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Sweileh WM. Analysis and mapping the research landscape on patient-centred care in the context of chronic disease management. J Eval Clin Pract 2024; 30:638-650. [PMID: 38567707 DOI: 10.1111/jep.13988] [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] [Received: 06/17/2023] [Revised: 02/07/2024] [Accepted: 03/18/2024] [Indexed: 05/25/2024]
Abstract
RATIONALE Patient-centred care has emerged as a transformative approach in managing chronic diseases, aiming to actively involve patients in their healthcare decisions. AIMS AND OBJECTIVES This study was conducted to analyse and map the research landscape on patient-centred care in the context of chronic disease management. METHODS This study used Scopus to retrieve the relevant articles. The analysis focused on the growth pattern, highly cited articles, randomised clinical trials, patients and providers perspectives, facilitators and barriers, frequent author keywords, emerging topics, and prolific countries and journals in the field. RESULTS In total, 926 research articles met the inclusion criteria. There was a notable increase in the number of publications over time. Cancer had the highest number of articles (n = 379, 40.9%), followed by diabetes mellitus, and mental health and psychiatric conditions. Studies on patient-centred care in diabetic patients received the highest number of citations. The results identified 52 randomised controlled trials that covered four major themes: patient-centred care for diabetes management, shared decision-making in mental health and primary care, shared decision-making in cancer care, and economic evaluation and cost-effectiveness. The study identified 51 studies that examined the impact of tools such as computer-based systems, decision aids, smartphone apps, and online tools to improve patient-centred outcomes. A map of author keywords showed that renal dialysis, HIV, and atrial fibrillation were the most recent topics in the field. Researchers from the United States contributed to more than half of the retrieved publications. The top active journals included "Patient Education and Counselling" and "Health Expectations". CONCLUSION This study provides valuable insights into the research landscape of patient-centred care within the context of chronic diseases. The current study provided a comprehensive overview of the research landscape on patient-centred care, which can empower patients by raising their awareness about clinical experiences and outcomes.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology and Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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2
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Poojari PG, Khan S, Shenoy S, Shetty S, Bose S, Pai K, Acharya LD, Thunga G. A narrative review of metabolic monitoring of adult prescribed second-generation antipsychotics for severe mental illness. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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3
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Thomas EC, Ben-David S, Treichler E, Roth S, Dixon L, Salzer M, Zisman-Ilani Y. A Systematic Review of Shared Decision-Making Interventions for Service Users With Serious Mental Illnesses: State of the Science and Future Directions. Psychiatr Serv 2021; 72:1288-1300. [PMID: 34369801 PMCID: PMC8570969 DOI: 10.1176/appi.ps.202000429] [Citation(s) in RCA: 12] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Shared decision making (SDM) is a health communication model that may be particularly appealing to service users with serious mental illnesses, who often want to be involved in making decisions about their mental health care. The purpose of this systematic review was to describe and evaluate participant, intervention, methodological, and outcome characteristics of SDM intervention studies conducted within this population. METHODS Systematic searches of the literature through April 2020 were conducted and supplemented by hand searching of reference lists of identified studies. A total of 53 independent studies of SDM interventions that were conducted with service users with serious mental illnesses and that included a quantitative or qualitative measure of the intervention were included in the review. Data were independently extracted by at least two authors. RESULTS Most studies were conducted with middle-age, male, White individuals from Western countries. Interventions fell into the following categories: decision support tools only, multicomponent interventions involving decision support tools, multicomponent interventions not involving decision support tools, and shared care planning and preference elicitation interventions. Most studies were randomized controlled trials with sufficient sample sizes. Outcomes assessed were diverse, spanning decision-making constructs, clinical and functional, treatment engagement or adherence, and other constructs. CONCLUSIONS Findings suggest important future directions for research, including the need to evaluate the impact of SDM in special populations (e.g., young adults and racial-ethnic minority groups); to expand interventions to a broader array of decisions, users, and contexts; and to establish consensus measures to assess intervention effectiveness.
