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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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Solberg JJ, Deyo-Svendsen ME, Nylander KR, Bruhl EJ, Heredia D, Angstman KB. Collaborative Care Management Associated With Improved Depression Outcomes in Patients With Personality Disorders, Compared to Usual Primary Care. J Prim Care Community Health 2018; 9:2150132718773266. [PMID: 29739287 PMCID: PMC5954311 DOI: 10.1177/2150132718773266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The use of a collaborative care management (CCM) model can dramatically improve short- and long-term treatment outcomes for patients with major depressive disorder (MDD). Patients with comorbid personality disorder (PD) may experience poorer treatment outcomes for MDD. Our study seeks to examine the differences in MDD treatment outcomes for patients with comorbid PD when using a CCM approach rather than usual care (UC). METHODS In our retrospective cohort study, we reviewed the records of 9614 adult patients enrolled in our depression registry with the clinical diagnosis MDD and the diagnosis of PD (Yes/No). Clinical outcomes for depression were measured with Patient Health Questionnaire-9 (PHQ-9) scores at 6 months. RESULTS In our study cohort, 59.4% of patients (7.1% of which had comorbid PD) were treated with CCM, as compared with 40.6% (6.8% with PD) treated with UC. We found that the presence of a PD adversely affected clinical outcomes of remission within both groups, however, at 6 months patients with PD had significantly lower MDD remission rates when treated with UC as compared with those treated with CCM (11.5% vs 25.2%, P = .002). Patients with PD in the UC group were also noted to have an increased rate of persistent depressive symptoms (PHQ-9 score ≥10) at 6 months as compared with those in the CCM group (67.7% vs 51.7%, P = .004). CONCLUSIONS In patients with comorbid MDD and PD, clinical outcomes at 6 months were significantly improved when treated with CCM compared with UC. This finding is encouraging and supports the idea that CCM is an effective model for caring for patients with behavioral concerns, and it may be of even greater benefit for those patients being treated for comorbid behavioral health conditions.
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153
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Mufson L, Rynn M, Yanes-Lukin P, Choo TH, Soren K, Stewart E, Wall M. Stepped Care Interpersonal Psychotherapy Treatment for Depressed Adolescents: A Pilot Study in Pediatric Clinics. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:417-431. [PMID: 29124527 PMCID: PMC5911397 DOI: 10.1007/s10488-017-0836-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Adolescents with depression are at risk for negative long-term consequences and recurrence of depression. Many do not receive nor access treatment, especially Latino youth. New treatment approaches are needed. This study examined the feasibility and acceptability of a stepped collaborative care treatment model (SCIPT-A) for adolescents with depression utilizing interpersonal psychotherapy for adolescents (IPT-A) and antidepressant medication (if needed) compared to Enhanced Treatment as Usual (E-TAU) in urban pediatric primary care clinics serving primarily Latino youth. Results suggest the SCIPT-A model is feasible, acceptable and potentially beneficial for urban Latino adolescents. Clinicians delivered the SCIPT-A model with fidelity using supervision successfully implemented in a community setting.
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Affiliation(s)
- Laura Mufson
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 74, New York, NY, 10032, USA.
| | - Moira Rynn
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Paula Yanes-Lukin
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 74, New York, NY, 10032, USA
| | - Tse Hwei Choo
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 74, New York, NY, 10032, USA
- Department of Biostatistics, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Karen Soren
- Department of Pediatrics, NYP-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
- Department of Social Work, NYP-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
| | - Eileen Stewart
- Department of Social Work, NYP-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
| | - Melanie Wall
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 74, New York, NY, 10032, USA
- Department of Biostatistics, Columbia University College of Physicians and Surgeons, New York, NY, USA
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154
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Sweetland AC, Kritski A, Oquendo MA, Sublette ME, Norcini Pala A, Silva LRB, Karpati A, Silva EC, Moraes MO, Silva JRLE, Wainberg ML. Addressing the tuberculosis-depression syndemic to end the tuberculosis epidemic. Int J Tuberc Lung Dis 2018; 21:852-861. [PMID: 28786792 DOI: 10.5588/ijtld.16.0584] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Tuberculosis (TB) and depression act synergistically via social, behavioral, and biological mechanisms to magnify the burden of disease. Clinical depression is a common, under-recognized, yet treatable condition that, if comorbid with TB, is associated with increased morbidity, mortality, community TB transmission, and drug resistance. Depression may increase risk of TB reactivation, contribute to disease progression, and/or inhibit the physiological response to anti-tuberculosis treatment because of poverty, undernutrition, immunosuppression, and/or negative coping behaviors, including substance abuse. Tuberculous infection and/or disease reactivation may precipitate depression as a result of the inflammatory response and/or dysregulation of the hypothalamic-pituitary-adrenal axis. Clinical depression may also be triggered by TB-related stigma, exacerbating other underlying social vulnerabilities, and/or may be attributed to the side effects of anti-tuberculosis treatment. Depression may negatively impact health behaviors such as diet, health care seeking, medication adherence, and/or treatment completion, posing a significant challenge for global TB elimination. As several of the core symptoms of TB and depression overlap, depression often goes unrecognized in individuals with active TB, or is dismissed as a normative reaction to situational stress. We used evidence to reframe TB and depression comorbidity as the 'TB-depression syndemic', and identified critical research gaps to further elucidate the underlying mechanisms. The World Health Organization's Global End TB Strategy calls for integrated patient-centered care and prevention linked to social protection and innovative research. It will require multidisciplinary approaches that consider conditions such as TB and depression together, rather than as separate problems and diseases, to end the global TB epidemic.
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Affiliation(s)
- A C Sweetland
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
| | - A Kritski
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil TB Research Network (REDE-TB), Rio de Janeiro, Rio de Janeiro, Brazil
| | - M A Oquendo
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M E Sublette
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
| | - A Norcini Pala
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
| | - L R Batista Silva
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Rio de Janeiro, Brazil
| | - A Karpati
- Vital Strategies, New York, New York, USA
| | - E C Silva
- State University of North Fluminense Darcy Ribeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - M O Moraes
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Rio de Janeiro, Brazil
| | - J R Lapa E Silva
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - M L Wainberg
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
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155
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Overbeck G, Kousgaard MB, Davidsen AS. The work and challenges of care managers in the implementation of collaborative care: A qualitative study. J Psychiatr Ment Health Nurs 2018; 25:167-175. [PMID: 29283474 DOI: 10.1111/jpm.12449] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: In collaborative care models between psychiatry and general practice, mental health nurses are used as care managers who carry out the treatment of patients with anxiety or depression in general practice and establish a collaborating relationship with the general practitioner. Although the care manager is the key person in the collaborative care model, there is little knowledge about this role and the challenges involved in it. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Our study shows that before the CMs could start treating patients in a routine collaborative relationship with GPs, they needed to carry out an extensive amount of implementation work. This included solving practical problems of location and logistics, engaging GPs in the intervention, and tailoring collaboration to meet the GP's particular preferences. Implementing the role requires high commitment and an enterprising approach on the part of the care managers. The very experienced mental health nurses of this study had these skills. However, the same expertise cannot be presumed in a disseminated model. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When introducing new collaborative care interventions, the care manager role should be well defined and be well prepared, especially as regards the arrival of the care manager in general practice, and supported during implementation by a coordinated leadership established in collaboration between hospital psychiatry and representatives from general practice. ABSTRACT Introduction In collaborative care models for anxiety and depression, the care manager (CM), often a mental health nurse, has a key role. However, the work and challenges related to this role remain poorly investigated. Aim To explore CMs' experiences of their work and the challenges they face when implementing their role in a collaborative care intervention in the Capital Region of Denmark. Methods Interviews with eight CMs, a group interview with five CMs and a recording of one supervision session were analysed by thematic analysis. Results The CM carried out considerable implementation work. This included finding suitable locations; initiating and sustaining communication with the GPs and maintaining their engagement in the model; adapting to the patient population in general practice; dealing with personal security issues, and developing supportive peer relations and meaningful supervision. Discussion We compare our findings to previous studies of collaborative care and advanced nursing roles in general practice. The importance of organizational leadership to support the CM's bridge-building role is emphasized. Implications for practice The planners of new collaborative care interventions should not only focus on the CM's clinical tasks but also on ensuring the sufficient organizational conditions for carrying out the role.
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Affiliation(s)
- G Overbeck
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M B Kousgaard
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A S Davidsen
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
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156
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Grubbs KM, Fortney JC, Pyne J, Mittal D, Ray J, Hudson TJ. A Comparison of Collaborative Care Outcomes in Two Health Care Systems: VA Clinics and Federally Qualified Health Centers. Psychiatr Serv 2018; 69:431-437. [PMID: 29334874 PMCID: PMC7061527 DOI: 10.1176/appi.ps.201700067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Collaborative care for depression results in symptom reduction when compared with usual care. No studies have systematically compared collaborative care outcomes between veterans treated at Veterans Affairs (VA) clinics and civilians treated at publicly funded federally qualified health centers (FQHCs) after controlling for demographic and clinical characteristics. METHODS Data from two randomized controlled trials that used a similar collaborative care intervention for depression were combined to conduct post hoc analyses (N=759). The Telemedicine-Enhanced Antidepressant Management intervention was delivered in VA community-based outpatient clinics (CBOCs), and the Outreach Using Telemedicine for Rural Enhanced Access in Community Health intervention was delivered in FQHCs. Multivariate logistic regression was used to determine whether veteran status moderated the effect of the intervention on treatment response (>50% reduction in symptoms). RESULTS There was a significant main effect for intervention (odds ratio [OR]=5.23, p<.001) and a moderating effect for veteran status, with lower response rates among veterans compared with civilians (OR=.21, p=.01). The addition of variables representing medication dosage and number of mental health and general health appointments did not influence the moderating effect. A sensitivity analysis stratified by gender found a significant moderating effect of veteran status for men but not women. CONCLUSIONS Veteran status was a significant moderator of collaborative care effectiveness for depression, indicating that veterans receiving collaborative care at a CBOC are at risk of nonresponse. Unmeasured patient- or system-level characteristics may contribute to poorer response among veterans.
