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Qureshi N, Huilgol SS, Timmins G, Meredith LS, Gidengil CA. Misaligned Supports: Differences in Reported Health Care Worker Well-being Supports Provided and Needed During the COVID-19 Pandemic. Am J Health Promot 2024:8901171241255764. [PMID: 38907369 DOI: 10.1177/08901171241255764] [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: 06/24/2024]
Abstract
PURPOSE To describe the well-being supports provided to health care workers (HCWs) during the COVID-19 pandemic in health centers and hospitals. DESIGN Cross-sectional qualitative interviews before and after implementation of a peer-based support intervention. SETTING Purposively sampled hospitals and health centers across the US. PARTICIPANTS 28 site leaders and 56 HCWs sampled from 16 hospitals and 12 health centers. METHOD Site leaders and HCWs were asked to describe supports available to HCWs during the COVID-19 pandemic. Thematic and content coding and analysis of interview responses were conducted using Dedoose. RESULTS Both site leaders and HCWs identified a range of support resources available. Communication resources were the most frequently cited in both groups. Health care workers reported bi-directional communication, while one-way communication was emphasized by site leaders. Hospitals highlighted counseling support, particularly Employee Assistance Programs (EAP), while health centers prioritized community support. Wellness activities were more prevalent in hospital settings, while health centers offered specific workplace-provided training for HCWs. Health care workers encountered barriers when accessing support, including limited time, fear of stigma, and disruptions to their existing support networks attributable to the pandemic. CONCLUSION While there are resources for HCWs, the available supports may not align with their needs and barriers to access may limit the effectiveness of these supports. Continued engagement between leaders and HCWs could help better align resources with needs.
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Affiliation(s)
- Nabeel Qureshi
- RAND Corporation, Santa Monica, CA, USA
- Pardee RAND Graduate School, Santa Monica,CA, USA
| | | | - George Timmins
- RAND Corporation, Santa Monica, CA, USA
- Pardee RAND Graduate School, Santa Monica,CA, USA
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Hemingway J, Kunz J, Draney D, Martin DE, Sukpraprut-Braaten S. Evaluating Stigmatization Toward Mental Illnesses Among Resident Physicians. Cureus 2024; 16:e61648. [PMID: 38966471 PMCID: PMC11223569 DOI: 10.7759/cureus.61648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/06/2024] Open
Abstract
Background Individuals with mental illness are stigmatized by peers in societal, workplace, and healthcare settings. The stigmatization individuals experience from healthcare providers is well documented and pervasive, often being a detriment to the quality of healthcare these individuals receive. Objective Recognizing and addressing stigmatization toward individuals with mental illnesses is imperative during residency training in Graduate Medical Education (GME) programs and throughout professional practice. We hope that this cross-sectional study will cultivate mindfulness and improve the healthcare outcomes of stigmatized individuals. Methodology A cross-sectional study using a web-based Attitude to Mental Illness Questionnaire (AMIQ) with additional scenarios was utilized to assess stigma among resident physicians in differing specialties in a hospital training system. The research investigators collected anonymous data on demographics, characteristics, specialties, and the AMIQ. In eight vignettes, participants responded to five items using a five-point Likert scale assessing attitudes toward individuals. Results Of the 104 resident physicians enrolled in the hospital training system where the study was conducted, 58 (56%) volunteered to participate. The participating residents markedly exhibited negative attitudes toward the individual in the vignette with multiple inpatient psychiatric admissions. Residents also exhibited more negative attitudes toward individuals with schizophrenia, self-harm by way of overdose, psychedelic users, cannabis users, and alcohol problems compared to diabetic and Christian individuals. Conclusions Residents exhibited negative attitudes toward individuals with mental illness. Additional research would further our understanding of the reasons for physician bias. Moreover, GME programs and medical educators can play a crucial role in mitigating stigma among future physicians, thereby enhancing care for individuals with mental illness.
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McQuillan MA, Wright M, Zechner MR, Di Prospero E, Karyczak S, Cimmino ML, Murphy AA. Physician Assistant Student Attitudes About People With Serious Mental Illness. J Physician Assist Educ 2024; 35:129-135. [PMID: 37991263 PMCID: PMC11101175 DOI: 10.1097/jpa.0000000000000564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
INTRODUCTION This study explored the attitudes of physician assistant (PA) students toward the future care of individuals with serious mental illness (SMI). Physician assistant student education offers a unique opportunity to confront and reduce bias toward individuals with SMI. However, no previous literature has documented PA student attitudes toward SMI. METHODS Preclinical students (n = 7) from a single PA program were invited to participate in 2 focus groups exploring attitudes toward the future care of patients with SMI. The focus groups lasted approximately 60 minutes and were conducted by non-PA faculty using a question guide. RESULTS Four themes emerged from interviews: perceptions about the population, knowledge of mental health conditions, approach to care, and program curriculum input. DISCUSSION Several themes aligned with the participant's level of training. Participants demonstrated didactic knowledge yet lacked clinical exposure to provide context. Future studies should focus on developing interactive learning techniques to prepare students for patients with SMI.
