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Chung H, Patel U, Stein D, Collado K, Blackmore M. Medicaid Costs and Utilization of Collaborative Versus Colocation Care for Patients With Depression. Psychiatr Serv 2023; 74:1132-1136. [PMID: 37221885 DOI: 10.1176/appi.ps.20220604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The authors examined cost and utilization metrics for racially diverse Medicaid primary care patients with depression receiving care through either a collaborative care model (CoCM) of integration or the standard colocation model. METHODS Data from a retrospective cohort of Medicaid patients screening positive for clinically significant depression during January 2016-December 2017 were analyzed to assess health care costs and selected utilization measures. Seven primary care clinics providing CoCM were compared with 16 clinics providing colocated behavioral health care. Data for the first year and second year after a patient received an initial Patient Health Questionnaire-9 score ≥10 were analyzed. RESULTS In the first year, compared with patients receiving colocated care (N=3,061), CoCM patients (N=4,315) had significantly lower odds of emergency department (ED) visits (OR=0.95) and medical specialty office visits (OR=0.92), with slightly higher odds of primary care provider (PCP) visits (OR=1.03) and behavioral health office visits (OR=1.03). In year 2, CoCM patients (N=2,623) had significantly lower odds of inpatient medical admissions (OR=0.87), ED visits (OR=0.84), medical specialty office visits (OR=0.89), and PCP visits (OR=0.94) than the colocated care patients (N=1,838). The two groups did not significantly differ in total cost in both years. CONCLUSIONS Access to CoCM treatment in primary care for racially diverse Medicaid patients with depression was associated with more positive health care utilization outcomes than for those accessing colocated treatment. As organizations continue to seek opportunities to integrate behavioral health care into primary care, consideration of health care costs and utilization may be helpful in the selection and implementation of integration models.
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Affiliation(s)
- Henry Chung
- Department of Psychiatry and Behavioral Sciences (Chung, Blackmore) and Department of Social and Family Medicine (Patel), Albert Einstein College of Medicine, Bronx, New York City; Optum Tri-State, Chappaqua, New York (Stein); Montefiore Care Management Organization, Yonkers, New York (Chung, Collado)
| | - Urvashi Patel
- Department of Psychiatry and Behavioral Sciences (Chung, Blackmore) and Department of Social and Family Medicine (Patel), Albert Einstein College of Medicine, Bronx, New York City; Optum Tri-State, Chappaqua, New York (Stein); Montefiore Care Management Organization, Yonkers, New York (Chung, Collado)
| | - Dana Stein
- Department of Psychiatry and Behavioral Sciences (Chung, Blackmore) and Department of Social and Family Medicine (Patel), Albert Einstein College of Medicine, Bronx, New York City; Optum Tri-State, Chappaqua, New York (Stein); Montefiore Care Management Organization, Yonkers, New York (Chung, Collado)
| | - Kayla Collado
- Department of Psychiatry and Behavioral Sciences (Chung, Blackmore) and Department of Social and Family Medicine (Patel), Albert Einstein College of Medicine, Bronx, New York City; Optum Tri-State, Chappaqua, New York (Stein); Montefiore Care Management Organization, Yonkers, New York (Chung, Collado)
| | - Michelle Blackmore
- Department of Psychiatry and Behavioral Sciences (Chung, Blackmore) and Department of Social and Family Medicine (Patel), Albert Einstein College of Medicine, Bronx, New York City; Optum Tri-State, Chappaqua, New York (Stein); Montefiore Care Management Organization, Yonkers, New York (Chung, Collado)
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2
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Pines R, Sheeran N, Jones L, Pearson A, Pamoso AH, Jin YB, Benedetti M. A Multinational Study of Patient Preferences for How Decisions Are Made in Their Care. Med Care Res Rev 2023; 80:205-215. [PMID: 35815591 DOI: 10.1177/10775587221108749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Inadequate consideration has been given to patient preferences for patient-centered care (PCC) across countries or cultures in our increasingly global society. We examined what 1,698 participants from the United States, Hong Kong, Philippines, and Australia described as important when making health care decisions. Analysis of frequencies following directed content coding of open-ended questions revealed differences in patients' preferences for doctor behaviors and decision-making considerations across countries. Being well informed by their doctor emerged as most important in decision-making, especially in Hong Kong. Participants in Australia and the United States wanted their doctor to meet their emotional needs. The safety and efficacy of treatments were the most common consideration, especially for Hong Kong. Findings suggest that doctors should focus on information exchange and identifying patient concerns about efficacy, lifestyle impact, cost, and recovery speed. Rather than assuming patients prefer shared decision-making, doctors must assess patient's decision control preferences.
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Affiliation(s)
| | - Nicola Sheeran
- Griffith University, Mount Gravatt, Queensland, Australia
| | - Liz Jones
- Monash University, Bandar Sunway, Malaysia
| | | | - Aron H Pamoso
- University of Southern Philippines Foundation, Cebu City, Philippines
| | - Yin Blair Jin
- The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Kunz-Lomelin A, Killian M, Eghaneyan BH, Sanchez K. Antidepressant Adherence Among Hispanics: Patients in an Integrated Health Care Model. J Multidiscip Healthc 2022; 15:3029-3037. [PMID: 36605408 PMCID: PMC9809177 DOI: 10.2147/jmdh.s387218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/07/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose We report on antidepressant (AD) adherence among Hispanics seeking mental health services in a community primary care clinic in Texas as an ancillary outcome from a National Institutes of Health-funded study that collected data on Hispanic AD adherence over a period of two years (February 2016-February 2018). Adherence to AD medications was measured throughout the year-long trial and compared across various demographic characteristics. Since Hispanic individuals often experience stigma and cultural barriers related to AD treatment, we sought to understand what factors may increase the likelihood of non-adherence in this population. Patients and Methods This study focused on 69 patients who were prescribed AD medications while receiving treatment through an integrated health care model. Adherence was measured with the Patient Adherence Questionnaire, a validated 2-item questionnaire that asks patients about their medication use (missed medications or dosage changes) over the past week. We looked at patient adherence at two key time points (4-weeks and 13-weeks) and utilized logistic regression to identify factors that may increase or decrease the likelihood of adherence in Hispanic patients at a community primary care clinic. Results Non-adherence to AD medication was 49.3% at 4-weeks and 57% at 13-weeks post-treatment initiation. Logistic regression analyses revealed that age was the only significant predictor of AD non-adherence. As age increased, the likelihood of adherence increased by 12.2% at 13-weeks post-treatment initiation and by 11.1% at 4-weeks post-treatment initiation. Conclusion The likelihood of Hispanic patients to adhere to AD therapy increased with the age of the patient. Since primary care is the most likely place to be prescribed an AD for Hispanic patients, further research to better understand adherence is essential. Integrated health care interventions designed to help identify, reduce, or eliminate barriers to adherence and improve cultural understanding may help address issues of non-adherence in primary care settings.