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Affiliation(s)
- Kathleen M Grubbs
- Dr. Grubbs is with the Department of Psychology, VA San Diego Healthcare System, San Diego. Dr. Fortney is with the Department of Psychiatry, University of Washington, Seattle, and the VA Health Services Research and Development (HSR&D) Service Center of Innovation, Seattle. Dr. Pyne, Dr. Mittal, Dr. Ray, and Dr. Hudson are with the Center for Mental Health Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Dr. Pyne, Dr. Ray, and Dr. Hudson are also with the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock
| | - John C Fortney
- Dr. Grubbs is with the Department of Psychology, VA San Diego Healthcare System, San Diego. Dr. Fortney is with the Department of Psychiatry, University of Washington, Seattle, and the VA Health Services Research and Development (HSR&D) Service Center of Innovation, Seattle. Dr. Pyne, Dr. Mittal, Dr. Ray, and Dr. Hudson are with the Center for Mental Health Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Dr. Pyne, Dr. Ray, and Dr. Hudson are also with the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Jeffrey Pyne
- Dr. Grubbs is with the Department of Psychology, VA San Diego Healthcare System, San Diego. Dr. Fortney is with the Department of Psychiatry, University of Washington, Seattle, and the VA Health Services Research and Development (HSR&D) Service Center of Innovation, Seattle. Dr. Pyne, Dr. Mittal, Dr. Ray, and Dr. Hudson are with the Center for Mental Health Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Dr. Pyne, Dr. Ray, and Dr. Hudson are also with the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Dinesh Mittal
- Dr. Grubbs is with the Department of Psychology, VA San Diego Healthcare System, San Diego. Dr. Fortney is with the Department of Psychiatry, University of Washington, Seattle, and the VA Health Services Research and Development (HSR&D) Service Center of Innovation, Seattle. Dr. Pyne, Dr. Mittal, Dr. Ray, and Dr. Hudson are with the Center for Mental Health Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Dr. Pyne, Dr. Ray, and Dr. Hudson are also with the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock
| | - John Ray
- Dr. Grubbs is with the Department of Psychology, VA San Diego Healthcare System, San Diego. Dr. Fortney is with the Department of Psychiatry, University of Washington, Seattle, and the VA Health Services Research and Development (HSR&D) Service Center of Innovation, Seattle. Dr. Pyne, Dr. Mittal, Dr. Ray, and Dr. Hudson are with the Center for Mental Health Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Dr. Pyne, Dr. Ray, and Dr. Hudson are also with the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Teresa J Hudson
- Dr. Grubbs is with the Department of Psychology, VA San Diego Healthcare System, San Diego. Dr. Fortney is with the Department of Psychiatry, University of Washington, Seattle, and the VA Health Services Research and Development (HSR&D) Service Center of Innovation, Seattle. Dr. Pyne, Dr. Mittal, Dr. Ray, and Dr. Hudson are with the Center for Mental Health Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Dr. Pyne, Dr. Ray, and Dr. Hudson are also with the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock
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157
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Van Damme A, Declercq T, Lemey L, Tandt H, Petrovic M. Late-life depression: issues for the general practitioner. Int J Gen Med 2018; 11:113-120. [PMID: 29636629 PMCID: PMC5880181 DOI: 10.2147/ijgm.s154876] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Late-life depression (LLD) is both a prevalent and life-threatening disorder, affecting up to 13.3% of the elderly population. LLD can be difficult to identify because patients mainly consult their general practitioner (GP) for somatic complaints. Moreover, patients may be hesitant to express the problem to their GP. Increased vigilance on the part of the GP can only benefit older people with depression. To recognize the risk of LLD, screening tools are provided in addition to treatment options for LLD. This review aims to provide the GP with guidance in recognizing and treating LLD. It tries to connect mainstream etiologies of LLD (e.g., vascular, inflammation, hypothalamo-pituitary-adrenal axis) with risk factors and current therapies. Therefore, we provide a basis to the GP for decision-making when choosing an appropriate therapy for LLD.
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Affiliation(s)
- Axel Van Damme
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Tom Declercq
- Department of General Practice and Primary Health Care, Ghent University, Ghent, Belgium
| | - Lieve Lemey
- Department of Psychiatry, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | - Hannelore Tandt
- Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
| | - Mirko Petrovic
- Department of Internal Medicine, Section of Geriatrics, Ghent University, Ghent, Belgium
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158
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Sultan MA, Pastrana CS, Pajer KA. Shared Care Models in the Treatment of Pediatric Attention-Deficit/Hyperactivity Disorder (ADHD): Are They Effective? Health Serv Res Manag Epidemiol 2018; 5:2333392818762886. [PMID: 29623286 PMCID: PMC5882038 DOI: 10.1177/2333392818762886] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/12/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives The aim of this review is to evaluate the effectiveness of shared/collaborative care between mental health-care providers and primary care providers (PCPs) on the outcomes of children and adolescents with attention-deficit/hyperactivity disorder (ADHD). This evaluation will be very helpful in the allocation of ADHD resources for models with the strongest evidence. Methods Using the Preferred Reporting Items for Systematic Review and Meta-analysis statement, we searched for randomized controlled trials, cohort, case-control, and cross-sectional studies on shared/collaborative care models in the treatment of ADHD. Using MEDLINE, PsycINFO, and CENTRAL databases from January 2000 to December 2016, we retrieved English language articles for review. The validation search identified 75 records. Five studies met the inclusion criteria and were analyzed in this systematic review. There were insufficient data for a meta-analysis. The included studies involved 655 children and adolescents who had a diagnosis of ADHD. The Cochrane Collaboration's tool for assessing risk of bias was used to estimate bias. Results Overall, the results show that the effects of shared/collaborative care models were small to moderate (effect size: 0.1-0.6, P = .04) on symptom rating scales, but all positively affected functional outcomes (effect size: 0.3-0.7, P = .04-.01). The data indicated that the models were associated with increased PCPs' comfort levels, but the evidence for increased capacity for diagnosing and managing ADHD was weaker. Conclusions This review concludes that the current studies do not show strong evidence for the outcome of collaboration between PCPs and mental health professionals on ADHD management. Future research should consider providing education to PCPs on management guidelines prior to conducting the trials, and more innovation is needed to discover methods of collaboration that affect the direct care of ADHD.
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Affiliation(s)
- Meshal A Sultan
- Mental Health Center of Excellence, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
| | - Carlos S Pastrana
- Neuroscience and Mental Health, Carleton University, Ottawa, Ontario, Canada
| | - Kathleen A Pajer
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
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159
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Kaipainen K, Välkkynen P, Kilkku N. Applicability of acceptance and commitment therapy-based mobile app in depression nursing. Transl Behav Med 2018; 7:242-253. [PMID: 27896798 DOI: 10.1007/s13142-016-0451-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Due to the high burden of depression, new models and methods of mental healthcare need to be developed. Prior research has shown the potential benefits of using technology tools such as mobile apps as self-help or combined with psychological treatment. Therefore, professionals should acquaint themselves with evidence-based apps to be able to use them with clients and guide the clients in their use. The purpose of this study was to explore how an acceptance and commitment therapy-based mobile app was perceived as a self-management tool among nurses, and how it could be applied in the prevention and treatment of depression and other mental health issues. Sixteen Finnish nurses undergoing depression nurse specialist education used the app for 5 weeks and participated in semistructured focus group interviews. Interviews were analyzed by qualitative content analysis. In general, the nurses found the app suitable as a self-management tool and identified three models of using it in clinical practice. Having used the app personally, the nurses were eager to take it into use with various client groups, especially in occupational health but also in the treatment of mental health problems. However, they also raised concerns about the effort needed in familiarizing oneself with the content and pointed out specific client groups for whom the benefits of the app should be carefully weighed against the potential risks. Despite the small sample size, the findings suggest that involving technology tools as part of the nurses' education could ease their adoption in clinical practice. The degree of professional support in the app use should be aligned to the severity of the mental health problems.
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Affiliation(s)
| | | | - Nina Kilkku
- Tampere University of Applied Sciences, Tampere, Finland
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160
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McGinty EE, Kennedy-Hendricks A, Linden S, Choksy S, Stone E, Daumit GL. An innovative model to coordinate healthcare and social services for people with serious mental illness: A mixed-methods case study of Maryland's Medicaid health home program. Gen Hosp Psychiatry 2018; 51:54-62. [PMID: 29316451 PMCID: PMC5869105 DOI: 10.1016/j.genhosppsych.2017.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We conducted a case study examining implementation of Maryland's Medicaid health home program, a unique model for integration of behavioral, somatic, and social services for people with serious mental illness (SMI) in the psychiatric rehabilitation program setting. METHOD We conducted interviews and surveys with health home leaders (N=72) and front-line staff (N=627) representing 46 of the 48 total health home programs active during the November 2015-December 2016 study period. We measured the structural and service characteristics of the 46 health home programs and leaders' and staff members' perceptions of program implementation. RESULTS Health home program structure varied across sites: for example, 15% of programs had co-located primary care providers and 76% had onsite supported employment providers. Most leaders and staff viewed the health home program as having strong organizational fit with psychiatric rehabilitation programs' organizational structures and missions, but noted implementation challenges around health IT, population health management, and coordination with external providers. CONCLUSION Maryland's psychiatric rehabilitation-based health home is a promising model for integration of behavioral, somatic, and social services for people with SMI but may be strengthened by additional policy and implementation supports, including incentives for external providers to engage in care coordination with health home providers.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205, United States.
| | - Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, United States
| | - Sarah Linden
- Division of General Internal Medicine, Johns Hopkins School of Medicine, United States
| | - Seema Choksy
- Division of General Internal Medicine, Johns Hopkins School of Medicine, United States
| | - Elizabeth Stone
- Division of General Internal Medicine, Johns Hopkins School of Medicine, United States
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, United States
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161
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Platts-Mills TF, Hollowell AG, Burke GF, Zimmerman S, Dayaa JA, Quigley BR, Bush M, Weinberger M, Weaver MA. Randomized controlled pilot study of an educational video plus telecare for the early outpatient management of musculoskeletal pain among older emergency department patients. Trials 2018; 19:10. [PMID: 29304831 PMCID: PMC5756407 DOI: 10.1186/s13063-017-2403-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/11/2017] [Indexed: 02/01/2023] Open
Abstract
Background Musculoskeletal pain is a common reason for emergency department (ED) visits. Following discharge from the ED, patients, particularly older patients, often have difficulty controlling their pain and managing analgesic side effects. We conducted a pilot study of an educational video about pain management with and without follow-up telephone support for older adults presenting to the ED with musculoskeletal pain. Methods ED patients aged 50 years and older with musculoskeletal pain were randomized to: (1) usual care, (2) a brief educational video only, or (3) a brief educational video plus a protocol-guided follow-up telephone call from a physician 48–72 hours after discharge (telecare). The primary outcome was the change from the average pain severity before the ED visit to the average pain severity during the past week assessed one month after the ED visit. Pain was assessed using a 0–10 numerical rating scale. Results Of 75 patients randomized (mean age 64 years), 57 (76%) completed follow up at one month. Of the 18 patients lost to follow up, 12 (67%) had non-working phone numbers. Among patients randomized to the video (arms 2 and 3), 46/50 viewed the entire video; among the 25 patients randomized to the video plus telecare (arm 3), 23 were reached for telecare. Baseline pain scores for the usual care, video, and video plus telecare groups were 7.3, 7.1, and 7.5. At one month, pain scores were 5.8, 4.9, and 4.5, corresponding to average decreases in pain of -1.5, -2.2, and -3.0, respectively. In the pairwise comparison between intervention groups, the video plus telecare group had a 1.7-point (95% CI 1.2, 2.1) greater decrease in pain compared to usual care, and the video group had a 1.1-point (95% CI 0.6, 1.6) greater decrease in pain compared to usual care after adjustment for baseline pain, age, and gender. At one month, clinically important differences were also observed between the video plus telecare and usual care groups for analgesic side effects, ongoing opioid use, and physical function. Conclusion Results of this pilot trial suggest the potential value of an educational video plus telecare to improve outcomes for older adults presenting to the ED with musculoskeletal pain. Changes to the protocol are identified to increase retention for assessment of outcomes. Trials registration ClinicalTrials.gov, NCT02438384. Registered on 5 May 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2403-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Timothy F Platts-Mills
- Department of Emergency Medicine and Division of Geriatrics, Department of Medicine, University of North Carolina Chapel Hill, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA.
| | - Allison G Hollowell
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gary F Burke
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sheryl Zimmerman
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph A Dayaa
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin R Quigley
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Montika Bush
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Morris Weinberger
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mark A Weaver
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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162
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Huang HC, Liu SI, Hwang LC, Sun FJ, Tjung JJ, Huang CR, Li TC, Huang YP, Yeung A. The effectiveness of Culturally Sensitive Collaborative Treatment of depressed Chinese in family medicine clinics: A randomized controlled trial. Gen Hosp Psychiatry 2018; 50:96-103. [PMID: 29127813 DOI: 10.1016/j.genhosppsych.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/08/2017] [Accepted: 10/09/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate whether the Culturally Sensitive Collaborative Treatment (CSCT) would improve outcomes for patients with major depression who were managed in family medicine clinics in Taiwan. METHOD A single-blinded randomized trial was conducted in 26 family medicine clinics. Patients with major depressive disorder were consecutively randomized to either CSCT or treatment as usual (TAU). The primary outcome was the severity of depression. Secondary outcomes included treatment response, treatment remission, quality of life, and medication adherence. Outcomes were compared using hierarchical linear models (mixed-effects models) from baseline to 26-week follow-up assessments. RESULTS Of the 280 patients, 141 were randomized to TAU and 139 to CSCT. Hierarchical linear modeling revealed that the CSCT group displayed significantly greater improvement in depressive symptoms over the study period when compared to the TAU group (B=-2.60, P<0.001). The odds of achieving the response, remission, and medication adherence were significantly greater for the CSCT group compared to the TAU group (odds ratio=4.65, 4.12, and 2.06, respectively; all Ps<0.05). However, both groups did not differ significantly in quality of life. CONCLUSION CSCT is effective in improving treatment outcomes for major depression in family medicine clinics in Taiwan.