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Affiliation(s)
- Matthew A. McQuillan
- Matthew A. McQuillan, DMSc, PA-C, DFAAPA, is a chair of Department of Physician Assistant Studies and Practice and associate professor of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Matthew Wright, MS, PA-C, RD, is a lecturer of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Michelle R. Zechner, PhD, LSW, CPRP, is an associate professor of Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, School of Health Professions, Piscataway, New Jersey
- Elizabeth Di Prospero, MD, is a medical director, Physician Assistant Program of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Sean Karyczak, MS, CRC, is an assistant research coordinator of Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Meredith L. Cimmino, PT, DPT, is an adjunct instructor of Department of Rehabilitation and Movement Sciences, Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Ann A. Murphy, PhD, CPRP, is a director of Northeast and Caribbean Mental Health Technology Transfer Center and an associate professor of Department of Psychiatric Rehabilitation & Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Matthew Wright
- Matthew A. McQuillan, DMSc, PA-C, DFAAPA, is a chair of Department of Physician Assistant Studies and Practice and associate professor of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Matthew Wright, MS, PA-C, RD, is a lecturer of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Michelle R. Zechner, PhD, LSW, CPRP, is an associate professor of Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, School of Health Professions, Piscataway, New Jersey
- Elizabeth Di Prospero, MD, is a medical director, Physician Assistant Program of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Sean Karyczak, MS, CRC, is an assistant research coordinator of Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Meredith L. Cimmino, PT, DPT, is an adjunct instructor of Department of Rehabilitation and Movement Sciences, Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Ann A. Murphy, PhD, CPRP, is a director of Northeast and Caribbean Mental Health Technology Transfer Center and an associate professor of Department of Psychiatric Rehabilitation & Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Michelle R. Zechner
- Matthew A. McQuillan, DMSc, PA-C, DFAAPA, is a chair of Department of Physician Assistant Studies and Practice and associate professor of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Matthew Wright, MS, PA-C, RD, is a lecturer of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Michelle R. Zechner, PhD, LSW, CPRP, is an associate professor of Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, School of Health Professions, Piscataway, New Jersey
- Elizabeth Di Prospero, MD, is a medical director, Physician Assistant Program of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Sean Karyczak, MS, CRC, is an assistant research coordinator of Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Meredith L. Cimmino, PT, DPT, is an adjunct instructor of Department of Rehabilitation and Movement Sciences, Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Ann A. Murphy, PhD, CPRP, is a director of Northeast and Caribbean Mental Health Technology Transfer Center and an associate professor of Department of Psychiatric Rehabilitation & Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Elizabeth Di Prospero
- Matthew A. McQuillan, DMSc, PA-C, DFAAPA, is a chair of Department of Physician Assistant Studies and Practice and associate professor of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Matthew Wright, MS, PA-C, RD, is a lecturer of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Michelle R. Zechner, PhD, LSW, CPRP, is an associate professor of Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, School of Health Professions, Piscataway, New Jersey
- Elizabeth Di Prospero, MD, is a medical director, Physician Assistant Program of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Sean Karyczak, MS, CRC, is an assistant research coordinator of Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Meredith L. Cimmino, PT, DPT, is an adjunct instructor of Department of Rehabilitation and Movement Sciences, Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Ann A. Murphy, PhD, CPRP, is a director of Northeast and Caribbean Mental Health Technology Transfer Center and an associate professor of Department of Psychiatric Rehabilitation & Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Sean Karyczak
- Matthew A. McQuillan, DMSc, PA-C, DFAAPA, is a chair of Department of Physician Assistant Studies and Practice and associate professor of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Matthew Wright, MS, PA-C, RD, is a lecturer of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Michelle R. Zechner, PhD, LSW, CPRP, is an associate professor of Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, School of Health Professions, Piscataway, New Jersey