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Affiliation(s)
- Alan Kunz-Lomelin
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA,Correspondence: Alan Kunz-Lomelin, 3825 Hunters Trail, Carrollton, TX, 75007, USA, Tel +1 (972) 358-0575, Email
| | - Michael Killian
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | | | - Katherine Sanchez
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
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4
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Goldhammer H, Marc LG, Chavis NS, Psihopaidas D, Massaquoi M, Cahill S, Bryant H, Bourdeau B, Mayer KH, Cohen SM, Keuroghlian AS. Interventions for Integrating Behavioral Health Services into HIV Clinical Care: A Narrative Review. Open Forum Infect Dis 2022; 9:ofac365. [PMID: 35967264 PMCID: PMC9364372 DOI: 10.1093/ofid/ofac365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
The integration of behavioral health services within human immunodeficiency virus (HIV) care settings holds promise for improving substance use, mental health, and HIV-related health outcomes for people with HIV. As part of an initiative funded by the Health Resources and Services Administration’s HIV/AIDS Bureau, we conducted a narrative review of interventions focused on behavioral health integration (BHI) in HIV care in the United States (US). Our literature search yielded 19 intervention studies published between 2010 and 2021. We categorized the interventions under 6 approaches: collaborative care; screening, brief intervention, and referral to treatment (SBIRT); patient-reported outcomes (PROs); onsite psychological consultation; integration of addiction specialists; and integration of buprenorphine/naloxone (BUP/NX) treatment. All intervention approaches appeared feasible to implement in diverse HIV care settings and most showed improvements in behavioral health outcomes; however, measurement of HIV outcomes was limited. Future research studies of BHI interventions should evaluate HIV outcomes and assess facilitators and barriers to intervention uptake.
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Affiliation(s)
| | - Linda G Marc
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Harvard T.H. Chan School of Public Health , Boston, MA , USA
| | - Nicole S Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration , Rockville, MD , USA
| | | | | | - Sean Cahill
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Boston University School of Public Health , Boston, MA , USA
- Bouve College of Health Sciences, Northeastern University , Boston, MA , USA
| | | | - Beth Bourdeau
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California San Francisco , San Francisco, CA , USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Harvard T.H. Chan School of Public Health , Boston, MA , USA
- Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
| | - Stacy M Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration , Rockville, MD , USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
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Joo JH, Rostov P, Feeser S, Berkowitz S, Lyketsos C. Engaging an Asian Immigrant Older Adult in Depression Care: Collaborative Care, Patient-Provider Communication and Ethnic Identity. Am J Geriatr Psychiatry 2021; 29:1267-1273. [PMID: 34419363 PMCID: PMC8808368 DOI: 10.1016/j.jagp.2021.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 04/06/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022]
Abstract
Minority older adults face multiple barriers when trying to access mental health services and often present with more severe symptoms of mental health conditions. We describe the multilevel factors that contributed to the engagement of an Asian immigrant older adult with depression. Systems-level innovations such as collaborative care in primary care can increase access to care for all, including minority older adults; however, one size fits all interventions may not meet the needs of communities of older adults with different life experiences, language needs, norms and values regarding help-seeking for mental health. Health outcomes remain unequal , suggesting the need to tailor interventions for minority older adults. For the patient, specific factors related to language and ethnic concordance between patient and healthcare provider, communication behaviors, ethnic identity, and social norms may be important to take into account. The recognition of the heterogeneity of patients and the limitations of cultural competence approaches defined as broad, general knowledge about ethnic cultures may be needed. A need to learn continuously from clinical experience and adopt a patient-oriented model of communication and decision-making may successfully engage Asian immigrant older adults in depression care services.
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Affiliation(s)
- Jin Hui Joo
- Department of Psychiatry and Behavioral Sciences, School of Medicine (JJ, PR, CL), Baltimore, MD.
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6
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Hassan TA, Sáenz JE, Ducinskiene D, Cook JP, Imperato JS, Zou KH. New Strategies to Improve Patient Adherence to Medications for Noncommunicable Diseases During and After the COVID-19 Era Identified via a Literature Review. J Multidiscip Healthc 2021; 14:2453-2465. [PMID: 34522102 PMCID: PMC8434910 DOI: 10.2147/jmdh.s313626] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/28/2021] [Indexed: 12/21/2022] Open
Abstract
Noncommunicable diseases (NCDs) place a huge burden on healthcare systems and society as a whole. Relatively early in the coronavirus disease 2019 (COVID-19) pandemic, clinicians became aware that in individuals infected with COVID-19, those with preexisting NCDs such as diabetes mellitus and cardiovascular disease (CVD) were at a greater risk of poor outcomes and mortality than those without. The importance of adherence to medications and lifestyle changes to control and prevent NCDs has been a major focus for many years, but with limited success - the proportion of patients adherent and persistent to their medications remains very low. There are many facets to adherence and persistence. Recent evidence suggests that a patient-centric approach is important, and ensuring that a patient is both motivated and empowered is critical to improving adherence/persistence. The COVID-19 pandemic has brought many changes to the way in which patients with NCDs are managed, with telemedicine and ehealth becoming more common. Changes have also occurred in the way in which patients can gain access to medications during the pandemic. The potential for these changes forms the basis of improving the management of patients with NCDs both during and after the pandemic. Over the coming months, a huge amount of work will be put into initiatives to promote adherence to COVID-19 vaccination programs. Those at highest risk of severe COVID-19, such as people aged 80 years and older, are likely to receive the vaccine first in some parts of world. Finally, social determinants of health are critical elements that can impact not just the likelihood of having an NCD or becoming infected with COVID-19, but also access to healthcare, and a patient's adherence and persistence with their treatments.