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Affiliation(s)
- Hui-Chun Huang
- Department of Medical Research, MacKay Memorial Hospital, Taipei 251, Taiwan; Department of Public Health, China Medical University, Taichung 404, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei 112, Taiwan
| | - Shen-Ing Liu
- Department of Psychiatry, MacKay Memorial Hospital, Taipei 104, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan.
| | - Lee-Ching Hwang
- MacKay Junior College of Medicine, Nursing and Management, Taipei 112, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan; Department of Family Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, MacKay Memorial Hospital, Taipei 251, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei 112, Taiwan
| | - Jin-Jin Tjung
- Department of Family Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
| | - Chiu-Ron Huang
- Department of Medical Research, MacKay Memorial Hospital, Taipei 251, Taiwan
| | - Tsai-Chung Li
- Department of Public Health, China Medical University, Taichung 404, Taiwan
| | - Yo-Ping Huang
- Department of Electrical Engineering, National Taipei University of Technology, Taipei 106, Taiwan
| | - Albert Yeung
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA
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163
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Aragonès E, Palao D, López-Cortacans G, Caballero A, Cardoner N, Casaus P, Cavero M, Monreal JA, Pérez-Sola V, Cirera M, Loren M, Bellerino E, Tomé-Pires C, Palacios L. Development and assessment of an active strategy for the implementation of a collaborative care approach for depression in primary care (the INDI·i project). BMC Health Serv Res 2017; 17:821. [PMID: 29237444 PMCID: PMC5729287 DOI: 10.1186/s12913-017-2774-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/01/2017] [Indexed: 11/05/2022] Open
Abstract
Background Primary care is the principal clinical setting for the management of depression. However, significant shortcomings have been detected in its diagnosis and clinical management, as well as in patient outcomes. We developed the INDI collaborative care model to improve the management of depression in primary care. This intervention has been favorably evaluated in terms of clinical efficacy and cost-effectiveness in a clinical trial. Our aim is to bring this intervention from the scientific context into clinical practice. Methods Objective: To test for the feasibility and impact of a strategy for implementing the INDI model for depression in primary care. Design: A quasi-experiment conducted in primary care. Several areas will be established to implement the new program and other, comparable areas will serve as control group. The study constitutes the preliminary phase preceding generalization of the model in the Catalan public healthcare system. Participants: The target population of the intervention are patients with major depression. The implementation strategy will also involve healthcare professionals, primary care centers, as well as management departments and the healthcare organization itself in the geographical areas where the study will be conducted: Camp de Tarragona and Vallès Occidental (Catalonia). Intervention: The INDI model is a program for improving the management of depression involving clinical, instructional, and organizational interventions including the participation of nurses as care managers, the efficacy and efficiency of which has been proven in a clinical trial. We will design an active implementation strategy for this model based on the PARIHS (Promoting Action on Research Implementation in Health Services) framework. Measures: Qualitative and quantitative measures will be used to evaluate variables related to the successful implementation of the model: acceptability, utility, penetration, sustainability, and clinical impact. Discussion This project tests the transferability of a healthcare intervention supported by scientific research to clinical practice. If implementation is successful in this experimental phase, we will use the information and experience obtained to propose and plan the generalization of the INDI model for depression in the Catalan healthcare system. We expect the program to benefit patients, the healthcare system, and society. Trial registration ClinicalTrials.gov identifier: NCT03285659; Registered 12th September, 2017.
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Affiliation(s)
- Enric Aragonès
- Primary Care Area Camp de Tarragona, Catalan Health Institute, Tarragona, Spain. .,Primary Care Research Institute IDIAP Jordi Gol, Barcelona, Spain. .,Centre d'Atenció Primària de Constantí, Carrer dels Horts, 6, 43120, Constantí (Tarragona), Spain.
| | - Diego Palao
- Mental Health Service, University Hospital Parc Taulí, Sabadell, Spain.,Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Germán López-Cortacans
- Primary Care Area Camp de Tarragona, Catalan Health Institute, Tarragona, Spain.,Primary Care Research Institute IDIAP Jordi Gol, Barcelona, Spain
| | - Antonia Caballero
- Primary Care Area Camp de Tarragona, Catalan Health Institute, Tarragona, Spain.,Primary Care Research Institute IDIAP Jordi Gol, Barcelona, Spain
| | - Narcís Cardoner
- Mental Health Service, University Hospital Parc Taulí, Sabadell, Spain.,Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Pilar Casaus
- University Psychiatric Hospital Pere Mata Institute, Reus, Spain
| | - Myriam Cavero
- Mental Health Centre Esquerra Eixample, Hospital Clínic, Barcelona, Spain
| | | | - Víctor Pérez-Sola
- Institute of Neuropsychiatry and Addictions, Hospital del Mar, IMIM, Barcelona, Spain.,CIBERSAM, Madrid, Spain
| | - Miquel Cirera
- Healthcare Corporation Parc Taulí, Primary Care Area, Sabadell, Spain
| | - Maite Loren
- Healthcare Corporation Parc Taulí, Primary Care Area, Sabadell, Spain
| | - Eva Bellerino
- Primary Care Service Vallès Occidental, Catalan Health Institute, Sabadell, Spain
| | - Catarina Tomé-Pires
- Primary Care Research Institute IDIAP Jordi Gol, Barcelona, Spain.,Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Tarragona, Spain.,Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain
| | - Laura Palacios
- Primary Care Area Camp de Tarragona, Catalan Health Institute, Tarragona, Spain
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164
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Kates N. Mental Health and Primary Care: Contributing to Mental Health System Transformation in Canada. ACTA ACUST UNITED AC 2017. [DOI: 10.7870/cjcmh-2017-033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
For 20 years mental health and primary care providers across Canada have been working collaboratively together to improve access to care, provider skills, and patient experience. The new strategic plan of the Mental Health Commission of Canada (MHCC) offers many opportunities for collaborative care to play a role in the transformation of Canada’s mental health systems. To assist the plan, this paper presents principles underlying successful projects and ways that mental health and primary care services can work together more collaboratively, including integrating mental health providers in primary care. It integrates these concepts into a Canadian Model for Collaborative Mental Health Care that can guide future expansion of these approaches, and suggests ways in which better collaboration can address wider issues facing all of Canada’s health care systems.
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165
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Individualising Chronic Care Management by Analysing Patients' Needs - A Mixed Method Approach. Int J Integr Care 2017; 17:2. [PMID: 29588635 PMCID: PMC5854149 DOI: 10.5334/ijic.3067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Modern health systems are increasingly faced with the challenge to provide effective, affordable and accessible health care for people with chronic conditions. As evidence on the specific unmet needs and their impact on health outcomes is limited, practical research is needed to tailor chronic care to individual needs of patients with diabetes. Qualitative approaches to describe professional and informal caregiving will support understanding the complexity of chronic care. Results are intended to provide practical recommendations to be used for systematic implementation of sustainable chronic care models. Method A mixed method study was conducted. A standardised survey (n = 92) of experts in chronic care using mail responses to open-ended questions was conducted to analyse existing chronic care programs focusing on effective, problematic and missing components. An expert workshop (n = 22) of professionals and scientists of a European funded research project MANAGE CARE was used to define a limited number of unmet needs and priorities of elderly patients with type 2 diabetes mellitus and comorbidities. This list was validated and ranked using a multilingual online survey (n = 650). Participants of the online survey included patients, health care professionals and other stakeholders from 56 countries. Results The survey indicated that current care models need to be improved in terms of financial support, case management and the consideration of social care. The expert workshop identified 150 patient needs which were summarised in 13 needs dimensions. The online survey of these pre-defined dimensions revealed that financial issues, education of both patients and professionals, availability of services as well as health promotion are the most important unmet needs for both patients and professionals. Conclusion The study uncovered competing demands which are not limited to medical conditions. The findings emphasise that future care models need to focus stronger on individual patient needs and promote their active involvement in co-design and implementation. Future research is needed to develop new chronic care models providing evidence-based and practical implications for the regional care setting.
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166
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Souliotis K, Agapidaki E, Tzavara C, Economou M. Psychiatrists role in primary health care in Greece: findings from a quantitative study. Int J Ment Health Syst 2017; 11:65. [PMID: 29075320 PMCID: PMC5651643 DOI: 10.1186/s13033-017-0172-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/10/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Although the need for integration of mental health services into primary care is well established little has been done. The outbreak of the recession found the Greek mental health system in transition. As a response to the crisis, governments implemented horizontal budget cuts instead of health reforms. This resulted in an unfavorable situation for mental health which was set once again on the sidelines of the health policy agenda. Previous studies suggest that the most prevalent disorders in the years of financial crisis in Greece are depression and anxiety while a general increase of the psychiatric morbidity is observed does not follow the population' needs. METHODS The present descriptive study was carried out between March and June of 2015. A convenience sample of 174 psychiatrists and psychiatry residents who met the inclusion criteria were finally selected to participate. Data were collected by using a 40-items questionnaire consisted of three sections: (a) nine questions about demographics, (b) nine questions pertaining to general aspects of administrative regulations related to primary care, (c) 22 questions about psychiatrists attitudes and perceptions towards their role in primary care. Quantitative variables are expressed as mean values, while qualitative variables as absolute and relative frequencies. RESULTS The vast majority of participants perceives the public primary care services and mental health services in their community as inadequate and considers psychiatrists' participation in primary care as important in order to improve the detection and management rates of people demonstrating mental health symptoms. They also believe that: (a) primary care practitioners' usually fail to detect the mental health conditions of patients; (b) their participation in primary care will decrease the social stigmatization for mental health conditions; (c) patients receiving pharmaceutical treatment for mental health problems by GPs and other primary care professionals usually fail to comply. CONCLUSIONS Respondents in the present study are receptive to participate in primary care. They believe that their inclusion to primary care will result to decreased social stigmatization for mental health problems, increased patient' access and improved detection and management rates for common mental health conditions.