- Elizabeth Di Prospero, MD, is a medical director, Physician Assistant Program of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Sean Karyczak, MS, CRC, is an assistant research coordinator of Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Meredith L. Cimmino, PT, DPT, is an adjunct instructor of Department of Rehabilitation and Movement Sciences, Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Ann A. Murphy, PhD, CPRP, is a director of Northeast and Caribbean Mental Health Technology Transfer Center and an associate professor of Department of Psychiatric Rehabilitation & Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Meredith L. Cimmino
- Matthew A. McQuillan, DMSc, PA-C, DFAAPA, is a chair of Department of Physician Assistant Studies and Practice and associate professor of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Matthew Wright, MS, PA-C, RD, is a lecturer of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Michelle R. Zechner, PhD, LSW, CPRP, is an associate professor of Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, School of Health Professions, Piscataway, New Jersey
- Elizabeth Di Prospero, MD, is a medical director, Physician Assistant Program of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Sean Karyczak, MS, CRC, is an assistant research coordinator of Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Meredith L. Cimmino, PT, DPT, is an adjunct instructor of Department of Rehabilitation and Movement Sciences, Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Ann A. Murphy, PhD, CPRP, is a director of Northeast and Caribbean Mental Health Technology Transfer Center and an associate professor of Department of Psychiatric Rehabilitation & Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Ann A. Murphy
- Matthew A. McQuillan, DMSc, PA-C, DFAAPA, is a chair of Department of Physician Assistant Studies and Practice and associate professor of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Matthew Wright, MS, PA-C, RD, is a lecturer of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Michelle R. Zechner, PhD, LSW, CPRP, is an associate professor of Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, School of Health Professions, Piscataway, New Jersey
- Elizabeth Di Prospero, MD, is a medical director, Physician Assistant Program of School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Sean Karyczak, MS, CRC, is an assistant research coordinator of Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Meredith L. Cimmino, PT, DPT, is an adjunct instructor of Department of Rehabilitation and Movement Sciences, Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Ann A. Murphy, PhD, CPRP, is a director of Northeast and Caribbean Mental Health Technology Transfer Center and an associate professor of Department of Psychiatric Rehabilitation & Counseling Professions, School of Health Professions, Rutgers, The State University of New Jersey, Piscataway, New Jersey
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Jønsson ABR, Brodersen JB, Reventlow S, Svanholm C, Møller A, Kousgaard MB. General practitioners' experiences of providing somatic care for patients with severe mental illness: a qualitative study. BMC PRIMARY CARE 2024; 25:96. [PMID: 38519880 PMCID: PMC10958876 DOI: 10.1186/s12875-024-02338-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Patients dealing with severe mental illnesses (SMI) often face suboptimal clinical outcomes and higher mortality rates due to a range of factors, including undetected physical health conditions. The provision of care for individuals with SMI is frequently disjointed, as they engage with diverse healthcare providers. Despite this fragmentation, primary care, particularly general practitioners (GPs), assumes a pivotal role in the care of SMI patients. Our study aimed to delve into the first-hand experiences of GPs in delivering somatic care to SMI patients, concentrating on the challenges they encounter and the strategies they employ to navigate these difficulties. METHODS We conducted in-depth interviews with fifteen GPs, utilizing a semi-structured interview guide, supplemented by ethnographic observations during clinical consultations in general practice. Through inductive coding, interview transcripts and observational field notes were systematically analysed using interpretative phenomenological analysis (IPA). The findings were then deliberated upon within the author group. RESULTS GPs revealed that managing the chronic somatic care of SMI patients posed significant challenges. These challenges encompassed the multifaceted needs of patients, their behavior tied to symptoms, a lack of care continuity, and overarching time constraints. To tackle these challenges, the GPs had devised various strategies. However, all participants underscored the critical importance of having adequate time to properly prepare for, conduct, and follow up on consultations. CONCLUSION The GPs' interactions with SMI patients brought numerous challenges, although treating these patients were concurrently acknowledged as vital and fulfilling. The findings suggest that increased allocated time in general practice consultations for patients with SMI is important to support the somatic treatment requirements of this patient group.
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Affiliation(s)
- Alexandra Brandt Ryborg Jønsson
- Center for General Practice, University of Copenhagen, Copenhagen, Denmark.
- Department of People and Technology, Roskilde University, Roskilde, Denmark.
- Department of Community Health, The Arctic University of Norway, Tromsø, Norway.