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Affiliation(s)
- Tarek A Hassan
- Global Medical and Clinical, Viatris, Canonsburg, PA, USA
| | | | | | - Joseph P Cook
- Global Medical and Clinical, Viatris, Canonsburg, PA, USA
| | | | - Kelly H Zou
- Global Medical and Clinical, Viatris, Canonsburg, PA, USA
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7
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de Pinho LG, Lopes MJ, Correia T, Sampaio F, do Arco HR, Mendes A, Marques MDC, Fonseca C. Patient-Centered Care for Patients with Depression or Anxiety Disorder: An Integrative Review. J Pers Med 2021; 11:776. [PMID: 34442420 PMCID: PMC8400282 DOI: 10.3390/jpm11080776] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 12/23/2022] Open
Abstract
People have specific and unique individual and contextual characteristics, so healthcare should increasingly opt for person-centered care models. Thus, this review aimed to identify and synthesize the indicators for the care process of the person with depression and/or anxiety disorders, based on patient-centered care, going through the stages of diagnostic assessment and care planning, including intervention. An integrative literature review with research in seven scientific databases and a narrative analysis were carried out. Twenty articles were included, with indicators for diagnostic evaluation and care/intervention planning being extracted. Care planning focused on people with depression and/or anxiety disorder must be individualized, dynamic, flexible, andparticipatory. It must respond to the specific needs of the person, contemplating the identification of problems, the establishment of individual objectives, shared decision making, information and education, systematic feedback, and case management, and it should meet the patient's preferences and satisfaction with care and involve the family and therapeutic management in care. The existence of comorbidities reinforces the importance of flexible and individualized care planning in order to respond to the specific health conditions of each person.
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Affiliation(s)
- Lara Guedes de Pinho
- Escola Superior de Enfermagem São João de Deus, Universidade de Évora, 7000-811 Évora, Portugal; (M.J.L.); (M.d.C.M.); (C.F.)
- Comprehensive Health Research Centre (CHRC), 7000-811 Évora, Portugal;
| | - Manuel José Lopes
- Escola Superior de Enfermagem São João de Deus, Universidade de Évora, 7000-811 Évora, Portugal; (M.J.L.); (M.d.C.M.); (C.F.)
- Comprehensive Health Research Centre (CHRC), 7000-811 Évora, Portugal;
| | - Tânia Correia
- Abel Salazar Institute of Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal;
- NursID: Innovation & Development in Nursing Research Group, CINTESIS—Center for Health Technology and Services Research, 4200-450 Porto, Portugal;
| | - Francisco Sampaio
- NursID: Innovation & Development in Nursing Research Group, CINTESIS—Center for Health Technology and Services Research, 4200-450 Porto, Portugal;
- Higher School of Health Fernando Pessoa, 4249-004 Porto, Portugal
| | - Helena Reis do Arco
- Comprehensive Health Research Centre (CHRC), 7000-811 Évora, Portugal;
- Superior School of Health, Polytechnic Institute of Portalegre, 7300-555 Portalegre, Portugal
| | - Artur Mendes
- Psychiatry Department, Hospital Espírito Santo, 7000-811 Évora, Portugal;
| | - Maria do Céu Marques
- Escola Superior de Enfermagem São João de Deus, Universidade de Évora, 7000-811 Évora, Portugal; (M.J.L.); (M.d.C.M.); (C.F.)
- Comprehensive Health Research Centre (CHRC), 7000-811 Évora, Portugal;
| | - César Fonseca
- Escola Superior de Enfermagem São João de Deus, Universidade de Évora, 7000-811 Évora, Portugal; (M.J.L.); (M.d.C.M.); (C.F.)
- Comprehensive Health Research Centre (CHRC), 7000-811 Évora, Portugal;
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Huang SCC, Morgan A, Peck V, Khoury L. Improving Communications With Patients and Families in Geriatric Care. The How, When, and What. J Patient Exp 2021; 8:23743735211034047. [PMID: 34368432 PMCID: PMC8317236 DOI: 10.1177/23743735211034047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
There has been little published literature examining the unique communication challenges older adults pose for health care providers. Using an explanatory mixed-methods design, this study explored patients’ and their family/caregivers’ experiences communicating with health care providers on a Canadian tertiary care, inpatient Geriatric unit between March and September 2018. In part 1, the modified patient–health care provider communication scale was used and responses scored using a 5-point scale. In part 2, one-on-one telephone interviews were conducted and responses transcribed, coded, and thematically analyzed. Thirteen patients and 7 family/caregivers completed part 1. Both groups scored items pertaining to adequacy of information sharing and involvement in decision-making in the lowest 25th percentile. Two patients and 4 family/caregivers participated in telephone interviews in part 2. Interview transcript analysis resulted in key themes that fit into the “How, When, and What” framework outlining the aspects of communication most important to the participants. Patients and family/caregivers identified strategic use of written information and predischarge family meetings as potentially valuable tools to improve communication and shared decision-making.
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Affiliation(s)
- Shirley Chien-Chieh Huang
- Department of Medicine, Division of Geriatric Medicine, University of Ottawa, The Ottawa Hospital, and the Ottawa Hospital Research Institute, Ontario, Canada
| | - Alden Morgan
- Faculty of Medicine, University of Ottawa and The Ottawa Hospital, Ontario, Canada
| | | | - Lara Khoury
- Department of Medicine, Division of Geriatric Medicine, University of Ottawa, The Ottawa Hospital, and the Ottawa Hospital Research Institute, Ontario, Canada
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Kan K, Jörg F, Buskens E, Schoevers RA, Alma MA. Patients' and clinicians' perspectives on relevant treatment outcomes in depression: qualitative study. BJPsych Open 2020; 6:e44. [PMID: 32364101 PMCID: PMC7331080 DOI: 10.1192/bjo.2020.27] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although symptomatic remission is considered the optimal outcome in depression, this is not always achieved. Furthermore, symptom indicators do not fully capture patients' and clinicians' perspectives on remission. Broader indicators of (partial) remission from depression should be considered. AIMS To investigate relevant outcomes of depression treatment in specialist care from patients' and clinicians' perspectives and to investigate whether these perspectives differ from each other. METHOD Three focus groups with 11 patients with depression and seven semi-structured interviews with clinicians were conducted exploring their perspectives on remission. All interviews were audio-recorded and transcribed verbatim. We analysed the transcripts thematically using the phenomenologist approach. RESULTS Independently, both patients and clinicians perceived the following outcomes relevant: restoring social functioning and interpersonal relations, regaining quality of life and achieving personal goals. All clinicians emphasised symptom reduction and satisfaction with treatment as relevant outcomes, whereas the former was not an obvious theme in patients. Unlike clinicians, patients made a clear distinction between treatment outcomes in first versus recurrent/chronic depression. CONCLUSIONS Classically defined study outcomes based on symptom resolution only partly reflect issues considered important by patients and clinicians in specialist depression treatment. Incorporating patients' and clinicians' perspectives in the development of measurable end-points makes them more suitable for use in trials and subsequent translation to clinical practice. Furthermore, evaluating patients' perspectives on treatment outcomes helps in the development of tailored interventions according to patients' needs.