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Affiliation(s)
- Kyriakos Souliotis
- Faculty of Social and Political Sciences, Department of Social and Education Policy, University of Peloponnese, Damaskinou & Kolokotroni Str., 20100 Corinth, Greece
- Health Policy Institute, Athens, Greece
| | - Eirini Agapidaki
- Health Policy Institute, 36-38, Amaryssias Artemidos Str., 15124 Athens, Greece
| | - Chara Tzavara
- Health Policy Institute, 36-38, Amaryssias Artemidos Str., 15124 Athens, Greece
| | - Marina Economou
- University Mental Health Research Institute (UMHRI), Athens, Greece
- First Department of Psychiatry, Medical School, University of Athens, Eginition Hospital, Soranou Ephesiou st., 115 27 Athens, Greece
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167
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Witt DR, Garrison GM, Gonzalez CA, Witt TJ, Angstman KB. Six-Month Outcomes for Collaborative Care Management of Depression Among Smoking and Nonsmoking Patients. Health Serv Res Manag Epidemiol 2017; 4:2333392817721648. [PMID: 28890910 PMCID: PMC5580839 DOI: 10.1177/2333392817721648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 06/22/2017] [Indexed: 01/22/2023] Open
Abstract
Background: Collaborative care management (CCM) is an evidence-based model that contributes to better outcomes for depression treatment in the primary care setting. Tobacco use increases overall economic costs, morbidity, and mortality and has been shown to impact behavioral health outcomes. Our study aims to observe clinical outcomes for depression treatment for patients with comorbid tobacco use and depression within the CCM model. Methods: A retrospective chart review study of 2826 adult patients with depression enrolled in CCM was performed to determine the association between regular tobacco use and depression outcomes. Baseline intake data consisting of clinical and demographic variables along with 6-month follow-up of Patient Health Questionnaire-9 (PHQ-9) scores for smokers (n = 727, 25.7%) and nonsmokers (n = 2099, 74.3%) were obtained. Depression remission was defined as a PHQ-9 score <5 and persistent depressive symptoms (PDS) as a PHQ-9 score ≥10 at 6 months. Results: Using an intention-to-treat analysis, the multivariate modeling demonstrated that smokers, at 6 months, had an increased adjusted odds ratio (AOR) for PDS: 1.624 (95% CI: 1.353-1.949). Furthermore, smokers had a lower AOR of depression remission: 0.603 (95% CI: 0.492-0.739). Patient adherence to treatment was also lower in smokers with an AOR of 0.666 (95% CI: 0.553-0.802). Conclusions: Smokers enrolled in CCM were associated with reduced treatment adherence and worse outcomes for depression treatment at 6 months compared to nonsmokers, even when baseline clinical and demographic variables were controlled. Thus, new tailored practices may be warranted within the CCM model to treat comorbid depression and tobacco use disorders.
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Affiliation(s)
- Daniel R Witt
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Cesar A Gonzalez
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Terrence J Witt
- Department of Family Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Kurt B Angstman
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
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168
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Bauer AM, Hodsdon S, Hunter S, Choi Y, Bechtel J, Fortney JC. Lessons from the Deployment of the SPIRIT App to Support Collaborative Care for Rural Patients with Complex Psychiatric Conditions. PROCEEDINGS OF THE ... ACM INTERNATIONAL CONFERENCE ON UBIQUITOUS COMPUTING . UBICOMP (CONFERENCE) 2017; 2017:772-780. [PMID: 29075683 DOI: 10.1145/3123024.3125610] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We report the design and deployment of a mobile health system for patients receiving primary care-based mental health services (Collaborative Care) for post-traumatic stress disorder and/or bipolar disorder in rural health centers. Here we describe the clinical model, our participatory approach to designing and deploying the mobile system, and describe the final system. We focus on the integration of the system into providers' clinical workflow and patient registry system. 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.
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Affiliation(s)
- Amy M Bauer
- Psychiatry & Behavioral Sciences, University of Washington, Seattle WA 98195-6560, USA
| | | | - Suzanne Hunter
- Psychiatry & Behavioral Sciences, University of Washington, Seattle WA 98195-6560, USA
| | - Youlim Choi
- Psychiatry & Behavioral Sciences, University of Washington, Seattle WA 98195-6560, USA
| | - Jared Bechtel
- Psychiatry & Behavioral Sciences, University of Washington, Seattle WA 98195-6560, USA
| | - John C Fortney
- Psychiatry & Behavioral Sciences, University of Washington, Seattle WA 98195-6560, USA
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169
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Ortíz-Barrios MA, Escorcia-Caballero JP, Sánchez-Sánchez F, De Felice F, Petrillo A. Efficiency Analysis of Integrated Public Hospital Networks in Outpatient Internal Medicine. J Med Syst 2017; 41:163. [DOI: 10.1007/s10916-017-0812-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 08/29/2017] [Indexed: 11/25/2022]
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170
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Shen N, Sockalingam S, Abi Jaoude A, Bailey SM, Bernier T, Freeland A, Hawa A, Hollenberg E, Woldemichael B, Wiljer D. Scoping review protocol: education initiatives for medical psychiatry collaborative care. BMJ Open 2017; 7:e015886. [PMID: 28871017 PMCID: PMC5588937 DOI: 10.1136/bmjopen-2017-015886] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The collaborative care model is an approach providing care to those with mental health and addictions disorders in the primary care setting. There is a robust evidence base demonstrating its clinical and cost-effectiveness in comparison with usual care; however, the transitioning to this new paradigm of care has been difficult. While there are efforts to train and prepare healthcare professionals, not much is known about the current state of collaborative care training programmes. The objective of this scoping review is to understand how widespread these collaborative care education initiatives are, how they are implemented and their impacts. METHODS AND ANALYSIS The scoping review methodology uses the established review methodology by Arksey and O'Malley. The search strategy was developed by a medical librarian and will be applied in eight different databases spanning multiple disciplines. A two-stage screening process consisting of a title and abstract scan and a full-text review will be used to determine the eligibility of articles. To be included, articles must report on an existing collaborative care education initiative for healthcare providers. All articles will be independently assessed for eligibility by pairs of reviewers, and all eligible articles will be abstracted and charted in duplicate using a standardised form. The extracted data will undergo a 'narrative review' or a descriptive analysis of the contextual or process-oriented data and simple quantitative analysis using descriptive statistics. ETHICS AND DISSEMINATION Research ethics approval is not required for this scoping review. The results of this scoping review will inform the development of a collaborative care training initiative emerging from the Medical Psychiatry Alliance, a four-institution philanthropic partnership in Ontario, Canada. The results will also be presented at relevant national and international conferences and published in a peer-reviewed journal.
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Affiliation(s)
- Nelson Shen
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Alexxa Abi Jaoude
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sharon M Bailey
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Thérèse Bernier
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Alison Freeland
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Trillium Health Partners, Mississauga, Ontario, Canada
| | - Aceel Hawa
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Elisa Hollenberg
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Bethel Woldemichael
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - David Wiljer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, University Health Network, Toronto, Ontario, Canada
- Trillium Health Partners, Mississauga, Ontario, Canada
- UHN Digital, University Health Network, Toronto, Ontario, Canada
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171
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Joseph R, Kester R, O’Brien C, Huang H. The Evolving Practice of Psychiatry in the Era of Integrated Care. PSYCHOSOMATICS 2017; 58:466-473. [DOI: 10.1016/j.psym.2017.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/08/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
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172
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Gunn J, Wachtler C, Fletcher S, Davidson S, Mihalopoulos C, Palmer V, Hegarty K, Coe A, Murray E, Dowrick C, Andrews G, Chondros P. Target-D: a stratified individually randomized controlled trial of the diamond clinical prediction tool to triage and target treatment for depressive symptoms in general practice: study protocol for a randomized controlled trial. Trials 2017; 18:342. [PMID: 28728604 PMCID: PMC5520374 DOI: 10.1186/s13063-017-2089-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/05/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Depression is a highly prevalent and costly disorder. Effective treatments are available but are not always delivered to the right person at the right time, with both under- and over-treatment a problem. Up to half the patients presenting to general practice report symptoms of depression, but general practitioners have no systematic way of efficiently identifying level of need and allocating treatment accordingly. Therefore, our team developed a new clinical prediction tool (CPT) to assist with this task. The CPT predicts depressive symptom severity in three months' time and based on these scores classifies individuals into three groups (minimal/mild, moderate, severe), then provides a matched treatment recommendation. This study aims to test whether using the CPT reduces depressive symptoms at three months compared with usual care. METHODS The Target-D study is an individually randomized controlled trial. Participants will be 1320 general practice patients with depressive symptoms who will be approached in the practice waiting room by a research assistant and invited to complete eligibility screening on an iPad. Eligible patients will provide informed consent and complete the CPT on a purpose-built website. A computer-generated allocation sequence stratified by practice and depressive symptom severity group, will randomly assign participants to intervention (treatment recommendation matched to predicted depressive symptom severity group) or comparison (usual care plus Target-D attention control) arms. Follow-up assessments will be completed online at three and 12 months. The primary outcome is depressive symptom severity at three months. Secondary outcomes include anxiety, mental health self-efficacy, quality of life, and cost-effectiveness. Intention-to-treat analyses will test for differences in outcome means between study arms overall and by depressive symptom severity group. DISCUSSION To our knowledge, this is the first depressive symptom stratification tool designed for primary care which takes a prognosis-based approach to provide a tailored treatment recommendation. If shown to be effective, this tool could be used to assist general practitioners to implement stepped mental-healthcare models and contribute to a more efficient and effective mental health system. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR 12616000537459 ). Retrospectively registered on 27 April 2016. See Additional file 1 for trial registration data.
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Affiliation(s)
- Jane Gunn
- Department of General Practice, University of Melbourne, Melbourne, VIC Australia
| | - Caroline Wachtler
- Department of General Practice, University of Melbourne, Melbourne, VIC Australia
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Susan Fletcher
- Department of General Practice, University of Melbourne, Melbourne, VIC Australia
| | - Sandra Davidson
- Department of General Practice, University of Melbourne, Melbourne, VIC Australia
| | | | - Victoria Palmer
- Department of General Practice, University of Melbourne, Melbourne, VIC Australia
| | - Kelsey Hegarty
- Department of General Practice, University of Melbourne, Melbourne, VIC Australia
| | - Amy Coe
- Department of General Practice, University of Melbourne, Melbourne, VIC Australia
| | - Elizabeth Murray
- Department of General Practice, University of Melbourne, Melbourne, VIC Australia
- eHealth Unit, Department of Primary Care and Population Health, University College London, London, UK
| | - Christopher Dowrick
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Gavin Andrews
- School of Psychiatry, University of New South Wales, Sydney, NSW Australia
| | - Patty Chondros
- Department of General Practice, University of Melbourne, Melbourne, VIC Australia
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Katzelnick DJ. Systematic Case Review in Integrated Care. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2017; 15:292-293. [PMID: 31975860 DOI: 10.1176/appi.focus.20170019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- David J Katzelnick
- Dr. Katzelnick is with the Department of Psychiatry and Psychology, Division of Integrated Behavioral Health, Mayo Clinic, Rochester, Minnesota (e-mail: )
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174
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Why Collaborative Care for Depressed Patients is so Difficult: A Belgian Qualitative Study. Int J Integr Care 2017; 17:7. [PMID: 28970748 PMCID: PMC5624092 DOI: 10.5334/ijic.2491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although current guidelines recommend collaborative care for severely depressed patients, few patients get adequate treatment. In this study we aimed to identify the thresholds for interdisciplinary collaboration amongst practitioners when treating severely depressed patients. In addition, we aimed to identify specific and feasible steps that may add to improved collaboration amongst first and second level Belgian health care providers when treating depressed patients. In two standard focus groups (n = 8; n = 12), general practitioners and psychiatrists first outlined current practice and its shortcomings. In a next phase, the same participants were gathered in nominal groups to identify and prioritise steps that could give rise to improved collaboration. Thematic analyses were performed. Though some barriers for interdisciplinary collaboration may seem easy to overcome, participants stressed the importance of certain boundary conditions on a macro- (e.g., financing of care, secure communication technology) and meso-level (e.g., support for first level practitioner). Findings are discussed against the background of frameworks on collaboration in healthcare and recent developments in mental health care.