| | - John Brandt Brodersen
- Center for General Practice, University of Copenhagen, Copenhagen, Denmark
- Department of Community Health, The Arctic University of Norway, Tromsø, Norway
- Research Unit for General Practice, Region Zealand, Denmark
| | - Susanne Reventlow
- Center for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Christina Svanholm
- Center for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Anne Møller
- Center for General Practice, University of Copenhagen, Copenhagen, Denmark
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Ba S, Bianchi V, Carpentier A, Kieffer É, Lequin L, Cadou MN, Trinh E, Lecardeur L. Somatic health according to people with severe mental disease. L'ENCEPHALE 2024; 50:26-31. [PMID: 37088575 DOI: 10.1016/j.encep.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 04/25/2023]
Abstract
OBJECTIVES Patients with schizophrenia have a 15- to 20-year shorter life expectancy compared with the general population. The aim of this study was to explore these patients' perception of their physical health. METHODS A patient reported outcomes measure (PROM) has been developed by patients with severe mental disease. This survey had to better capture undetected, under-rated and non-prioritized physical domains by traditional routine clinical scales that are important for people who live with mental health disease. These patients have tested the applicability of this PROM with peers with severe mental disease in medical, social and community-based centers from Hauts-de-France. RESULTS Two and a half years have been required to develop this PROM, to test its applicability to patients with severe mental disease and to analyze the results. The study process has been slowed by the sanitary context induced by the COVID-19 pandemic. Thirty-two questionnaires have been collected by the participants. Despite this low number of data, participants have been satisfied by the results and their experience. The results show that people with severe mental disease consider physical health as a major concern, notably pain and somatic diseases. External factors (such as accessibility to health care and medication) and internal factors (such as self-esteem, cognitive and negative symptoms, sleep, alimentation, and substance use) have been identified as barriers for physical health. CONCLUSIONS These results support the development of PROMs highlighting personal experience of people with severe mental disease. The data obtained thanks to these measures will allow to build programs to help them to cope with barriers for physical health.
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Affiliation(s)
- Shirley Ba
- Crehpsy Hauts-de-France, Parc Eurasanté Est, 235, avenue de la Recherche, 59120 Loos, France
| | - Vincent Bianchi
- Crehpsy Hauts-de-France, Parc Eurasanté Est, 235, avenue de la Recherche, 59120 Loos, France
| | - Antoine Carpentier
- Crehpsy Hauts-de-France, Parc Eurasanté Est, 235, avenue de la Recherche, 59120 Loos, France
| | - Éric Kieffer
- Crehpsy Hauts-de-France, Parc Eurasanté Est, 235, avenue de la Recherche, 59120 Loos, France
| | - Laurent Lequin
- Crehpsy Hauts-de-France, Parc Eurasanté Est, 235, avenue de la Recherche, 59120 Loos, France
| | - Marie-Noëlle Cadou
- Crehpsy Hauts-de-France, Parc Eurasanté Est, 235, avenue de la Recherche, 59120 Loos, France
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Moon KJ, Stephenson S, Hasenstab KA, Sridhar S, Seiber EE, Breitborde NJK, Nawaz S. Policy Complexities in Financing First Episode Psychosis Services: Implementation Realities from a Home Rule State. J Behav Health Serv Res 2024; 51:132-145. [PMID: 38017296 DOI: 10.1007/s11414-023-09865-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/30/2023]
Abstract
Over the past decade, significant investments have been made in coordinated specialty care (CSC) models for first episode psychosis (FEP), with the goal of promoting recovery and preventing disability. CSC programs have proliferated as a result, but financing challenges imperil their growth and sustainability. In this commentary, the authors discuss (1) entrenched and emergent challenges in behavioral health policy of consequence for CSC financing; (2) implementation realities in the home rule context of Ohio, where significant variability exists across counties; and (3) recommendations to improve both care quality and access for individuals with FEP. The authors aim to provoke careful thought about policy interventions to bridge science-to-service gaps, and in this way, advance behavioral health equity.
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Affiliation(s)
- Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kathryn A Hasenstab
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Srinivasan Sridhar
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Eric E Seiber
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA
| | - Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus, OH, USA
- Department of Psychology, Ohio State University, Columbus, OH, USA
| | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA.
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA.