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Affiliation(s)
- Kaying Kan
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Interdisciplinary Centre for Psychopathology and Emotion Regulation, the Netherlands
| | - Frederike Jörg
- GGZ Friesland, Research Department, Leeuwarden; and University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Interdisciplinary Centre for Psychopathology and Emotion Regulation, the Netherlands
| | - Erik Buskens
- University Medical Center Groningen, Department of Epidemiology, Groningen; and University of Groningen, Faculty of Economics and Business, the Netherlands
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, the Netherlands
| | - Manna A Alma
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Applied Health Research, Groningen, the Netherlands
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Sanderson A, West DJ. A Model for Sustaining Health at the Primary Care Level. Hosp Top 2019; 97:46-53. [PMID: 31025907 DOI: 10.1080/00185868.2019.1605321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
As the healthcare industry in USA is changing from a fee-for-service to a value-based system, the need for a shift in how patients are treated is evident. Healthcare organizations are reimbursed based on value and quality of service. The system shift recognizes that each patient possesses differing medical needs moving care from generalized medical treatments to individualistic care. To deal with this change and attempt to increase quality and value, many healthcare organizations are adopting a team care approach through the development of Patient-Centered Medical Homes (PCMH). In many examples of the team approach, the Primary Care Practitioner (PCP) is viewed as the main coordinator of care. Having this responsibility can create added stress for practitioners, which can lead to a decrease in the quality of care. The proposed model, in this article, outlines an example of how individualistic care can be achieved and assembled in the PCMH with the PCP as the main coordinator of care to sustain patient health.
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Affiliation(s)
- Alyssa Sanderson
- a Graduate Student, Department of Health Administration and Human Resources, University of Scranton, Scranton , PA , USA
| | - Daniel J West
- b Professor and Chairman, Department of Health Administration and Human Resources, University of Scranton, Scranton , PA , USA
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11
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Zickmund SL, Burkitt KH, Gao S, Stone RA, Jones AL, Hausmann LRM, Switzer GE, Borrero S, Rodriguez KL, Fine MJ. Racial, Ethnic, and Gender Equity in Veteran Satisfaction with Health Care in the Veterans Affairs Health Care System. J Gen Intern Med 2018; 33:305-331. [PMID: 29313226 PMCID: PMC5834960 DOI: 10.1007/s11606-017-4221-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/05/2017] [Accepted: 11/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient satisfaction is an important dimension of health care quality. The Veterans Health Administration (VA) is committed to providing high-quality care to an increasingly diverse patient population. OBJECTIVE To assess Veteran satisfaction with VA health care by race/ethnicity and gender. DESIGN AND PARTICIPANTS We conducted semi-structured telephone interviews with gender-specific stratified samples of black, white, and Hispanic Veterans from 25 predominantly minority-serving VA Medical Centers from June 2013 to January 2015. MAIN MEASURES Satisfaction with health care was assessed in 16 domains using five-point Likert scales. We compared the proportions of Veterans who were very satisfied, somewhat satisfied, and less than satisfied (i.e., neither satisfied nor dissatisfied, somewhat dissatisfied, or very dissatisfied) in each domain, and used random-effects multinomial regression to estimate racial/ethnic differences by gender and gender differences by race/ethnicity. KEY RESULTS Interviews were completed for 1222 of the 1929 Veterans known to be eligible for the interview (63.3%), including 421 white, 389 black, and 396 Hispanic Veterans, 616 of whom were female. Veterans were less likely to be somewhat satisfied or less than satisfied versus very satisfied with care in each of the 16 domains. The highest satisfaction ratings were reported for costs, outpatient facilities, and pharmacy (74-76% very satisfied); the lowest ratings were reported for access, pain management, and mental health care (21-24% less than satisfied). None of the joint tests of racial/ethnic or gender differences in satisfaction (simultaneously comparing all three satisfaction levels) was statistically significant (p > 0.05). Pairwise comparisons of specific levels of satisfaction revealed racial/ethnic differences by gender in three domains and gender differences by race/ethnicity in five domains, with no consistent directionality across demographic subgroups. CONCLUSIONS Our multisite interviews of a diverse sample of Veterans at primarily minority-serving sites showed generally high levels of health care satisfaction across 16 domains, with few quantitative differences by race/ethnicity or gender.
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Affiliation(s)
- Susan L Zickmund
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, UT, USA. .,Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Kelly H Burkitt
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Shasha Gao
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Roslyn A Stone
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Galen E Switzer
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sonya Borrero
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Keri L Rodriguez
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael J Fine
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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C. Schneider B, Bücker L, Riker S, Karamatskos E, Jelinek L. A Pilot Study of Metacognitive Training (D-MCT) for Older Adults with Depression. ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2018. [DOI: 10.1024/1016-264x/a000210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract. Depression remains one of the most common psychological disorders among older adults. Their response to antidepressants: however, is often unsatisfactory, and despite the proven efficacy of psychotherapies, a large treatment gap remains. Metacognitive Training for Depression (D-MCT) is a low-threshold group intervention. This article examines the feasibility, acceptance, and effects of D-MCT as an add-on intervention among a group of older adults (55+ years; N = 116). Participants completed measures of depression and dysfunctional attitudes, and provided subjective appraisals of the training. Per protocol analyses (n = 55) revealed a significant decrease in depressive symptoms (d = 1.06) and cognitive biases (d = 0.33). The findings demonstrate the feasibility and acceptance of D-MCT among older adults with depression.