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175
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Angstman KB, Seshadri A, Marcelin A, Gonzalez CA, Garrison GM, Allen JS. Personality Disorders in Primary Care: Impact on Depression Outcomes Within Collaborative Care. J Prim Care Community Health 2017; 8:233-238. [PMID: 28613090 PMCID: PMC5932731 DOI: 10.1177/2150131917714929] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background:Individuals with personality disorders (PDs) are high utilizers of primary care and mental health services; however, they struggle to utilize the care effectively and studies have shown a strong association between having a PD and higher impairment in social role functioning. This is especially important because PDs are highly comorbid with a wide range of other mental health disorders. The collaborative care model (CCM) for depression was developed with an emphasis on patient engagement and aimed to reduce health care utilization, while improving treatment outcomes in primary care. We hypothesized that the diagnosis of a personality disorder in primary care patients will negatively affect 6-month depression outcomes after enrollment into a CCM. Methods: This retrospective chart review study was conducted on patients enrolled into CCM over a period of 7 years with collection of 6-month follow-up data. A total of 2826 patients were enrolled into CCM with a clinical diagnosis of depression and a baseline Patient Health Questionnaire–9 (PHQ-9) ≥10 were included in the study cohort. Using the depression database, baseline and 6-month follow-up data were obtained. Adjusted odds ratios (AORs) were determined for both remission and persistent depressive symptoms using logistic regression modeling for the 6-month PHQ-9 outcome; while retaining all the study variables. Results: Of the 2826 CCM patients with depression in our study, 216 (7.6%) were found to have a PD. Patients with PD were younger (37.7 vs 42.5 years, P < .001) and more likely to be unmarried (36.1% vs 55.6%, P < .001) than patients without a PD. While age, marital status, clinical diagnosis, and Mood Disorders Questionnaire (MDQ) score were significant predictors of remission; anxiety symptoms, gender, and race were not. The presence of a PD diagnosis was associated with a 60% lower likelihood of remission at 6 months (AOR = 0.39; 95% CI 0.28-0.54). Conversely, patients without a PD were 2.5 times as likely to experience remission at 6-month remission compared to patients with PD (AOR =2.57; 95% CI 1.85-3.56). Conclusion: Patients with a personality disorder were more likely to have a recurrent depressive disorder diagnosis, an abnormal MDQ score, increased anxiety symptoms, and higher baseline PHQ-9 score. Patients with PD had worse CCM outcomes at 6 months with only 25.0% able to achieve remission versus 54.3% (P < .001) without a PD. The presence of a PD with depression was associated with poor outcomes (reduced remission rates and increased persistent depressive symptoms rates) in comparison to patients without a diagnosis of PD, while treated within CCM.
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176
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Khodyakov D, Williams P, Bromley E, Chung B, Wells K. Using Stakeholder Input to Inform an Innovative Research and Policy Initiative to Improve Depression in Safety Net Communities. Prog Community Health Partnersh 2017; 11:93-98. [PMID: 28529465 DOI: 10.1353/cpr.2017.0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
THE PROBLEM Depression quality improvement programs based on chronic disease management models have been shown to improve depression outcomes. Nonetheless, access to and the use of such programs is limited in minority, under-resourced communities. PURPOSE OF ARTICLE We report on the outcomes of a Delphi-based consensus exercise conducted by our partnership at a community-wide conference in Los Angeles. Participants identified and prioritized the needs of depressed individuals that should be addressed in a county-wide Health Neighborhood Initiative designed to increase existing mental health, substance use, healthcare, and social services for individuals with low socioeconomic position. KEY POINTS Participants agreed that housing is the number one priority. Delphi results also illustrate the importance of addressing social, spiritual, and healthcare access needs of depressed individuals. CONCLUSIONS Our study shows how to systematically engage community-based organizations, patients, families, and community members in the process of improving the design of community-wide health policy initiatives.
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Affiliation(s)
| | - Pluscedia Williams
- Healthy African American Families II.,Charles R. Drew University of Medicine and Science
| | - Elizabeth Bromley
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine at University of California Los Angeles.,VA Mental Illness Research, Education and Clinical Center, Greater Los Angeles VA Healthcare System
| | - Bowen Chung
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine at University of California Los Angeles.,Department of Psychiatry, Harbor-UCLA Medical Center/Los Angeles Biomedical Research Institute
| | - Kenneth Wells
- RAND Corporation.,Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine at University of California Los Angeles.,Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health
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177
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Puyat JH, Kazanjian A, Wong H, Goldner EM. Is the Road to Mental Health Paved With Good Incentives? Estimating the Population Impact of Physician Incentives on Mental Health Care Using Linked Administrative Data. Med Care 2017; 55:182-190. [PMID: 27632766 DOI: 10.1097/mlr.0000000000000639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The use of physician incentives to improve health care, in general, has been extensively studied but its value in mental health care has rarely been demonstrated. In this study the population-level impact of physician incentives on mental health care was estimated using indicators for receipt of counseling/psychotherapy (CP); antidepressant therapy (AT); minimally adequate counseling/psychotherapy; and minimally adequate antidepressant therapy. The incentives' impacts on overall continuity of care and of mental health care were also examined. MATERIALS AND METHODS Monthly cohorts of individuals diagnosed with major depression were identified between January 2005 and December 2012 and their use of mental health services tracked for 12 months following initial diagnosis. Linked health administrative data were used to ascertain cases and measure health service use. Pre-post changes associated with the introduction of physician incentives were estimated using segmented regression analyses, after adjusting for seasonal variation. RESULTS Physician incentives reversed the downward and upward trends in CP and AT. Five years postintervention, the estimated impacts in percentage points for CP, AT, minimally adequate counseling/psychotherapy, and minimally adequate antidepressant therapy were +3.28 [95% confidence interval (CI), 2.05-4.52], -4.47 (95% CI, -6.06 to -2.87), +1.77 (95% CI, 0.94-2.59), and -2.24 (95% CI, -4.04 to -0.45). Postintervention, the downward trends in continuity of care failed to reverse, but were disrupted, netting estimated impacts of +7.53 (95% CI, 4.54-10.53) and +4.37 (95% CI, 2.64-6.09) for continuity of care and of mental health care. CONCLUSIONS The impact of physician incentives on mental health care was modest at best. Other policy interventions are needed to close existing gaps in mental health care.
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Affiliation(s)
- Joseph H Puyat
- *School of Population and Public Health, University of British Columbia †Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
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178
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[Reliability and dimensionality of PHQ-9 in screening depression symptoms among health science students in Cartagena, 2014]. BIOMEDICA 2017; 37:112-120. [PMID: 28527273 DOI: 10.7705/biomedica.v37i0.3221] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 11/10/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Depression among university students must be screened with valid instruments. The Patient Health Questionnaire (PHQ-9) is reliable and valid for screening depression in a university context; however, its psychometric performance in Colombia is unknown. OBJECTIVE To estimate the reliability and dimensionality of PHQ-9 as a screening instrument for depressive symptoms among health sciences students of a university in Cartagena, Colombia.Materials y methods: We analyzed the factorial structure and reliability of the PHQ-9 in a sample of 550 students for expected prevalence of clinically-meaningful depressive symptoms (CMDS) of 25% with a confidence level of 95% and an error level of 3%. We used the free Spanish version of PHQ-9 for Colombia, authorized by its creators. A confirmatory factorial analysis, and an estimate of internal consistency using Cronbach´s alfa and McDonald´s omega were obtained. RESULTS We analyzed 541 surveys. The average age of the group was 20.18 (SD=2.59) years old, 354 (63.77%) participants were women and 196 (36.23%) men. CMDS prevalence was 27.3%. The confirmatory factorial analysis exhibited a two-factor model, which explained the total variance of 42.80%. The proportion of variance explained by the factors was 0.243 (item 5) and 0.587 (item 2). Cronbach´s alfa was 0.830 and McDonald´s omega, 0.89. CONCLUSIONS PHQ-9 was a valid and reliable tool for screening depressive symptoms among health sciences students in a university in Cartagena, Colombia.
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179
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Closing the False Divide: Sustainable Approaches to Integrating Mental Health Services into Primary Care. J Gen Intern Med 2017; 32:404-410. [PMID: 28243873 PMCID: PMC5377893 DOI: 10.1007/s11606-016-3967-9] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/21/2016] [Accepted: 12/06/2016] [Indexed: 01/18/2023]
Abstract
Mental disorders account for 25% of all health-related disability worldwide. More patients receive treatment for mental disorders in the primary care sector than in the mental health specialty setting. However, brief visits, inadequate reimbursement, deficits in primary care provider (PCP) training, and competing demands often limit the capacity of the PCP to produce optimal outcomes in patients with common mental disorders. More than 80 randomized trials have shown the benefits of collaborative care (CC) models for improving outcomes of patients with depression and anxiety. Six key components of CC include a population-based approach, measurement-based care, treatment to target strategy, care management, supervision by a mental health professional (MHP), and brief psychological therapies. Multiple trials have also shown that CC for depression is equally or more cost-effective than many of the current treatments for medical disorders. Factors that may facilitate the implementation of CC include a more favorable alignment of medical and mental health services in accountable care organizations and patient-centered medical homes; greater use of telecare as well as automated outcome monitoring; identification of patients who might benefit most from CC; and systematic training of both PCPs and MHPs in integrated team-based care.
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180
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Mendoza W, Miranda JJ. Global Shifts in Cardiovascular Disease, the Epidemiologic Transition, and Other Contributing Factors: Toward a New Practice of Global Health Cardiology. Cardiol Clin 2017; 35:1-12. [PMID: 27886780 DOI: 10.1016/j.ccl.2016.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
One of the major drivers of change in the practice of cardiology is population change. This article discusses the current debate about epidemiologic transition paired with other ongoing transitions with direct relevance to cardiovascular conditions. Challenges specific to patterns of risk factors over time; readiness for disease surveillance and meeting global targets; health system, prevention, and treatment efforts; and physiologic traits and human-environment interactions are identified. This article concludes that a focus on the most populated regions of the world will contribute substantially to protecting the large gains in global survival and life expectancy accrued over the last decades.
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Affiliation(s)
- Walter Mendoza
- United Nations Population Fund, Peru Country Office, Av. Guardia Civil 1231, San Isidro, Lima 27, Peru
| | - J Jaime Miranda
- School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb. Ingeniería, San Martín de Porres, Lima 31, Peru; CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru.