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Chung DH, Slat S, Rao A, Thomas J, Kehne A, Macleod C, Madden EF, Lagisetty P. Improving Medical Student Knowledge and Reducing Stigmatizing Attitudes Toward Treating Patients With Opioid Use Disorder. SUBSTANCE USE : RESEARCH AND TREATMENT 2024; 18:11782218241234808. [PMID: 38433746 PMCID: PMC10908233 DOI: 10.1177/11782218241234808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/07/2024] [Indexed: 03/05/2024]
Abstract
Objectives Stigma and lack of knowledge are barriers to clinicians when caring for individuals with opioid use disorder (OUD). In 2018, only about 15 out of 180 American medical schools had comprehensive addiction programs. The AAMC reports that institutions are increasingly incorporating competencies to address the OUD and opioid epidemic. There have been few evaluated curriculums focused on reducing stigmatizing attitudes. This study evaluated whether a 4-hour case-based curriculum focused on improving stigmatizing attitudes toward patients with OUD could reduce medical student perceptions around viewing addiction as a punitive condition and other substitution-based misconceptions around opioid agonist-based medication. Methods Medical students completed a 4-hour curricular workshop which included learning objectives focusing on barriers to healthcare/stigmatizing attitudes, effective behavioral therapy options, and appropriate use of opioid medications. We measured changes in knowledge and attitudes using validated scales on stigma. Non-parametric repeated measure tests determined statistically significant differences between pre and post assessments between OUD related perceptions and a control condition (diabetes). Results Of 135 eligible participants, 99 (76%) students completed both pre- and post-surveys. Mean scores across knowledge questions improved (60%-81%, P < .001) and stigmatizing attitudes regarding perceived violence of people with OUD decreased (2.04-1.82, P = .016). There was significant improvement in mean scores for OUD-related opinions including desire to work with and effectively treat patients with OUD (3.58-3.88, P < .001) while no significant concurrent change was observed in mean opinion scores of a non-OUD comparator, diabetes (3.88-3.97, P = .201). Conclusions Results indicate that the workshop was associated with measurable changes in knowledge and attitudinal forms of OUD stigma. With recent policy changes eliminating the X-waiver, healthcare institutions are eager to design curriculum around OUD management and treatment. This study provides a blueprint for an effective curriculum that improves clinician knowledge and reduces stigmatizing attitudes.
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Affiliation(s)
- Dana H. Chung
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Stephanie Slat
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Aditi Rao
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jennifer Thomas
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Adrianne Kehne
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Colin Macleod
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Erin F. Madden
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Pooja Lagisetty
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management and Research, Ann Arbor VA Hospital, Ann Arbor, MI, USA
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Saadi A, Ray VE. Police Violence in Health Care Settings in US Media Coverage. JAMA Netw Open 2023; 6:e2342998. [PMID: 37955898 PMCID: PMC10644214 DOI: 10.1001/jamanetworkopen.2023.42998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023] Open
Abstract
Importance Hospitals do not collect or share data tracking their policing and security activities despite their reliance on police and security personnel, including armed officers. Thus, little is known about how hospital security is associated with patient and staff safety. Objective To examine the harms exerted by health care-affiliated police and security personnel. Design, Setting, and Participants For this qualitative study, data were collected using a systematic Media Cloud search for US news media coverage from January 2011 to May 2022. A total of 18 987 articles on policing and hospitals were screened and a content and thematic analysis of articles that met the search criteria was conducted, which involved incidents that revealed harm to patients, patients' families, and staff. Data were analyzed from October 2022 to April 2023. Main Outcomes and Measures Incident year, incident location (hospital name, city, state), survivor and victim characteristics (race and ethnicity, presence of mental illness), and a narrative description of the incident focusing on outcomes of harm exerted by police and security personnel in the health care setting. Results A total of 48 unique stories across 25 US states were included. The median (range) year published was 2017 (2009-2022). Harms reported to have been perpetuated by health care-affiliated police and security personnel were identified within 5 domains from 48 unique incidents: (1) patients shot by police or security personnel (17 patients); (2) patients subject to excessive use of force (17 patients); (3) patients arrested (7 patients); (4) patients subject to sexual assault (2 patients); and (5) hospital personnel or those considered collateral damage shot, injured, or arrested (5 individuals). Most survivors and victims were Black, although the race and/or ethnicity of involved individuals was not routinely reported across the news stories. Mental illness was the most documented medical condition among patients injured or killed by health care-affiliated police and security personnel. Conclusions and Relevance This qualitative study of US news media found that police and security personnel in hospitals were reported to have perpetuated harm via excessive force, sexual assaults, injuring patients and health care workers, and fatal shootings. Compounded by a lack of transparency and accountability mechanisms, this may represent an underrecognized manifestation of structural racism at the organizational level. Policy suggestions include introducing accountability measures, deescalation techniques, and removing arms from hospital security personnel to reduce harm and fulfill health care's healing mission.