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Affiliation(s)
- Brooke C. Schneider
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Riker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evangelos Karamatskos
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Jelinek L, Moritz S, Hauschildt M. Patients' perspectives on treatment with Metacognitive Training for Depression (D-MCT): Results on acceptability. J Affect Disord 2017. [PMID: 28628763 DOI: 10.1016/j.jad.2017.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Our understanding of how patients perceive and evaluate treatment for depression is scarce. Because dropout rates are high among individuals in treatment for depression, it is necessary to expand the focus of research to patients' perspectives on the treatment they receive. The aim of the two studies presented was to evaluate patient acceptance of Metacognitive Training for Depression (D-MCT), a highly standardized group intervention. METHODS Acceptability was evaluated in an open case series (Study 1, N = 70) and a randomized controlled trial (RCT; Study 2, N = 84). In both studies, participants rated their subjective appraisal on a 15-item questionnaire after administration of eight D-MCT modules. In Study 1, a subsample of patients also evaluated modules individually after each session. In Study 2, ratings were compared to an active control intervention (walking and psychoeducation sessions), and assessment was repeated at 6-months follow-up. RESULTS High rates of acceptance of the D-MCT were demonstrated in both studies immediately after treatment (post-assessment). In addition, the RCT showed better evaluations for the D-MCT than for the control condition at post-assessment as well as at 6-months follow-up. Weekly session evaluations in Study 1 indicated good acceptance for individual modules. LIMITATIONS Evaluations could only be obtained from completers; blinding of patients and therapists was not possible. CONCLUSIONS Results of the two studies suggest that D-MCT represents a promising group treatment in terms of patient acceptance and provide an example of how patients' feedback may be used to improve treatment.
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Affiliation(s)
- Lena Jelinek
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany.
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany
| | - Marit Hauschildt
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany
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Mays VM, Jones A, Delany-Brumsey A, Coles C, Cochran SD. Perceived Discrimination in Health Care and Mental Health/Substance Abuse Treatment Among Blacks, Latinos, and Whites. Med Care 2017; 55:173-181. [PMID: 27753743 PMCID: PMC5233585 DOI: 10.1097/mlr.0000000000000638] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Experiences of discrimination in health care settings may contribute to disparities in mental health outcomes for blacks and Latinos. We investigate whether perceived discrimination in mental health/substance abuse visits contributes to participants' ratings of treatment helpfulness and stopped treatment. RESEARCH METHODS We used data from 3 waves of the California Quality of Life Survey, a statewide population-based telephone survey assessing mental health/substance disorders and their treatment. In a sample of 1099 adults (age 18-72) who indicated prior year mental health/substance abuse visits, we examined: experiences of discrimination that occurred during health care and mental health/substance abuse visits, ratings of treatment helpfulness, and reports of stopping treatment early. RESULTS Fifteen percent of California adults reported discrimination during a health care visit and 4% specifically during mental health/substance abuse visits. Latinos, the uninsured, and those with past year mental disorders were twice as likely as others to report health care discrimination [adjusted odds ratio (AORs)=2.08, 2.77, and 2.51]. Uninsured patients were 7 times more likely to report discrimination in mental health/substance abuse visits (AOR=7.27, P<0.01). The most commonly reported reasons for health care discrimination were race/ethnicity for blacks (52%) and Latinos (31%), and insurance status for whites (40%). Experiences of discrimination in mental health/substance abuse visits were associated with less helpful treatment ratings for Latinos (AOR=0.09, P<0.05) and whites (AOR=0.25, P<0.01), and early treatment termination for blacks (AOR=13.38, P<0.05). CONCLUSIONS Experiences of discrimination are associated with negative mental health/substance abuse treatment experiences and stopped treatment, and could be a factor in mental health outcomes.
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Affiliation(s)
- Vickie M. Mays
- Psychology and Health Policy and Management, UCLA Fielding School of Public Health and UCLA Center for Bridging Research, Innovation, Training and Education for Minority Health Disparities Solutions, UCLA; 405 Hilgard Avenue, Box 951563 Los Angeles, CA 90095-1563; ; Telephone: 310-206-5159; Fax: 310-206-5895
| | - Audrey Jones
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System– and UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, Address: University Drive 151C, Building 30, Pittsburgh, PA 15240-1001
| | - Ayesha Delany-Brumsey
- Vera Institute of Justice and UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, Address: 233 Broadway 12 Floor, New York, NY 10279
| | - Courtney Coles
- Department of Health Policy and Management, UCLA Fielding School of Public Health and UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, Address: 31-269 Center for the Health Sciences, Box 951772, Los Angeles, CA 90095-1772
| | - Susan D. Cochran
- Epidemiology and Statistics, UCLA Fielding School of Public Health and UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, Address: UCLA Department of Epidemiology, 650 Charles E. Young Dr., UCLA School of Public Health, Los Angeles, CA 90095
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van Grieken RA, Verburg HF, Koeter MWJ, Stricker J, Nabitz UW, Schene AH. Helpful Factors in the Treatment of Depression from the Patient's, Carer's and Professional's Perspective: A Concept Map Study. PLoS One 2016; 11:e0167719. [PMID: 27992453 PMCID: PMC5161328 DOI: 10.1371/journal.pone.0167719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/18/2016] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Depression research has resulted in knowledge about neurobiology, pharmacological strategies and short-term cost-effective treatments. However, more than two-thirds of all depressed patients experience insufficient improvement. Therefore, a better understanding of what patients, carers and professionals perceive as most helpful in the treatment of depression is needed. METHODS Concept mapping, a mixed-method design, was used to identify the patients (n = 33), carers (n = 22) and professionals (n = 50) perspectives. In six brainstorm sessions, the patients, carers and professionals generated 795 ideas, which were condensed into 55 unique statements. Subsequently, 100 participants prioritized and sorted these statements, which were analysed by multidimensional scaling and cluster analysis and visualized as a two-dimensional map. RESULTS The 55 statements were clustered in 10 factors and further grouped into four main-factors (meta-clusters): 'Professional therapist', 'Treatment content', 'Structured treatment process' and 'Treatment organisation'. Patients and carers prioritized 'Treatment organisation' higher than professionals, but overall there was considerable agreement about the factors of treatment the participants perceived as most helpful including factors related to the therapeutic relationship and the 'creation of hope'. CONCLUSIONS Our study identified factors of depression treatment perceived as helpful according to patients, carers and professionals. Findings suggest that in a scientific era with emphasis on biological psychiatry, not only patients and carers, but also professionals consider aspecific factors the most helpful. Further studies might show that factors we found to be helpful in the treatment for depression, can be generalized to mental health treatment in general.