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181
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Wagner EH, Flinter M, Hsu C, Cromp D, Austin BT, Etz R, Crabtree BF, Ladden MD. Effective team-based primary care: observations from innovative practices. BMC FAMILY PRACTICE 2017; 18:13. [PMID: 28148227 PMCID: PMC5289007 DOI: 10.1186/s12875-017-0590-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 01/22/2017] [Indexed: 11/22/2022]
Abstract
Background Team-based care is now recognized as an essential feature of high quality primary care, but there is limited empiric evidence to guide practice transformation. The purpose of this paper is to describe advances in the configuration and deployment of practice teams based on in-depth study of 30 primary care practices viewed as innovators in team-based care. Methods As part of LEAP, a national program of the Robert Wood Johnson Foundation, primary care experts nominated 227 innovative primary care practices. We selected 30 practices for intensive study through review of practice descriptive and performance data. Each practice hosted a 3-day site visit between August, 2012 and September, 2013, where specific advances in team configuration and roles were noted. Advances were identified by site visitors and confirmed at a meeting involving representatives from each of the 30 practices. Results LEAP practices have expanded the roles of existing staff and added new personnel to provide the person power and skills needed to perform the tasks and functions expected of a patient-centered medical home (PCMH). LEAP practice teams generally include a rich array of staff, especially registered nurses (RNs), behavioral health specialists, and lay health workers. Most LEAP practices organize their staff into core teams, which are built around partnerships between providers and specific Medical Assistants (MAs), and often include registered nurses (RNs) and others such as health coaches or receptionists. MAs, RNs, and other staff are heavily involved in the planning and delivery of preventive and chronic illness care. The care of more complex patients is supported by behavioral health specialists, RN care managers, and pharmacists. Standing orders and protocols enable staff to act independently. Conclusions The 30 LEAP practices engage health professional and lay staff in patient care to the maximum extent, which enables the practices to meet the expectations of a PCMH and helps free up providers to focus on tasks that only they can perform. Electronic supplementary material The online version of this article (doi:10.1186/s12875-017-0590-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edward H Wagner
- MacColl Center for Health Care Innovation, Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA.
| | | | - Clarissa Hsu
- Center for Community Health and Evaluation, Group Health Research Institute, Seattle, WA, USA
| | - DeAnn Cromp
- Center for Community Health and Evaluation, Group Health Research Institute, Seattle, WA, USA
| | - Brian T Austin
- MacColl Center for Health Care Innovation, Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA
| | - Rebecca Etz
- Department of Family Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Benjamin F Crabtree
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, Piscataway Township, NJ, USA
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182
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Chauhan BF, Jeyaraman MM, Mann AS, Lys J, Skidmore B, Sibley KM, Abou-Setta AM, Zarychanski R. Behavior change interventions and policies influencing primary healthcare professionals' practice-an overview of reviews. Implement Sci 2017; 12:3. [PMID: 28057024 PMCID: PMC5216570 DOI: 10.1186/s13012-016-0538-8] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/13/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is a plethora of interventions and policies aimed at changing practice habits of primary healthcare professionals, but it is unclear which are the most appropriate, sustainable, and effective. We aimed to evaluate the evidence on behavior change interventions and policies directed at healthcare professionals working in primary healthcare centers. METHODS Study design: overview of reviews. DATA SOURCE MEDLINE (Ovid), Embase (Ovid), The Cochrane Library (Wiley), CINAHL (EbscoHost), and grey literature (January 2005 to July 2015). STUDY SELECTION two reviewers independently, and in duplicate, identified systematic reviews, overviews of reviews, scoping reviews, rapid reviews, and relevant health technology reports published in full-text in the English language. DATA EXTRACTION AND SYNTHESIS two reviewers extracted data pertaining to the types of reviews, study designs, number of studies, demographics of the professionals enrolled, interventions, outcomes, and authors' conclusions for the included studies. We evaluated the methodological quality of the included studies using the AMSTAR scale. For the comparative evaluation, we classified interventions according to the behavior change wheel (Michie et al.). RESULTS Of 2771 citations retrieved, we included 138 reviews representing 3502 individual studies. The majority of systematic reviews (91%) investigated behavior and practice changes among family physicians. Interactive and multifaceted continuous medical education programs, training with audit and feedback, and clinical decision support systems were found to be beneficial in improving knowledge, optimizing screening rate and prescriptions, enhancing patient outcomes, and reducing adverse events. Collaborative team-based policies involving primarily family physicians, nurses, and pharmacists were found to be most effective. Available evidence on environmental restructuring and modeling was found to be effective in improving collaboration and adherence to treatment guidelines. Limited evidence on nurse-led care approaches were found to be as effective as general practitioners in patient satisfaction in settings like asthma, cardiovascular, and diabetes clinics, although this needs further evaluation. Evidence does not support the use of financial incentives to family physicians, especially for long-term behavior change. CONCLUSIONS Behavior change interventions including education, training, and enablement in the context of collaborative team-based approaches are effective to change practice of primary healthcare professionals. Environmental restructuring approaches including nurse-led care and modeling need further evaluation. Financial incentives to family physicians do not influence long-term practice change.
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Affiliation(s)
- Bhupendrasinh F Chauhan
- College of Pharmacy, University of Manitoba, Winnipeg, Canada.
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.
| | - Maya M Jeyaraman
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | | | - Justin Lys
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | | | - Kathryn M Sibley
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ryan Zarychanski
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Haematology and Medical Oncology, CancerCare Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
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183
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Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Determine the prevalence of clinician-diagnosed posttraumatic stress disorder (PTSD) in primary care patients• Identify the prevalence of questionnaire-ascertained PTSD symptoms in primary care patients OBJECTIVE: Determine the prevalence of clinician-diagnosed PTSD and questionnaire-ascertained PTSD symptoms in primary care patients. METHODS A systematic review of the literature using the PRISMA method, searching MEDLINE, CINAHL, Cochrane Database, PsycINFO, EMBASE, Google Scholar, and relevant book chapter bibliographies. Studies that reported on the prevalence, including point or lifetime prevalence, of PTSD ascertained using diagnostic interviews or self-report questionnaires, or from administrative data, among patients seen in primary care were deemed eligible for inclusion. We abstracted data on the PTSD assessment tool, the mean questionnaire scores/cutoff scores, the time period of PTSD symptoms, and PTSD prevalence reported. RESULTS Of 10,614 titles screened, 41 studies were eligible for inclusion. The included studies assessed PTSD in a total of 7,256,826 primary care patients. The median point prevalence of PTSD across studies was 12.5%. The median point prevalence in the civilian population was 11.1%; in the special-risk population, 12.5%; and in veterans, 24.5%. The point prevalence of diagnostic interview-ascertained PTSD ranged from 2% to 32.5%, and the point prevalence of questionnaire-based substantial PTSD symptoms ranged from 2.9% to 39.1%. Lifetime prevalence of diagnostic interview-ascertained PTSD ranged from 14.5% to 48.8%. The prevalence of PTSD in administrative data-based studies ranged from 3.5% to 29.2%. CONCLUSIONS PTSD is common in primary care settings. Additional research on effective and generalizable interventions for PTSD in primary care is needed.
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184
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Whitebird RR, Solberg LI, Crain AL, Rossom RC, Beck A, Neely C, Dreskin M, Coleman KJ. Clinician burnout and satisfaction with resources in caring for complex patients. Gen Hosp Psychiatry 2017; 44:91-95. [PMID: 27432586 DOI: 10.1016/j.genhosppsych.2016.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 03/21/2016] [Accepted: 03/25/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe primary care clinicians' self-reported satisfaction, burnout and barriers for treating complex patients. METHODS We conducted a survey of 1554 primary care clinicians in 172 primary care clinics in 18 health care systems across 8 states prior to the implementation of a collaborative model of care for patients with depression and diabetes and/or cardiovascular disease. RESULTS Of the clinicians who responded to the survey (n=709; 46%), we found that a substantial minority (31%) were experiencing burnout that was associated with lower career satisfaction (P<.0001) and lower satisfaction with resources to treat complex patients (P<.0001). Less than 50% of clinicians rated their ability to treat complex patients as very good to excellent with 21% rating their ability as fair to poor. The majority of clinicians (72%) thought that a collaborative model of care would be very helpful for treating complex patients. CONCLUSIONS Burnout remains a problem for primary care clinicians and is associated with low job satisfaction and low satisfaction with resources to treat complex patients. A collaborative care model for patients with mental and physical health problems may provide the resources needed to improve the quality of care for these patients.
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Affiliation(s)
- Robin R Whitebird
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA; School of Social Work, University of St. Thomas, St. Paul, MN, USA.
| | - Leif I Solberg
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA
| | - A Lauren Crain
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA
| | - Rebecca C Rossom
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA
| | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA
| | - Claire Neely
- Institute for Clinical Systems Improvement, Minneapolis, MN, USA
| | - Mark Dreskin
- Kaiser Permanente Southern California, Pasadena, CA, USA
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185
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Rossom RC, Solberg LI, Magnan S, Crain AL, Beck A, Coleman KJ, Katzelnick D, Williams MD, Neely C, Ohnsorg K, Whitebird R, Brandenfels E, Pollock B, Ferguson R, Williams S, Unützer J. Impact of a national collaborative care initiative for patients with depression and diabetes or cardiovascular disease. Gen Hosp Psychiatry 2017; 44:77-85. [PMID: 27558106 DOI: 10.1016/j.genhosppsych.2016.05.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The spread of evidence-based care is an important challenge in healthcare. We evaluated spread of an evidence-based large-scale multisite collaborative care model for patients with depression and diabetes and/or cardiovascular disease (COMPASS). METHODS Primary care patients with depression and comorbid diabetes or cardiovascular disease were recruited. Collaborative care teams used care management tracking systems and systematic case reviews to track and intensify treatment for patients not improving. Targeted outcomes were depression remission and response (assessed with the Patient Health Questionnaire-9) and control of diabetes (assessed by HbA1c) and blood pressure. Patients and clinicians were surveyed about satisfaction with care. RESULTS Eighteen care systems and 172 clinics enrolled 3609 patients across the US. Of those with uncontrolled disease at enrollment, 40% achieved depression remission or response, 23% glucose control and 58% blood pressure control during a mean follow-up of 11 months. There were large variations in outcomes across medical groups. Patients and clinicians were satisfied with COMPASS care. CONCLUSIONS COMPASS was successfully spread across diverse care systems and demonstrated improved outcomes for complex patients with previously uncontrolled chronic disease. Future large-scale implementation projects should create robust processes to identify and reduce expected variation in implementation to consistently provide improved care.