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Affiliation(s)
- Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Victor E. Ray
- Department of Sociology and Criminology, University of Iowa, Iowa City
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Kious BM, Pabst Peggy Battin M. A Focus Group Study of the Views of Persons with a History of Psychiatric Illness about Psychiatric Medical Aid in Dying. AJOB Empir Bioeth 2023; 15:1-10. [PMID: 37339278 DOI: 10.1080/23294515.2023.2224591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
BACKGROUND Medical aid in dying (MAID) is legal in a number of countries, including some states in the U.S. While MAID is only permitted for terminal illnesses in the U.S., some other countries allow it for persons with psychiatric illness. Psychiatric MAID, however, raises unique ethical concerns, especially related to its effects on mental illness stigma and on how persons with psychiatric illnesses would come to feel about treatment and suicide. To explore those concerns, we conducted several focus groups with persons with lived experience of mental illness. METHODS We conducted three video-conference-based focus groups involving adults residing in the U.S. who reported a prior diagnosis of any psychiatric illness. Only participants who reported thinking that MAID for terminal illness was morally acceptable were included. Focus group participants were asked to respond to a series of four questions. Groups were facilitated by a coordinator who was independent of the research team. RESULTS A total of 22 persons participated in the focus groups. The majority of participants had depression and anxiety disorders; no participants had psychotic disorders such as schizophrenia. Many participants strongly favored permitting psychiatric MAID, generally on the basis of respect for autonomy, its effects on stigma, and the severe suffering caused by mental illness. Others expressed concerns, typically related to difficulties in ensuring decision-making capacity and to the risk that MAID would be used in lieu of suicide. CONCLUSIONS Persons with a history of psychiatric illness, as a group, have a diverse array of views about the permissibility of psychiatric MAID, reflecting nuanced consideration of how it relates to the public perception of mental illness, stigma, autonomy, and suicide risk.
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Affiliation(s)
- Brent M Kious
- Department of Psychiatry, University of Utah, Salt Lake City, Utah, USA
- Department of Philosophy, University of Utah, Salt Lake City, Utah, USA
- Center for Health Ethics, Arts, and Humanities, University of Utah, Salt Lake City, Utah, USA
| | - Margaret Pabst Peggy Battin
- Department of Philosophy, University of Utah, Salt Lake City, Utah, USA
- Center for Health Ethics, Arts, and Humanities, University of Utah, Salt Lake City, Utah, USA
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10
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Tam To B, Roy R, Melikian N, Gaughran FP, O’Gallagher K. Coronary Artery Disease in Patients with Severe Mental Illness. Interv Cardiol 2023; 18:e16. [PMID: 37398869 PMCID: PMC10311395 DOI: 10.15420/icr.2022.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/23/2022] [Indexed: 07/04/2023] Open
Abstract
Severe mental illnesses (SMI), such as schizophrenia and bipolar disorder, are associated with a decrease in life expectancy of up to two decades compared with the general population, with cardiovascular disease as the leading cause of death. SMI is associated with increased cardiovascular risk profile and early onset of incident cardiovascular disease. Following an acute coronary syndrome, patients with SMI have a worse prognosis, but are less likely to receive invasive treatment. In this narrative review, the management of coronary artery disease in patients with SMI is discussed, and avenues for future research are highlighted.
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Affiliation(s)
- Brian Tam To
- Cardiovascular Department, King’s College Hospital NHS Foundation TrustLondon, UK
| | - Roman Roy
- Cardiovascular Department, King’s College Hospital NHS Foundation TrustLondon, UK
| | - Narbeh Melikian
- Cardiovascular Department, King’s College Hospital NHS Foundation TrustLondon, UK
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King’s College LondonLondon, UK
| | - Fiona P Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondon, UK
- National Psychosis Service, South London and Maudsley NHS Foundation TrustLondon, UK
| | - Kevin O’Gallagher
- Cardiovascular Department, King’s College Hospital NHS Foundation TrustLondon, UK
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King’s College LondonLondon, UK
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11
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Murphy KA, Daumit GL. Establishing a Care Continuum for Cardiometabolic Conditions for Patients with Serious Mental Illness. Curr Cardiol Rep 2023; 25:193-202. [PMID: 36847991 PMCID: PMC10042919 DOI: 10.1007/s11886-023-01848-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE OF REVIEW Addressing cardiometabolic risk factors in persons with serious mental illness requires early screening and proactive medical management in both medical and mental health settings. RECENT FINDINGS Cardiovascular disease remains the leading cause of death for persons with serious mental illness (SMI), such as schizophrenia or bipolar disorder, much of which is driven by a high prevalence of metabolic syndrome, diabetes, and tobacco use. We summarize barriers and recent approaches to screening and treatment for metabolic cardiovascular risk factors within physical health and specialty mental health settings. Incorporating system-based and provider-level support within physical health and psychiatric clinical settings should contribute to improvement for screening, diagnosis, and treatment for cardiometabolic conditions for patients with SMI. Targeted education for clinicians and leveraging multi-disciplinary teams are important first steps to recognize and treat populations with SMI at risk of CVD.
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Affiliation(s)
- Karly A Murphy
- Division of General Internal Medicine, University of California San Francisco School of Medicine, 1701 Divisidero Street, Suite 500, 94117, San Francisco, CA, USA.