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Affiliation(s)
- Rosa A. van Grieken
- Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanka F. Verburg
- Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten W. J. Koeter
- Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jessica Stricker
- Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Udo W. Nabitz
- Department of Research and Quality, Arkin Mental Health Care Services, Amsterdam, The Netherlands
| | - Aart H. Schene
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
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Agreli HF, Peduzzi M, Silva MC. Atenção centrada no paciente na prática interprofissional colaborativa. ACTA ACUST UNITED AC 2016. [DOI: 10.1590/1807-57622015.0511] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Este estudo foi realizado com o objetivo de descrever os elementos-chave da atenção centrada no paciente e sua relação com a prática interprofissional colaborativa na atenção primária à saúde, no contexto do Sistema Único de Saúde, apoiado em revisão de literatura nacional e internacional. Os resultados mostram que, à medida que os profissionais centram atenção no paciente e suas necessidades de saúde, operam simultaneamente um deslocamento de foco para um horizonte mais amplo e além de sua própria atuação profissional. Esse deslocamento é reconhecido como componente de mudança do modelo de atenção à saúde na perspectiva da integralidade, com potencial de impacto na qualidade da atenção.
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Bashshur RL, Shannon GW, Bashshur N, Yellowlees PM. The Empirical Evidence for Telemedicine Interventions in Mental Disorders. Telemed J E Health 2016; 22:87-113. [PMID: 26624248 PMCID: PMC4744872 DOI: 10.1089/tmj.2015.0206] [Citation(s) in RCA: 211] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 10/16/2015] [Indexed: 01/02/2023] Open
Abstract
PROBLEM AND OBJECTIVE This research derives from the confluence of several factors, namely, the prevalence of a complex array of mental health issues across age, social, ethnic, and economic groups, an increasingly critical shortage of mental health professionals and the associated disability and productivity loss in the population, and the potential of telemental health (TMH) to ameliorate these problems. Definitive information regarding the true merit of telemedicine applications and intervention is now of paramount importance among policymakers, providers of care, researchers, payers, program developers, and the public at large. This is necessary for rational policymaking, prudent resource allocation decisions, and informed strategic planning. This article is aimed at assessing the state of scientific knowledge regarding the merit of telemedicine interventions in the treatment of mental disorders (TMH) in terms of feasibility/acceptance, effects on medication compliance, health outcomes, and cost. MATERIALS AND METHODS We started by casting a wide net to identify the relevant studies and to examine in detail the content of studies that met the eligibility criteria for inclusion. Only studies that met rigorous methodological criteria were included. Necessary details include the specific nature and content of the intervention, the research methodology, clinical focus, technological configuration, and the modality of the intervention. RESULTS The published scientific literature on TMH reveals strong and consistent evidence of the feasibility of this modality of care and its acceptance by its intended users, as well as uniform indication of improvement in symptomology and quality of life among patients across a broad range of demographic and diagnostic groups. Similarly, positive trends are shown in terms of cost savings. CONCLUSION There is substantial empirical evidence for supporting the use of telemedicine interventions in patients with mental disorders.
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Affiliation(s)
- Rashid L. Bashshur
- University of Michigan Health System, University of Michigan, Ann Arbor, Michigan
| | - Gary W. Shannon
- Department of Geography, University of Kentucky, Lexington, Kentucky
| | - Noura Bashshur
- University of Michigan Health System, University of Michigan, Ann Arbor, Michigan
| | - Peter M. Yellowlees
- Department of Psychiatry, University of California Davis, Sacramento, California
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van Grieken RA, Beune EJAJ, Kirkenier ACE, Koeter MWJ, van Zwieten MCB, Schene AH. Patients׳ perspectives on how treatment can impede their recovery from depression. J Affect Disord 2015; 167:153-9. [PMID: 24972363 DOI: 10.1016/j.jad.2014.05.065] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 05/29/2014] [Accepted: 05/29/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND More than 50% of all major depressive disorder (MDD) patients experience insufficient improvement from the available treatment options. There is emerging evidence that patients׳ beliefs and experiences about MDD treatment influence treatment outcomes. The aim was to explore patients׳ perspectives on impeding characteristics of professional treatment for the recovery of MDD. METHODS In-depth interviews in a purposive sample with 27 recovered MDD patients who had received professional treatment. Data were qualitatively analyzed using constant comparison. RESULTS Participants׳ accounts yielded four major impeding themes: lack of clarity and consensus about the nature of the participants׳ MDD and the content of their treatment; precarious relationship with the clinician; unavailability of mental health care; and insufficient involvement of significant others. LIMITATIONS The external generalizability may be limited due to missed other subgroups within depression. CONCLUSIONS This study identified a comprehensive overview of impeding characteristics in MDD treatment from patients׳ perspectives. This may help clinicians to understand how patients experience MDD treatment, and to incorporate patients׳ perspectives about treatment into their joint decision-making. This can lead towards increased treatment adherence, motivation and finally success.
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Affiliation(s)
- Rosa A van Grieken
- Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands.
| | - Erik J A J Beune
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anneloes C E Kirkenier
- Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands
| | - Maarten W J Koeter
- Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands
| | - Myra C B van Zwieten
- Department of General Practice/Medical Ethics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Aart H Schene
- Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands; Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
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Abstract
This study assessed the experiences of patients receiving split-care treatment, focusing on communication between the two treating professionals and its impact on patient satisfaction. Studies have documented that for more than 20% of patients, no communication occurs between providers, and the present study provides further data. Split-care patients completed a 23-item questionnaire on SurveyMonkey via Mechanical Turk, a crowd-sourcing Website, assessing patients' split-care experiences, including whether their providers had communicated and the impact of communication on patients' satisfaction with treatment. Of respondents who knew if their providers communicated, 30% reported that no communication occurred. Similarly, 30% and 36% of respondents were never asked by their psychotherapist or psychopharmacologist, respectively, for permission to speak to the other professional. Non-communication yielded significantly lower patient satisfaction with treatment. This study replicates the high frequency of non-communication between providers of split care and has great implications for the impact of communication on treatment compliance and outcome.