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Affiliation(s)
| | | | - Emily Treichler
- VA Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA
- Department of Psychiatry, University of California San Diego, La Jolla, CA
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4
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Soda T, Richards J, Gaynes BN, Cueva M, Laux J, McClain C, Frische R, Lindquist LK, Cuddeback GS, Jarskog LF. Systematic Quality Improvement and Metabolic Monitoring for Individuals Taking Antipsychotic Drugs. Psychiatr Serv 2021; 72:647-653. [PMID: 33887956 PMCID: PMC8192348 DOI: 10.1176/appi.ps.202000155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to increase the rate of cardiometabolic monitoring for patients receiving antipsychotic drugs in an academic outpatient psychiatric clinic serving people with serious mental illness. METHODS Using a prospective quasi-experimental, interrupted time-series design with data from the electronic health record (EHR), the authors determined metabolic monitoring rates before, during, and after implementation of prespecified quality improvement (QI) measures between August 2016 and July 2017. QI measures included a combination of provider, patient, and staff education; systematic barrier reduction; and an EHR-based reminder system. RESULTS After 1 year of QI implementation, the rate of metabolic monitoring had increased from 33% to 49% (p<0.01) for the primary outcome measure (hemoglobin A1C and lipid panel). This increased monitoring rate was sustained for 27 months beyond the end of the QI intervention. More than 75% of providers did not find the QI reminders burdensome. CONCLUSIONS Significant improvement in the rate of metabolic monitoring for people taking antipsychotic drugs can be achieved with little added burden on providers. Future research needs to assess the full range of patient, provider, and system barriers that prevent cardiometabolic monitoring for all individuals receiving antipsychotic drugs.
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Affiliation(s)
- Takahiro Soda
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Jennifer Richards
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Bradley N Gaynes
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Michelle Cueva
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Jeffrey Laux
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Christine McClain
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Rachel Frische
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Lisa K Lindquist
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Gary S Cuddeback
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - L Fredrik Jarskog
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
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5
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Leung JG, Owen A, Webb AJ, Johnson EK, Dively-White M, Kreps M, Anderson KK, Schak KM. Improvement of Inpatient Psychiatric Facility Quality Reporting program measure: Screening for metabolic disorders through pharmacy collaborative practice agreement. J Am Pharm Assoc (2003) 2021; 61:e126-e131. [PMID: 33931352 DOI: 10.1016/j.japh.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Second-generation antipsychotics are associated with lower risks of extrapyramidal symptoms, including tardive dyskinesia. However, many second-generation antipsychotics are associated with metabolic adverse effects, including weight gain, impaired blood glucose control, and hyperlipidemia. Metabolic monitoring for patients prescribed antipsychotic medication is 1 of several measures of the Centers for Medicare & Medicaid Services' Inpatient Psychiatric Facility Quality Reporting program. Screening for metabolic disorders (SMD) must be obtained within the previous 365 days before the hospital discharge date. National data suggest that compliance with this measure is low. OBJECTIVE To improve compliance of metabolic monitoring by 20% while ensuring that the quality improvement interventions did not cause any unintended adverse effects on other aspects of our system. PRACTICE DESCRIPTION This quality initiative was conducted at a large, 2000-bed academic medical center with approximately 80 inpatient psychiatric beds. PRACTICE INNOVATION To improve the metabolic screening rates, a pharmacist collaborative practice agreement (CPA) was established as part of a quality improvement project. Previously, there were no formal processes at the institution to ensure that appropriate laboratory tests were conducted. EVALUATION METHODS Using an uncontrolled before-and-after design, SMD data were gathered from 6 months before and 6 months after CPA implementation. Pearson chi-square test or Fisher exact test were used to compare the pre- and postintervention groups in this quasi-experimental design. RESULTS Compared with the preintervention period, compliance of SMD monitoring increased by 21.2% in the postintervention phase-from 69.2% to 90.4% (P < 0.001). CONCLUSION The empowerment of clinical pharmacists with a CPA significantly improved guideline-concordant metabolic monitoring of antipsychotics. These findings may have significant impact on the approach to the safe use of these essential psychotropic medications and provide a framework for other inpatient mental health facilities to optimally use the skills of their interdisciplinary team.
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Howard R, Kuhn L, Millar F, Street M. Physical health assessment and cardiometabolic monitoring practices across three adult mental health inpatient units - a retrospective cohort study. Int J Ment Health Nurs 2020; 29:1144-1156. [PMID: 32743951 DOI: 10.1111/inm.12755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/07/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023]
Abstract
Australians with lived experience of mental illness die on average 10 or more years earlier than the general population. Cardiometabolic disorders, including cardiovascular disease and diabetes mellitus, are common causes of premature death in this cohort. Little is known about cardiometabolic monitoring practices in mental health inpatient units. The aim of this study was to examine the characteristics of cardiometabolic monitoring and physical health assessments of adult mental health consumers within the first 72 hours of admission to an inpatient unit. We implemented a retrospective descriptive exploratory design by medical record audit. Data were collected using a pre-validated audit tool, adapted with recent literature and policy, from a randomly selected sample of consumers admitted to three acute mental health adult inpatient units of a large Australian metropolitan health service in 2016. Of 228 consumers, the mean age was 37.5 (range 18-64) years and 51.3% were women. Cardiometabolic risks were common, yet most consumers received incomplete cardiometabolic monitoring. While few consumers (15%) were diagnosed with cardiometabolic comorbidities, 67.5% were prescribed psychotropic medications with high cardiometabolic risk. Compliance with recommended cardiometabolic monitoring varied considerably between risk factors: for example, blood pressure was measured in 56.1% of consumers, whereas waist circumference was never recorded. There were no statistically significant associations between cardiometabolic monitoring completion and sex or cardiometabolic risk. These findings demonstrate the need for increased education and awareness of cardiometabolic risk and identify a critical gap between physical health assessment practices and recommendations for this cohort.