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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12
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Holland C, Hudson-Jessop P. Quantifying consultations to medical specialties during psychiatric inpatient admissions in a Queensland tertiary hospital. Australas Psychiatry 2023; 31:65-68. [PMID: 36341710 DOI: 10.1177/10398562221131160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To identify and characterise medical consultations to psychiatric inpatients. METHOD Retrospective cross-sectional descriptive study of 451 psychiatric inpatients' electronic medical records between 1 January and 30 June 2021 with descriptive statistics. RESULTS Thirty one percent (n = 131) of inpatients required medical consultation, with 382 total consultations including ward call. Half (57.9%) were telephone advice. Main consulting specialties were general medicine (25%), anaesthetics (12%), neurology (9.9%), cardiology (6.5%) and endocrinology (6.2%). Almost all (99.0%) consultations resulted in documented management plans. CONCLUSIONS This is the first Australian descriptive study quantifying and characterising psychiatric inpatient consultation requests. Physical and psychiatric healthcare integration requires ongoing efforts, including improved referral pathways.
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Affiliation(s)
- Carissa Holland
- 523457Sunshine Coast University Hospital, Sunshine Coast, QLD, AU
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13
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A Bridge of Distress: Distress as the Critical Mediator Between Substance Use Disorders and Compulsive Sexual Behavior Disorder Among Women. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00964-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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14
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O'Gallagher K, Teo JTH, Shah AM, Gaughran F. Interaction Between Race, Ethnicity, Severe Mental Illness, and Cardiovascular Disease. J Am Heart Assoc 2022; 11:e025621. [PMID: 35699192 PMCID: PMC9238657 DOI: 10.1161/jaha.121.025621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Severe mental illnesses, such as schizophrenia or bipolar disorder, affect ≈1% of the population who, as a group, experience significant disadvantage in terms of physical health and reduced life expectancy. In this review, we explore the interaction between race, ethnicity, severe mental illness, and cardiovascular disease, with a focus on cardiovascular care pathways. Finally, we discuss strategies to investigate and address disparities in cardiovascular care for patients with severe mental illness.
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Affiliation(s)
- Kevin O'Gallagher
- British Heart Foundation Centre of Research ExcellenceKing’s College LondonLondonUnited Kingdom
- King’s College Hospital NHS Foundation TrustLondonUnited Kingdom
| | - James TH. Teo
- King’s College Hospital NHS Foundation TrustLondonUnited Kingdom
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUnited Kingdom
| | - Ajay M. Shah
- British Heart Foundation Centre of Research ExcellenceKing’s College LondonLondonUnited Kingdom
- King’s College Hospital NHS Foundation TrustLondonUnited Kingdom
| | - Fiona Gaughran
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUnited Kingdom
- South London and Maudsley NHS Foundation TrustLondonUnited Kingdom
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15
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Fisher K, Weissinger G, O'Rorke R, Edwards E, Diamond G. Consumers With Serious Mental Illness Perspectives on Care Integration: Preparation for Integration. J Am Psychiatr Nurses Assoc 2022; 28:193-202. [PMID: 35546134 DOI: 10.1177/10783903221091974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Those with serious mental illness (SMI) experience poor health outcomes which may be addressed by the integration of mental health and primary care services. This integration could be enhanced by the inclusion of consumers in the planning process. AIMS This study sought to bring the voice of the consumer with SMI to assist with the integration of primary care and mental health services. METHODS Working with a community advisory board in the City of Philadelphia, we carried out a sequential explanatory mixed-methods study. The team conducted 12 focus groups (n=149) and surveys (n = 137) of consumers with SMI about their experiences of the health care system and perspectives on integrated health. Data from surveys and focus groups were analyzed and integrated. RESULTS Three relevant themes emerged: primary care experiences; health care stigma; and social determinants as barriers to health. Generally, individuals with SMI supported the integration of care, with careful consideration given to social determinants of health, patient privacy, and respect between providers and patients. CONCLUSIONS Integration may reduce health disparities experienced by individuals with SMI, but the process must be informed by intended consumers. Policymakers and administrators will need to address barriers to care, healthcare stigma, and social determinants of health. Nurses are well placed to inform and lead healthcare integration and overcome the siloing of mental and physical healthcare systems.