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Affiliation(s)
- Rebecca C Rossom
- HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425.
| | - Leif I Solberg
- HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425
| | - Sanne Magnan
- Institute for Clinical Systems Improvement, 8009 34th Ave. S., Suite 1200, Bloomington, MN, 55425-1624
| | - A Lauren Crain
- HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425
| | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research, P.O. Box 378066, Denver, CO, 80237-8066
| | - Karen J Coleman
- Kaiser Permanente Southern California, Department of Research and Evaluation, 100 S. Los Robles Ave., 2nd Floor, Pasadena, CA, 91101-2453
| | - David Katzelnick
- Mayo Clinic, Psychiatry and Psychology Division of Integrated Behavioral Health, 200 First St. SW, Rochester, MN, 55905
| | - Mark D Williams
- Mayo Clinic, Psychiatry and Psychology Division of Integrated Behavioral Health, 200 First St. SW, Rochester, MN, 55905
| | - Claire Neely
- Institute for Clinical Systems Improvement, 8009 34th Ave. S., Suite 1200, Bloomington, MN, 55425-1624
| | - Kris Ohnsorg
- HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425
| | - Robin Whitebird
- HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425; University of St. Thomas, School of Social Work, 2115 Summit Ave, St. Paul, MN, 55105
| | - Emily Brandenfels
- Community Health Plan of Washington, 720 Olive Way, Suite 300, Seattle, WA, 98101-1830
| | - Betsy Pollock
- Mount Auburn Cambridge Independent Practice Association, 1380 Soldiers Field Rd., Floor 2, Brighton, MA, 02135-1023
| | - Robert Ferguson
- Pittsburgh Regional Health Initiative, 650 Smithfield St., Centre City Tower, Suite 2400, Pittsburgh, PA, 15222-3900
| | - Steve Williams
- Michigan Center for Clinical Systems Improvement, 233 E. Fulton St., Suite 20, Grand Rapids, MI, 49503-3261
| | - Jürgen Unützer
- University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195-6560
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Kilbourne AM, Barbaresso MM, Lai Z, Nord KM, Bramlet M, Goodrich DE, Post EP, Almirall D, Bauer MS. Improving Physical Health in Patients With Chronic Mental Disorders: Twelve-Month Results From a Randomized Controlled Collaborative Care Trial. J Clin Psychiatry 2017; 78:129-137. [PMID: 27780336 PMCID: PMC5272777 DOI: 10.4088/jcp.15m10301] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/09/2015] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Persons with chronic mental disorders are disproportionately burdened with physical health conditions. We determined whether Life Goals Collaborative Care compared to usual care improves physical health in patients with mental disorders within 12 months. METHODS This single-blind randomized controlled effectiveness study of a collaborative care model was conducted at a midwestern Veterans Affairs urban outpatient mental health clinic. Patients (N = 293 out of 474 eligible approached) with an ICD-9-CM diagnosis of schizophrenia, bipolar disorder, or major depressive disorder and at least 1 cardiovascular disease risk factor provided informed consent and were randomized (February 24, 2010, to April 29, 2015) to Life Goals (n = 146) or usual care (n = 147). A total of 287 completed baseline assessments, and 245 completed 12-month follow-up assessments. Life Goals included 5 weekly sessions that provided semistructured guidance on managing physical and mental health symptoms through healthy behavior changes, augmented by ongoing care coordination. The primary outcome was change in physical health-related quality of life score (Veterans RAND 12-item Short Form Health Survey [VR-12] physical health component score). Secondary outcomes included control of cardiovascular risk factors from baseline to 12 months (blood pressure, lipids, weight), mental health-related quality of life, and mental health symptoms. RESULTS Among patients completing baseline and 12-month outcomes assessments (N = 245), the mean age was 55.3 years (SD = 10.8; range, 25-78 years), and 15.4% were female. Intent-to-treat analysis revealed that compared to those in usual care, patients randomized to Life Goals had slightly increased VR-12 physical health scores (coefficient = 3.21; P = .01). CONCLUSIONS Patients with chronic mental disorders and cardiovascular disease risk who received Life Goals had improved physical health-related quality of life. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT01487668 and NCT01244854.
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Affiliation(s)
- Amy M. Kilbourne
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA,Author for correspondence: Amy M. Kilbourne, PhD, MPH, VA Center for Clinical Management Research, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI, 48105. Voice: 734-845-3452; fax: 734-222-7503,
| | | | - Zongshan Lai
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kristina M. Nord
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - David E. Goodrich
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Edward P. Post
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel Almirall
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Mark S. Bauer
- VA Center for Healthcare Organization and Implementation Research, Boston, MA, USA, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Coleman KJ, Magnan S, Neely C, Solberg L, Beck A, Trevis J, Heim C, Williams M, Katzelnick D, Unützer J, Pollock B, Hafer E, Ferguson R, Williams S. The COMPASS initiative: description of a nationwide collaborative approach to the care of patients with depression and diabetes and/or cardiovascular disease. Gen Hosp Psychiatry 2017; 44:69-76. [PMID: 27558107 DOI: 10.1016/j.genhosppsych.2016.05.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe a national effort to disseminate and implement an evidence-based collaborative care management model for patients with both depression and poorly controlled diabetes and/or cardiovascular disease across multiple, real-world diverse clinical practice sites. METHODS Goals for the initiative were as follows: (1) to improve depression symptoms in 40% of patients, (2) to improve diabetes and hypertension control rates by 20%, (3) to increase provider satisfaction by 20%, (4) to improve patient satisfaction with their care by 20% and (5) to demonstrate cost savings. A Care Management Tracking System was used for collecting clinical care information to create performance measures for quality improvement while also assessing the overall accomplishment of these goals. RESULTS The Care of Mental, Physical and Substance-use Syndromes (COMPASS) initiative spread an evidence-based collaborative care model among 18 medical groups and 172 clinics in eight states. We describe the initiative's evidence-base and methods for others to replicate our work. CONCLUSIONS The COMPASS initiative demonstrated that a diverse set of health care systems and other organizations can work together to rapidly implement an evidence-based care model for complex, hard-to-reach patients. We present this model as an example of how the time gap between research and practice can be reduced on a large scale.
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Affiliation(s)
- Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California (KPSC), 100 S. Los Robles Ave., 2nd Floor, Pasadena, CA 91101-2453, USA.
| | - Sanne Magnan
- Institute for Clinical Systems Improvement (ICSI), 8009 34th Ave. S., Suite 1200, Bloomington, MN 55425-1624, USA
| | - Claire Neely
- Institute for Clinical Systems Improvement (ICSI), 8009 34th Ave. S., Suite 1200, Bloomington, MN 55425-1624, USA
| | - Leif Solberg
- HealthPartners Institute for Education and Research (HPIER), 8170 33rd Ave. S., MS23301A, P.O. Box 1524, Bloomington, MN 55440-1524, USA
| | - Arne Beck
- Institute for Health Research (KPCO), Kaiser Permanente Colorado, P.O. Box 378066, Denver, CO 80237-8066, USA
| | - Jim Trevis
- Institute for Clinical Systems Improvement (ICSI), 8009 34th Ave. S., Suite 1200, Bloomington, MN 55425-1624, USA
| | - Carla Heim
- Institute for Clinical Systems Improvement (ICSI), 8009 34th Ave. S., Suite 1200, Bloomington, MN 55425-1624, USA
| | - Mark Williams
- Mayo Clinic Health System, 200 First St. SW, Rochester, MN 55905, USA
| | - David Katzelnick
- Mayo Clinic Health System, 200 First St. SW, Rochester, MN 55905, USA
| | - Jürgen Unützer
- AIMS Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St., Box 356650, Seattle, WA 98195-6560, USA
| | - Betsy Pollock
- AIMS Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St., Box 356650, Seattle, WA 98195-6560, USA; Mount Auburn Cambridge IPA (MACIPA), 1380 Soldiers Field Rd., Floor 2, Brighton, MA 02135-1023, USA
| | - Erin Hafer
- Community Health Plan of Washington (CHPW), 720 Olive Way, Suite 300, Seattle, WA 98101-1830, USA
| | - Robert Ferguson
- Pittsburgh Regional Health Initiative (PRHI), 650 Smithfield St., Centre City Tower, Suite 2400, Pittsburgh, PA 15222-3900, USA
| | - Steve Williams
- Michigan Center for Clinical Systems Improvement (Mi-CCSI), 233 E. Fulton St., Suite 20, Grand Rapids, MI 49503-3261, USA
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Breslau J, Yu H, Horvitz-Lennon M, Leckman-Westin E, Scharf DM, Connor KL, Finnerty MT. Enrollment of Specialty Mental Health Clinics in a State Medicaid Program to Promote General Medical Services. Psychiatr Serv 2017; 68:63-69. [PMID: 27524372 PMCID: PMC5205557 DOI: 10.1176/appi.ps.201600104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To promote integrated general medical care for individuals with serious mental illness, the New York State Office of Mental Health (OMH) established regulations allowing specialty mental health clinics to provide Medicaid-reimbursable health monitoring (HM) and health physicals (HP). This study examined clinics' enrollment in this program to understand its potential to reach individuals with serious mental illness. METHODS Information on enrollment and characteristics of clinics (N=500) was obtained from OMH administrative databases. Clinic enrollment in the HM/HP program was examined for the program's first five years (2010-2015). Logistic regression models accounting for the clustering of multiple clinics within agencies were used to examine characteristics associated with enrollment. RESULTS A total of 291 of 500 (58%) licensed clinics in New York State in 2015 enrolled in the HM/HP program, potentially reaching 62% of all Medicaid enrollees with serious mental illness seen in specialty mental health clinics in the state. State-operated clinics were required to participate, and had 91% enrollment. Over half of hospital-affiliated and freestanding mental health clinics elected to enroll (53% and 54%, respectively). In adjusted models, enrollment was higher among freestanding clinics compared with hospital-affiliated clinics, higher in larger than smaller clinics, and higher in county-operated than in private nonprofit clinics. CONCLUSIONS The high level of enrollment in the HM/HP program indicates strong interest among mental health clinics in providing general medical care services. However, supplemental policies may be needed to extend the program to areas of the mental health system where barriers to general medical care services are highest.