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Affiliation(s)
- Rebekah Howard
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Eastern Health, Adult Mental Health Services, Melbourne, Victoria, Australia
| | - Lisa Kuhn
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | | | - Maryann Street
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research - Eastern Health Partnership, Melbourne, Victoria, Australia
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7
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Screening for Diabetes and Self-Care in Patients With Severe Mental Illness. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2019.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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8
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Melamed OC, Wong EN, LaChance LR, Kanji S, Taylor VH. Interventions to Improve Metabolic Risk Screening Among Adult Patients Taking Antipsychotic Medication: A Systematic Review. Psychiatr Serv 2019; 70:1138-1156. [PMID: 31522630 DOI: 10.1176/appi.ps.201900108] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Antipsychotic use is associated with elevated cardiometabolic risk. Guidelines for metabolic risk screening of individuals taking antipsychotics have been issued, but with little uptake into clinical practice. This review systematically assessed interventions that address this guideline-to-practice gap and described their quality, improvement strategies, and effect on screening rates. METHODS Studies of interventions that addressed metabolic risk screening of adult patients taking antipsychotics, published from inception to July 2018, were selected from MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane Reviews databases. Information was extracted on study characteristics; improvement strategies at the provider, patient, and system levels; and screening rates in the intervention and comparison groups. RESULTS The review included 30 complex interventions that used between one and nine unique improvement strategies. Social influence to shift provider and health organization culture to encourage metabolic risk screening was a common strategy, as were clinical prompts and monitoring tools to capture provider attention. Most studies were deemed at high risk of bias. Relative to comparison groups, the interventions were associated with an increase in median screening rates for glucose (28% to 65%), lipids (22% to 61%), weight (19% to 67%), and blood pressure (22% to 80%). CONCLUSIONS This knowledge synthesis points to shortcomings of current interventions to improve antipsychotic metabolic risk screening, both in quality and in outcomes. Findings may be used to inform the design of future programs. Additional interventions are needed to address the current guideline-to-practice gap, in which approximately one-third of patients are unscreened for metabolic risk.
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Affiliation(s)
- Osnat C Melamed
- Centre for Addiction and Mental Health, Toronto (Melamed, LaChance); Department of Psychiatry, University of Toronto, Toronto (Melamed, Wong, Kanji, Taylor); Department of Psychiatry, McGill University, Montreal (LaChance); Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Taylor)
| | - Erin N Wong
- Centre for Addiction and Mental Health, Toronto (Melamed, LaChance); Department of Psychiatry, University of Toronto, Toronto (Melamed, Wong, Kanji, Taylor); Department of Psychiatry, McGill University, Montreal (LaChance); Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Taylor)
| | - Laura R LaChance
- Centre for Addiction and Mental Health, Toronto (Melamed, LaChance); Department of Psychiatry, University of Toronto, Toronto (Melamed, Wong, Kanji, Taylor); Department of Psychiatry, McGill University, Montreal (LaChance); Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Taylor)
| | - Sarah Kanji
- Centre for Addiction and Mental Health, Toronto (Melamed, LaChance); Department of Psychiatry, University of Toronto, Toronto (Melamed, Wong, Kanji, Taylor); Department of Psychiatry, McGill University, Montreal (LaChance); Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Taylor)
| | - Valerie H Taylor
- Centre for Addiction and Mental Health, Toronto (Melamed, LaChance); Department of Psychiatry, University of Toronto, Toronto (Melamed, Wong, Kanji, Taylor); Department of Psychiatry, McGill University, Montreal (LaChance); Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Taylor)
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9
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Reich CM, Hack SM, Klingaman EA, Brown CH, Fang LJ, Dixon LB, Jahn DR, Kreyenbuhl JA. Consumer satisfaction with antipsychotic medication-monitoring appointments: the role of consumer-prescriber communication patterns. Int J Psychiatry Clin Pract 2018; 22:89-94. [PMID: 28920491 PMCID: PMC5909968 DOI: 10.1080/13651501.2017.1375530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 08/04/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The study was designed to explore patterns of prescriber communication behaviors as they relate to consumer satisfaction among a serious mental illness sample. METHODS Recordings from 175 antipsychotic medication-monitoring appointments between veterans with psychiatric disorders and their prescribers were coded using the Roter Interaction Analysis System (RIAS) for communication behavioral patterns. RESULTS The frequency of prescriber communication behaviors (i.e., facilitation, rapport, procedural, psychosocial, biomedical, and total utterances) did not reliably predict consumer satisfaction. The ratio of prescriber to consumer utterances did predict consumer satisfaction. CONCLUSIONS Consistent with client-centered care theory, antipsychotic medication consumers were more satisfied with their encounters when their prescriber did not dominate the conversation. PRACTICE IMPLICATIONS Therefore, one potential recommendation from these findings could be for medication prescribers to spend more of their time listening to, rather than speaking with, their SMI consumers.
