMID: 29972636 DOI: 10.3310/hsdr06250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundThe Multispecialty Community Provider (MCP) model was introduced to the NHS as a primary care-led, community-based integrated care model to provide better quality, experience and value for local populations.ObjectivesThe three main objectives were to (1) articulate the underlying programme theories for the MCP model of care; (2) identify sources of theoretical, empirical and practice evidence to test the programme theories; and (3) explain how mechanisms used in different contexts contribute to outcomes and process variables.DesignThere were three main phases: (1) identification of programme theories from logic models of MCP vanguards, prioritising key theories for investigation; (2) appraisal, extraction and analysis of evidence against a best-fit framework; and (3) realist reviews of prioritised theory components and maps of remaining theory components.Main outcome measuresThe quadruple aim outcomes addressed population health, cost-effectiveness, patient experience and staff experience.Data sourcesSearches of electronic databases with forward- and backward-citation tracking, identifying research-based evidence and practice-derived evidence.Review methodsA realist synthesis was used to identify, test and refine the following programme theory components: (1) community-based, co-ordinated care is more accessible; (2) place-based contracting and payment systems incentivise shared accountability; and (3) fostering relational behaviours builds resilience within communities.ResultsDelivery of a MCP model requires professional and service user engagement, which is dependent on building trust and empowerment. These are generated if values and incentives for new ways of working are aligned and there are opportunities for training and development. Together, these can facilitate accountability at the individual, community and system levels. The evidence base relating to these theory components was, for the most part, limited by initiatives that are relatively new or not formally evaluated. Support for the programme theory components varies, with moderate support for enhanced primary care and community involvement in care, and relatively weak support for new contracting models.Strengths and limitationsThe project benefited from a close relationship with national and local MCP leads, reflecting the value of the proximity of the research team to decision-makers. Our use of logic models to identify theories of change could present a relatively static position for what is a dynamic programme of change.ConclusionsMultispecialty Community Providers can be described as complex adaptive systems (CASs) and, as such, connectivity, feedback loops, system learning and adaptation of CASs play a critical role in their design. Implementation can be further reinforced by paying attention to contextual factors that influence behaviour change, in order to support more integrated working.Future workA set of evidence-derived ‘key ingredients’ has been compiled to inform the design and delivery of future iterations of population health-based models of care. Suggested priorities for future research include the impact of enhanced primary care on the workforce, the effects of longer-term contracts on sustainability and capacity, the conditions needed for successful continuous improvement and learning, the role of carers in patient empowerment and how community participation might contribute to community resilience.Study registrationThis study is registered as PROSPERO CRD42016039552.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Alison Turner
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Abeda Mulla
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Shiona Aldridge
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Sharon Stevens
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Mahmoda Begum
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Anam Malik
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
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