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20
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Coulter A, Entwistle VA, Eccles A, Ryan S, Shepperd S, Perera R. Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database Syst Rev 2015; 2015:CD010523. [PMID: 25733495 PMCID: PMC6486144 DOI: 10.1002/14651858.cd010523.pub2] [Citation(s) in RCA: 275] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Personalised care planning is a collaborative process used in chronic condition management in which patients and clinicians identify and discuss problems caused by or related to the patient's condition, and develop a plan for tackling these. In essence it is a conversation, or series of conversations, in which they jointly agree goals and actions for managing the patient's condition. OBJECTIVES To assess the effects of personalised care planning for adults with long-term health conditions compared to usual care (i.e. forms of care in which active involvement of patients in treatment and management decisions is not explicitly attempted or achieved). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, ProQuest, clinicaltrials.gov and WHO International Clinical Trials Registry Platform to July 2013. SELECTION CRITERIA We included randomised controlled trials and cluster-randomised trials involving adults with long-term conditions where the intervention included collaborative (between individual patients and clinicians) goal setting and action planning. We excluded studies where there was little or no opportunity for the patient to have meaningful influence on goal selection, choice of treatment or support package, or both. DATA COLLECTION AND ANALYSIS Two of three review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. The primary outcomes were effects on physical health, psychological health, subjective health status, and capabilities for self management. Secondary outcomes included effects on health-related behaviours, resource use and costs, and type of intervention. A patient advisory group of people with experience of living with long-term conditions advised on various aspects of the review, including the protocol, selection of outcome measures and emerging findings. MAIN RESULTS We included 19 studies involving a total of 10,856 participants. Twelve of these studies focused on diabetes, three on mental health, one on heart failure, one on end-stage renal disease, one on asthma, and one on various chronic conditions. All 19 studies included components that were intended to support behaviour change among patients, involving either face-to-face or telephone support. All but three of the personalised care planning interventions took place in primary care or community settings; the remaining three were located in hospital clinics. There was some concern about risk of bias for each of the included studies in respect of one or more criteria, usually due to inadequate or unclear descriptions of research methods. Physical healthNine studies measured glycated haemoglobin (HbA1c), giving a combined mean difference (MD) between intervention and control of -0.24% (95% confidence interval (CI) -0.35 to -0.14), a small positive effect in favour of personalised care planning compared to usual care (moderate quality evidence).Six studies measured systolic blood pressure, a combined mean difference of -2.64 mm/Hg (95% CI -4.47 to -0.82) favouring personalised care (moderate quality evidence). The pooled results from four studies showed no significant effect on diastolic blood pressure, MD -0.71 mm/Hg (95% CI -2.26 to 0.84).We found no evidence of an effect on cholesterol (LDL-C), standardised mean difference (SMD) 0.01 (95% CI -0.09 to 0.11) (five studies) or body mass index, MD -0.11 (95% CI -0.35 to 0.13) (four studies).A single study of people with asthma reported that personalised care planning led to improvements in lung function and asthma control. Psychological healthSix studies measured depression. We were able to pool results from five of these, giving an SMD of -0.36 (95% CI -0.52 to -0.20), a small effect in favour of personalised care (moderate quality evidence). The remaining study found greater improvement in the control group than the intervention group.Four other studies used a variety of psychological measures that were conceptually different so could not be pooled. Of these, three found greater improvement for the personalised care group than the usual care group and one was too small to detect differences in outcomes. Subjective health statusTen studies used various patient-reported measures of health status (or health-related quality of life), including both generic health status measures and condition-specific ones. We were able to pool data from three studies that used the SF-36 or SF-12, but found no effect on the physical component summary score SMD 0.16 (95% CI -0.05 to 0.38) or the mental component summary score SMD 0.07 (95% CI -0.15 to 0.28) (moderate quality evidence). Of the three other studies that measured generic health status, two found improvements related to personalised care and one did not.Four studies measured condition-specific health status. The combined results showed no difference between the intervention and control groups, SMD -0.01 (95% CI -0.11 to 0.10) (moderate quality evidence). Self-management capabilitiesNine studies looked at the effect of personalised care on self-management capabilities using a variety of outcome measures, but they focused primarily on self efficacy. We were able to pool results from five studies that measured self efficacy, giving a small positive result in favour of personalised care planning: SMD 0.25 (95% CI 0.07 to 0.43) (moderate quality evidence).A further five studies measured other attributes that contribute to self-management capabilities. The results from these were mixed: two studies found evidence of an effect on patient activation, one found an effect on empowerment, and one found improvements in perceived interpersonal support. Other outcomesPooled data from five studies on exercise levels showed no effect due to personalised care planning, but there was a positive effect on people's self-reported ability to carry out self-care activities: SMD 0.35 (95% CI 0.17 to 0.52).We found no evidence of adverse effects due to personalised care planning.The effects of personalised care planning were greater when more stages of the care planning cycle were completed, when contacts between patients and health professionals were more frequent, and when the patient's usual clinician was involved in the process. AUTHORS' CONCLUSIONS Personalised care planning leads to improvements in certain indicators of physical and psychological health status, and people's capability to self-manage their condition when compared to usual care. The effects are not large, but they appear greater when the intervention is more comprehensive, more intensive, and better integrated into routine care.
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Affiliation(s)
- Angela Coulter
- University of OxfordHealth Services Research Unit, Nuffield Department of Population HealthOld Road Campus, HeadingtonOxfordUKOX3 7LF
| | - Vikki A Entwistle
- University of AberdeenHealth Services Research UnitHealth Services Building Level 3ForesterhillAberdeenUKAB25 2ZD
| | - Abi Eccles
- University of OxfordDepartment of Primary Care Health Sciences23‐28 Hythe Bridge StreetOxfordUKOX1 2ET
| | - Sara Ryan
- University of OxfordQuality and Outcomes Research Unit and Health Experiences Research Group23‐28 Hythe Bridge StreetOxfordUKOX1 2ET
| | - Sasha Shepperd
- University of OxfordNuffield Department of Population HealthRosemary Rue Building, Old Road CampusHeadingtonOxfordUKOX3 7LF
| | - Rafael Perera
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
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Fox A, Reeves S. Interprofessional collaborative patient-centred care: a critical exploration of two related discourses. J Interprof Care 2014; 29:113-8. [PMID: 25180630 DOI: 10.3109/13561820.2014.954284] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There has been sustained international interest from health care policy makers, practitioners, and researchers in developing interprofessional approaches to delivering patient-centred care. In this paper, we offer a critical exploration of a selection of professional discourses related to these practice paradigms, including interprofessional collaboration, patient-centred care, and the combination of the two. We argue that for some groups of patients, inequalities between different health and social care professions and between professionals and patients challenge the successful realization of the positive aims associated with these discourses. Specifically, we argue that interprofessional and professional-patient hierarchies raise a number of key questions about the nature of professions, their relationships with one another as well as their relationship with patients. We explore how the focus on interprofessional collaboration and patient-centred care have the potential to reinforce a patient compliance model by shifting responsibility to patients to do the "right thing" and by extending the reach of medical power across other groups of professionals. Our goal is to stimulate debate that leads to enhanced practice opportunities for health professionals and improved care for patients.