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Affiliation(s)
| | - Samantha M. Hack
- VA Capitol Health Care Network, Baltimore, Maryland and University of Maryland School of Medicine, USA
| | - Elizabeth A. Klingaman
- VA Capitol Health Care Network, Baltimore, Maryland and University of Maryland School of Medicine, USA
| | - Clayton H. Brown
- VA Capitol Health Care Network, Baltimore, Maryland and University of Maryland School of Medicine, USA
| | - Li Juan Fang
- VA Capitol Health Care Network, Baltimore, Maryland and University of Maryland School of Medicine, USA
| | - Lisa B. Dixon
- New York State Psychiatric Institute, New York, New York, and Columbia University, USA
| | | | - Julie A. Kreyenbuhl
- VA Capitol Health Care Network, Baltimore, Maryland and University of Maryland School of Medicine, USA
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10
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Hwong AR, Mangurian C. Improving Breast Cancer Screening and Care for Women With Severe Mental Illness. J Clin Oncol 2017; 35:3996-3998. [PMID: 29095679 DOI: 10.1200/jco.2017.76.0462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Alison R Hwong
- Alison R. Hwong and Christina Mangurian, University of California, San Francisco, San Francisco, CA
| | - Christina Mangurian
- Alison R. Hwong and Christina Mangurian, University of California, San Francisco, San Francisco, CA
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11
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Mangurian C, Niu GC, Schillinger D, Newcomer JW, Dilley J, Handley MA. Utilization of the Behavior Change Wheel framework to develop a model to improve cardiometabolic screening for people with severe mental illness. Implement Sci 2017; 12:134. [PMID: 29137666 PMCID: PMC5686815 DOI: 10.1186/s13012-017-0663-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 11/01/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Individuals with severe mental illness (e.g., schizophrenia, bipolar disorder) die 10-25 years earlier than the general population, primarily from premature cardiovascular disease (CVD). Contributing factors are complex, but include systemic-related factors of poorly integrated primary care and mental health services. Although evidence-based models exist for integrating mental health care into primary care settings, the evidence base for integrating medical care into specialty mental health settings is limited. Such models are referred to as "reverse" integration. In this paper, we describe the application of an implementation science framework in designing a model to improve CVD outcomes for individuals with severe mental illness (SMI) who receive services in a community mental health setting. METHODS Using principles from the theory of planned behavior, focus groups were conducted to understand stakeholder perspectives of barriers to CVD risk factor screening and treatment identify potential target behaviors. We then applied results to the overarching Behavior Change Wheel framework, a systematic and theory-driven approach that incorporates the COM-B model (capability, opportunity, motivation, and behavior), to build an intervention to improve CVD risk factor screening and treatment for people with SMI. RESULTS Following a stepped approach from the Behavior Change Wheel framework, a model to deliver primary preventive care for people that use community mental health settings as their de facto health home was developed. The CRANIUM (cardiometabolic risk assessment and treatment through a novel integration model for underserved populations with mental illness) model focuses on engaging community psychiatrists to expand their scope of practice to become responsible for CVD risk, with significant clinical decision support. CONCLUSION The CRANIUM model was designed by integrating behavioral change theory and implementation theory. CRANIUM is feasible to implement, is highly acceptable to, and targets provider behavior change, and is replicable and efficient for helping to integrate primary preventive care services in community mental health settings. CRANIUM can be scaled up to increase CVD preventive care delivery and ultimately improve health outcomes among people with SMI served within a public mental health care system.