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Affiliation(s)
- Joshua Breslau
- Dr. Breslau, Dr. Yu, Dr. Scharf, and Ms. Connor are with the Health and Behavioral Sciences Division, RAND Corporation, Pittsburgh (e-mail: ). Dr. Horvitz-Lennon is with the Health Division, RAND Corporation, Boston. Dr. Leckman-Westin is with the New York State Office of Mental Health (NYSOMH), Albany, and with the Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York. Dr. Finnerty is with the NYSOMH, New York City
| | - Hao Yu
- Dr. Breslau, Dr. Yu, Dr. Scharf, and Ms. Connor are with the Health and Behavioral Sciences Division, RAND Corporation, Pittsburgh (e-mail: ). Dr. Horvitz-Lennon is with the Health Division, RAND Corporation, Boston. Dr. Leckman-Westin is with the New York State Office of Mental Health (NYSOMH), Albany, and with the Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York. Dr. Finnerty is with the NYSOMH, New York City
| | - Marcela Horvitz-Lennon
- Dr. Breslau, Dr. Yu, Dr. Scharf, and Ms. Connor are with the Health and Behavioral Sciences Division, RAND Corporation, Pittsburgh (e-mail: ). Dr. Horvitz-Lennon is with the Health Division, RAND Corporation, Boston. Dr. Leckman-Westin is with the New York State Office of Mental Health (NYSOMH), Albany, and with the Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York. Dr. Finnerty is with the NYSOMH, New York City
| | - Emily Leckman-Westin
- Dr. Breslau, Dr. Yu, Dr. Scharf, and Ms. Connor are with the Health and Behavioral Sciences Division, RAND Corporation, Pittsburgh (e-mail: ). Dr. Horvitz-Lennon is with the Health Division, RAND Corporation, Boston. Dr. Leckman-Westin is with the New York State Office of Mental Health (NYSOMH), Albany, and with the Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York. Dr. Finnerty is with the NYSOMH, New York City
| | - Deborah M Scharf
- Dr. Breslau, Dr. Yu, Dr. Scharf, and Ms. Connor are with the Health and Behavioral Sciences Division, RAND Corporation, Pittsburgh (e-mail: ). Dr. Horvitz-Lennon is with the Health Division, RAND Corporation, Boston. Dr. Leckman-Westin is with the New York State Office of Mental Health (NYSOMH), Albany, and with the Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York. Dr. Finnerty is with the NYSOMH, New York City
| | - Kathryn L Connor
- Dr. Breslau, Dr. Yu, Dr. Scharf, and Ms. Connor are with the Health and Behavioral Sciences Division, RAND Corporation, Pittsburgh (e-mail: ). Dr. Horvitz-Lennon is with the Health Division, RAND Corporation, Boston. Dr. Leckman-Westin is with the New York State Office of Mental Health (NYSOMH), Albany, and with the Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York. Dr. Finnerty is with the NYSOMH, New York City
| | - Molly T Finnerty
- Dr. Breslau, Dr. Yu, Dr. Scharf, and Ms. Connor are with the Health and Behavioral Sciences Division, RAND Corporation, Pittsburgh (e-mail: ). Dr. Horvitz-Lennon is with the Health Division, RAND Corporation, Boston. Dr. Leckman-Westin is with the New York State Office of Mental Health (NYSOMH), Albany, and with the Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York. Dr. Finnerty is with the NYSOMH, New York City
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Huang H, Tabb KM, Cerimele JM, Ahmed N, Bhat A, Kester R. Collaborative Care for Women With Depression: A Systematic Review. PSYCHOSOMATICS 2017; 58:11-18. [DOI: 10.1016/j.psym.2016.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 08/31/2016] [Accepted: 09/01/2016] [Indexed: 11/16/2022]
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190
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Overbeck G, Davidsen AS, Kousgaard MB. Enablers and barriers to implementing collaborative care for anxiety and depression: a systematic qualitative review. Implement Sci 2016; 11:165. [PMID: 28031028 PMCID: PMC5192575 DOI: 10.1186/s13012-016-0519-y] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 11/01/2016] [Indexed: 12/26/2022] Open
Abstract
Background Collaborative care is an increasingly popular approach for improving quality of care for people with mental health problems through an intensified and structured collaboration between primary care providers and health professionals with specialized psychiatric expertise. Trials have shown significant positive effects for patients suffering from depression, but since collaborative care is a complex intervention, it is important to understand the factors which affect its implementation. We present a qualitative systematic review of the enablers and barriers to implementing collaborative care for patients with anxiety and depression. Methods We developed a comprehensive search strategy in cooperation with a research librarian and performed a search in five databases (EMBASE, PubMed, PsycINFO, ProQuest, and CINAHL). All authors independently screened titles and abstracts and reviewed full-text articles. Studies were included if they were published in English and based on the original qualitative data on the implementation of a collaborative care intervention targeted at depression or anxiety in an adult patient population in a high-income country. Our subsequent analysis employed the normalization process theory (NPT). Results We included 17 studies in our review of which 11 were conducted in the USA, five in the UK, and one in Canada. We identified several barriers and enablers within the four major analytical dimensions of NPT. Securing buy-in among primary care providers was found to be critical but sometimes difficult. Enablers included physician champions, reimbursement for extra work, and feedback on the effectiveness of collaborative care. The social and professional skills of the care managers seemed critical for integrating collaborative care in the primary health care clinic. Day-to-day implementation was also found to be facilitated by the care managers being located in the clinic since this supports regular face-to-face interactions between physicians and care managers. Conclusions The following areas require special attention when planning collaborative care interventions: effective educational programs, especially for care managers; issues of reimbursement in relation to primary care providers; good systems for communication and monitoring; and promoting face-to-face interaction between care managers and physicians, preferably through co-location. There is a need for well-sampled, in-depth qualitative studies on the implementation of collaborative care in settings outside the USA and the UK. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0519-y) contains supplementary material, which is available to authorized users.
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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, København, Denmark.
| | - Annette Sofie Davidsen
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, København, Denmark
| | - Marius Brostrøm Kousgaard
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, København, Denmark
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191
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Muntingh ADT, van der Feltz-Cornelis CM, van Marwijk HWJ, Spinhoven P, van Balkom AJLM. Collaborative care for anxiety disorders in primary care: a systematic review and meta-analysis. BMC FAMILY PRACTICE 2016. [DOI: 10.1186/s12875-016-0466-3 order by 1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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192
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Muntingh ADT, van der Feltz-Cornelis CM, van Marwijk HWJ, Spinhoven P, van Balkom AJLM. Collaborative care for anxiety disorders in primary care: a systematic review and meta-analysis. BMC FAMILY PRACTICE 2016. [DOI: 10.1186/s12875-016-0466-3 and 1880=1880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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193
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Muntingh ADT, van der Feltz-Cornelis CM, van Marwijk HWJ, Spinhoven P, van Balkom AJLM. Collaborative care for anxiety disorders in primary care: a systematic review and meta-analysis. BMC FAMILY PRACTICE 2016. [DOI: 10.1186/s12875-016-0466-3 order by 8029-- awyx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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194
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Muntingh ADT, van der Feltz-Cornelis CM, van Marwijk HWJ, Spinhoven P, van Balkom AJLM. Collaborative care for anxiety disorders in primary care: a systematic review and meta-analysis. BMC FAMILY PRACTICE 2016. [DOI: 10.1186/s12875-016-0466-3 order by 8029-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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195
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Muntingh ADT, van der Feltz-Cornelis CM, van Marwijk HWJ, Spinhoven P, van Balkom AJLM. Collaborative care for anxiety disorders in primary care: a systematic review and meta-analysis. BMC FAMILY PRACTICE 2016. [DOI: 10.1186/s12875-016-0466-3 order by 1-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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196
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Coates D. Client and parent feedback on a Youth Mental Health Service: The importance of family inclusive practice and working with client preferences. Int J Ment Health Nurs 2016; 25:526-535. [PMID: 27406035 DOI: 10.1111/inm.12240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/31/2016] [Accepted: 05/03/2016] [Indexed: 11/29/2022]
Abstract
In mental health settings, feedback from clients and carers is central to service evaluation, development and delivery. Increasingly, client and carer feedback is considered an integral part of service planning, and recognized as a critical element of the provision of recovery oriented service. This paper outlines the findings of a qualitative evaluation of a Youth Mental Health (YMH) service from the perspective of discharged clients and their parents. The service researcher conducted telephone interviews with 39 parents of discharged clients, and 17 young people themselves. Participants reported positive or mixed experiences with the service. In addition to more generic positive statements about the service, analysis identified two key themes: the importance of 'family inclusive practice' and the importance of 'working with client preferences'. Young people and their parents want to be actively engaged in treatment and have their treatment preferences considered in treatment planning. Participants expressed the importance of "a good fit" between the client and the worker in terms of the clinician's gender, personality and treatment style/modality. While for some participants these themes were raised in the context of service strengths, others identified them as limitations or opportunities for service improvement. The extent to which clients and their parents felt engaged and heard by their allocated clinician is critical to their satisfaction or dissatisfaction with the service, depending on their unique experience. As an outcome of this evaluation, a range of service improvement strategies have been recommended.
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Affiliation(s)
- Dominiek Coates
- Central Coast Local Health District, Central Coast Mental Health, Children and Young People's Mental Health Suite 1, Gosford, New South Wales, Australia
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197
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Zupančič V, Pahor M. The role of non-governmental organizations in the mental health area: differences in understanding. Zdr Varst 2016; 55:231-238. [PMID: 27703545 PMCID: PMC5030834 DOI: 10.1515/sjph-2016-0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 05/03/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction The contribution’s aim is highlighting the differences in understanding non-governmental organizations’ (NGOs) role in the mental health area within the public support network for patients with mental health problems from various viewpoints, in order to achieve progress in supporting patients with mental health problems in local communities. Methods Qualitative data gathered as a part of a cross-sectional study of NGOs in the support network for patients with mental health problems in two Slovenian health regions (56 local communities), carried out in 2013 and 2014, were used. Qualitative analysis of interviews, focus groups and answers to an open survey question was performed. Results There are differences in understanding NGOs’ role in the support network for patients with mental health problems, which stem from the roles of stakeholders (local community officials, experts, care providers, and patients) within this system and their experience. Discussion and conclusion The actual differences need to be addressed and overcome in order to provide integrated community care. The importance of knowing the current state of NGOs in their life cycle and the socio-chronological context of the local community support network is evident.
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Affiliation(s)
- Vesna Zupančič
- Faculty of Health Sciences Novo mesto, Na Loko 2, 8000 Novo mesto, Slovenia
| | - Majda Pahor
- University of Ljubljana, Faculty for Health Sciences, Zdravstvena pot 5, 1000 Ljubljana, Slovenia
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Muntingh ADT, van der Feltz-Cornelis CM, van Marwijk HWJ, Spinhoven P, van Balkom AJLM. Collaborative care for anxiety disorders in primary care: a systematic review and meta-analysis. BMC FAMILY PRACTICE 2016. [DOI: 10.1186/s12875-016-0466-3 order by 1-- gadu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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199
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Muntingh ADT, van der Feltz-Cornelis CM, van Marwijk HWJ, Spinhoven P, van Balkom AJLM. Collaborative care for anxiety disorders in primary care: a systematic review and meta-analysis. BMC FAMILY PRACTICE 2016. [DOI: 10.1186/s12875-016-0466-3 order by 8029-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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200
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Drummond KL, Painter JT, Curran GM, Stanley R, Gifford AL, Rodriguez-Barradas M, Rimland D, Monson TP, Pyne JM. HIV patient and provider feedback on a telehealth collaborative care for depression intervention. AIDS Care 2016; 29:290-298. [PMID: 27871183 DOI: 10.1080/09540121.2016.1255704] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In the HIV Translating Initiatives for Depression into Effective Solutions project, we conducted a randomized controlled effectiveness and implementation trial comparing depression collaborative care with enhanced usual care in Veterans Health Administration HIV clinics in the US. An offsite HIV depression care team including a psychiatrist, a depression care manager (DCM), and a clinical pharmacist provided collaborative care using a stepped-care model of treatment and made recommendations to providers through the electronic health record system. The DCM delivered care management to HIV patients through phone calls, performing routine assessments and providing counseling in self-management and problem-solving. The DCM documented all calls in each patient's electronic medical record. In this paper we present results from interviews conducted with patients and clinical staff in a multi-stage formative evaluation (FE). We conducted semi-structured FE interviews with 26 HIV patients and 30 clinical staff at the three participating sites during and after the trial period to gather their experiences and perspectives concerning the intervention components. Interviews were transcribed verbatim and analyzed using rapid content analysis techniques. Patients reported high satisfaction with the depression care manager (DCM) phone calls. Both HIV and mental health providers reported that the DCM's chart notes in the electronic health record were very helpful, and most felt that a dedicated DCM for HIV patients is ideal to meet patient needs. Sites encountered barriers to achieving and maintaining universal depression screening, but had greater success when such screening was incorporated into routine intake processes. FE results demonstrated that depression care management via telehealth from an offsite team is acceptable and helpful to both HIV patients and their providers. Given that a centralized offsite depression care team can deliver effective, cost-effective, cost-saving services for multiple HIV clinics in different locations with high patient and provider satisfaction, broad implementation should be considered.
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Affiliation(s)
- Karen L Drummond
- a Central Arkansas Veterans Healthcare System , North Little Rock , AR , USA
| | - Jacob T Painter
- a Central Arkansas Veterans Healthcare System , North Little Rock , AR , USA
| | - Geoffrey M Curran
- a Central Arkansas Veterans Healthcare System , North Little Rock , AR , USA
| | - Regina Stanley
- a Central Arkansas Veterans Healthcare System , North Little Rock , AR , USA
| | - Allen L Gifford
- b Edith Nourse Rogers Memorial VA Medical Center , Bedford , MA , USA
| | | | - David Rimland
- d Atlanta Veterans Affairs Medical Center , Atlanta , GA , USA
| | - Thomas P Monson
- a Central Arkansas Veterans Healthcare System , North Little Rock , AR , USA
| | - Jeffrey M Pyne
- a Central Arkansas Veterans Healthcare System , North Little Rock , AR , USA
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