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Affiliation(s)
- Ann Fox
- Department of Nutritional Sciences, Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario Canada and
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Heise BA, van Servellen G. The nurse's role in primary care antidepressant medication adherence. J Psychosoc Nurs Ment Health Serv 2013; 52:48-57. [PMID: 24305910 DOI: 10.3928/02793695-20131126-08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/20/2013] [Indexed: 11/20/2022]
Abstract
Depression remains one of the most common conditions seen in primary care settings. Antidepressant medications (ADMs) are considered standard treatment for moderate to severe depression, and in some instances, for minor depression. When ADM adherence is low, patients are at risk for treatment failure and poor quality of life. Nurses may be key in ensuring the success of ADM therapy; however, little is known about the interventions nurses use or the consequent patient outcomes. The objectives of this article were to identify studies in which nurses managed ADM adherence and to collect evidence about the efficacy of these interventions. A systematic literature review of clinical trial studies was conducted, which specifically included the role of the nurse. Nurse interventions identified were: patient care management, medication monitoring, depression education, and referrals to specialty providers. Nurses use a range of interventions to manage ADM adherence. In most studies, these approaches, including collaborative care, were efficacious.
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Kitchen KA, McKibbin CL, Wykes TL, Lee AA, Carrico CP, McConnell KA. Depression Treatment Among Rural Older Adults: Preferences and Factors Influencing Future Service Use. Clin Gerontol 2013; 36:10.1080/07317115.2013.767872. [PMID: 24409008 PMCID: PMC3881270 DOI: 10.1080/07317115.2013.767872] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The purpose of this study was to investigate depression treatment preferences and anticipated service use in a sample of adults aged 55 years or older who reside in rural Wyoming. Sixteen participants (mean age = 59) completed 30- to 60-minute, semi-structured interviews. Qualitative methods were used to characterize common themes. Social/provider support and community gatekeepers were perceived by participants as important potential facilitators for seeking depression treatment. In contrast, perceived stigma and the value placed on self-sufficiency emerged as key barriers to seeking treatment for depression in this rural, young-old sample. Participants anticipated presenting for treatment in the primary care sector and preferred a combination of medication and psychotherapy for treatment. Participants were, however, more willing to see mental health professionals if they were first referred by a clergy member or primary care physician.
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Affiliation(s)
| | | | | | - Aaron A Lee
- University of Wyoming, Laramie, Wyoming, USA
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Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev 2012; 10:CD006525. [PMID: 23076925 DOI: 10.1002/14651858.cd006525.pub2] [Citation(s) in RCA: 465] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Common mental health problems, such as depression and anxiety, are estimated to affect up to 15% of the UK population at any one time, and health care systems worldwide need to implement interventions to reduce the impact and burden of these conditions. Collaborative care is a complex intervention based on chronic disease management models that may be effective in the management of these common mental health problems. OBJECTIVES To assess the effectiveness of collaborative care for patients with depression or anxiety. SEARCH METHODS We searched the following databases to February 2012: The Cochrane Collaboration Depression, Anxiety and Neurosis Group (CCDAN) trials registers (CCDANCTR-References and CCDANCTR-Studies) which include relevant randomised controlled trials (RCTs) from MEDLINE (1950 to present), EMBASE (1974 to present), PsycINFO (1967 to present) and the Cochrane Central Register of Controlled Trials (CENTRAL, all years); the World Health Organization (WHO) trials portal (ICTRP); ClinicalTrials.gov; and CINAHL (to November 2010 only). We screened the reference lists of reports of all included studies and published systematic reviews for reports of additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of collaborative care for participants of all ages with depression or anxiety. DATA COLLECTION AND ANALYSIS Two independent researchers extracted data using a standardised data extraction sheet. Two independent researchers made 'Risk of bias' assessments using criteria from The Cochrane Collaboration. We combined continuous measures of outcome using standardised mean differences (SMDs) with 95% confidence intervals (CIs). We combined dichotomous measures using risk ratios (RRs) with 95% CIs. Sensitivity analyses tested the robustness of the results. MAIN RESULTS We included seventy-nine RCTs (including 90 relevant comparisons) involving 24,308 participants in the review. Studies varied in terms of risk of bias.The results of primary analyses demonstrated significantly greater improvement in depression outcomes for adults with depression treated with the collaborative care model in the short-term (SMD -0.34, 95% CI -0.41 to -0.27; RR 1.32, 95% CI 1.22 to 1.43), medium-term (SMD -0.28, 95% CI -0.41 to -0.15; RR 1.31, 95% CI 1.17 to 1.48), and long-term (SMD -0.35, 95% CI -0.46 to -0.24; RR 1.29, 95% CI 1.18 to 1.41). However, these significant benefits were not demonstrated into the very long-term (RR 1.12, 95% CI 0.98 to 1.27).The results also demonstrated significantly greater improvement in anxiety outcomes for adults with anxiety treated with the collaborative care model in the short-term (SMD -0.30, 95% CI -0.44 to -0.17; RR 1.50, 95% CI 1.21 to 1.87), medium-term (SMD -0.33, 95% CI -0.47 to -0.19; RR 1.41, 95% CI 1.18 to 1.69), and long-term (SMD -0.20, 95% CI -0.34 to -0.06; RR 1.26, 95% CI 1.11 to 1.42). No comparisons examined the effects of the intervention on anxiety outcomes in the very long-term.There was evidence of benefit in secondary outcomes including medication use, mental health quality of life, and patient satisfaction, although there was less evidence of benefit in physical quality of life. AUTHORS' CONCLUSIONS Collaborative care is associated with significant improvement in depression and anxiety outcomes compared with usual care, and represents a useful addition to clinical pathways for adult patients with depression and anxiety.
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Affiliation(s)
- Janine Archer
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
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