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Affiliation(s)
- Christina Mangurian
- Department of Psychiatry, Weill Institute for Neurosciences, UCSF at Zuckerberg San Francisco General (ZSFG), 1001 Potrero Avenue, 7M8, San Francisco, CA 94110 USA
- UCSF Center for Vulnerable Populations at ZSFG, San Francisco, CA USA
| | - Grace C. Niu
- Department of Psychiatry, Weill Institute for Neurosciences, UCSF at Zuckerberg San Francisco General (ZSFG), 1001 Potrero Avenue, 7M8, San Francisco, CA 94110 USA
| | - Dean Schillinger
- UCSF Center for Vulnerable Populations at ZSFG, San Francisco, CA USA
- UCSF Department of Medicine, Division of General Internal Medicine at ZSFG, 1001 Potrero Avenue, 1320A, San Francisco, CA 94110 USA
| | - John W. Newcomer
- Department of Clinical Biomedical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71 Rm 241, Boca Raton, FL 33431 USA
| | - James Dilley
- Department of Psychiatry, Weill Institute for Neurosciences, UCSF at Zuckerberg San Francisco General (ZSFG), 1001 Potrero Avenue, 7M8, San Francisco, CA 94110 USA
| | - Margaret A. Handley
- UCSF Center for Vulnerable Populations at ZSFG, San Francisco, CA USA
- UCSF Department of Medicine, Division of General Internal Medicine at ZSFG, 1001 Potrero Avenue, 1320A, San Francisco, CA 94110 USA
- UCSF Department of Epidemiology and Biostatistics, 550 16th Street, San Francisco, CA 64158 USA
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12
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Ali MK, Hack SM, Brown CH, Medoff D, Fang L, Klingaman EA, Park SG, Dixon LB, Kreyenbuhl JA. Racial Differences in Mental Health Recovery among Veterans with Serious Mental Illness. J Racial Ethn Health Disparities 2017; 5:235-242. [PMID: 28411327 DOI: 10.1007/s40615-017-0363-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/15/2017] [Accepted: 03/17/2017] [Indexed: 10/19/2022]
Abstract
Black consumers with serious mental illness (SMI) face significant challenges in obtaining quality mental health care and are at risk for experiencing significant disparities in mental health care outcomes, including recovery from mental illness. Patient-provider interactions may partly contribute to this disparity. The purpose of the current study was to understand the effects of race, psychosis, and therapeutic alliance on mental health recovery orientation among Veterans with SMI. Participants were Veterans who had an SMI being treated at two Veteran Affairs outpatient mental health clinics by a psychiatrist or nurse practitioner. Participants completed the Behavior and Symptom Identification Scale (BASIS-24), Mental Health Recovery Measure, and patient-report Scale to Assess the Therapeutic Relationship (STAR-P) which includes three subscales: positive collaboration, positive clinician input, and non-supportive clinician input. Regression analyses were used to determine interactive effects of race, psychosis severity, and therapeutic alliance variables. The sample was 226 Veterans (50% black, 50% white). Black participants were slightly older (p < .05), had higher baseline psychosis (p < .05), higher mental health recovery (p < .05), and perceived less non-supportive clinician input (p < .01) than white participants. Regression analyses indicated a significant three-way interaction among race, psychosis, and positive collaboration (p < .01). Greater positive collaboration attenuated the negative effect of higher levels of psychosis on mental health recovery orientation for black participants. Conversely, for white participants, positive collaboration had little effect on the negative relationship between psychosis severity and mental health recovery orientation. Increased levels of psychosis may inhibit patients' perceptions of their ability to recover from SMI. However, for black participants, positive collaboration with mental health providers may moderate the effects of psychotic symptomatology.
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Affiliation(s)
- Mana K Ali
- Department on Physical Medicine and Rehabilitation, Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
| | - Samantha M Hack
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA.,School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA
| | - Clayton H Brown
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA.,Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Howard Hall Suite 200, 660 W. Redwood Street, Baltimore, MD, 21201, USA
| | - Deborah Medoff
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA.,School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA
| | - Lijuan Fang
- School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA
| | - Elizabeth A Klingaman
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA.,School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA
| | - Stephanie G Park
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA.,School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Julie A Kreyenbuhl
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore VA Annex 209 W Fayette Street, Baltimore, MD, 21201, USA.,School of Medicine, University of Maryland, Department of Psychiatry, 110 South Paca Street, Baltimore, MD, 21201, USA
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