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Affiliation(s)
- Kathleen Fisher
- Kathleen Fisher, PhD, CRNP, Drexel University, Philadelphia, PA, USA
| | - Guy Weissinger
- Guy Weissinger, PhD, RN, Villanova University, Villanova, PA, USA
| | - Rosemary O'Rorke
- Rosemary O'Rorke, MEd, The Philadelphia Coalition, Philadelphia, PA, USA
| | - Erica Edwards
- Erica Edwards, MSW, The Consortium, Philadelphia, PA, USA
| | - Guy Diamond
- Guy Diamond, PhD, Drexel University, Philadelphia, PA, USA
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16
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Grover S, Singh OP. Basics for Physicians and Psychiatrists for Effective Practice of Consultation-Liaison Psychiatry Services. Indian J Psychiatry 2022; 64:S228-S235. [PMID: 35602360 PMCID: PMC9122166 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_714_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/26/2021] [Accepted: 01/01/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - O P Singh
- West Bengal Medical Services, Kolkata, West Bengal, India E-mail:
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17
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Martínez-Martínez C, Esteve-Claramunt F, Prieto-Callejero B, Ramos-Pichardo JD. Stigma towards Mental Disorders among Nursing Students and Professionals: A Bibliometric Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031839. [PMID: 35162862 PMCID: PMC8835101 DOI: 10.3390/ijerph19031839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 01/25/2023]
Abstract
Stigma is one of the main barriers to prevention, treatment and recovery from mental illness. However, bibliometric studies in this area are still scarce. Therefore, our aim was to quantify and analyze the scientific literature on the stigma of nursing students and professionals towards mental disorders. To this purpose, bibliometric indicators of scientific production, impact and collaboration were used. Among our results, it stands out that only 14.3% of the total number of studies analyzed measure the efficacy of the interventions carried out to reduce stigma. Furthermore, with exceptions such as Happell B and Byrne L, collaborations between authors and institutions are limited. “Service user involvement” appeared as a prominent keyword in 2018, coinciding with the increase in publications on the effectiveness of interventions. Interventions based on the involvement of people with psychiatric diagnoses in the design of nursing curricula seem to become a promising line of research. More studies measuring the efficacy of such interventions are needed. Knowledge of the lines of research that are being developed and of the researchers and institutions involved can contribute to creating synergy between the different researchers and to continue adding projects to the existing ones, thus contributing to the generation of more robust results that show the most indicated interventions to reduce the still present stigma and improve care for people with psychiatric diagnoses.
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Affiliation(s)
| | - Francisca Esteve-Claramunt
- Department of Nursing, Faculty of Health Sciences, Universidad Europea de Valencia, 46010 Valencia, Spain;
- Correspondence:
| | - Blanca Prieto-Callejero
- Nursing Department, University of Huelva, 21004 Huelva, Spain; (B.P.-C.); (J.D.R.-P.)
- Hospital Virgen de la Bella (Lepe), 21440 Huelva, Spain
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18
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Sideli L, Sartorio C, Ferraro L, Mannino G, Giunta S, Giannone F, Seminerio F, Barone MV, Maniaci G, Montana S, Marchese F, La Barbera D, La Cascia C. Views of Schizophrenia Among Future Healthcare Professionals: Differences in Relation to Diagnostic Labelling, Causal Explanations, and Type of Academic Degree Program. CLINICAL NEUROPSYCHIATRY 2021; 18:260-269. [PMID: 34984069 PMCID: PMC8696287 DOI: 10.36131/cnfioritieditore20210504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Stereotyped beliefs about schizophrenia are well-established in the society and relatively common among healthcare professionals and students. The aim of this study was to investigate the opinions about the causes, treatment, and outcome of schizophrenia among healthcare students. METHOD Undergraduate nursing and psychology students completed selected items of the Opinion on Mental Illness Questionnaire after reading a clinical vignette of undiagnosed schizophrenia. RESULTS Students who labelled the description as schizophrenia were more pessimistic regarding full recovery from the disorder. Those who acknowledged greater relevance to biogenetic risk factors were more convinced of the efficacy of medications. Respondents' opinions on the efficacy of psychological interventions were more positive among psychology students than among nursing students. CONCLUSIONS The study confirmed the associations of schizophrenia labelling with prognostic pessimism and beliefs about the efficacy of pharmacological treatment among future healthcare professionals. Students' opinions were less influenced by differences between academic degree programs. Information about current recovery rate and comprehensive care for schizophrenia may support future healthcare professionals in the relationship and the clinical management of PWS.
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Affiliation(s)
- Lucia Sideli
- Department of Human Science, LUMSA University, Rome, Italy.,Corresponding author Lucia Sideli Department of Human Sciences, LUMSA University, Rome, Italy. E-mail
| | - Crocettarachele Sartorio
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Laura Ferraro
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | | | | | - Francesca Giannone
- Department of Psychological and Educational Sciences, University of Palermo, Palermo, Italy
| | - Fabio Seminerio
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - M. Valentina Barone
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Giuseppe Maniaci
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Simonetta Montana
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Fulvio Marchese
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Daniele La Barbera
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Caterina La Cascia
- Section of Psychiatry, Department of Biomedicine, Neuroscience, and Advanced Diagnostic, University of Palermo, Palermo, Italy
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19
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Sølvhøj IN, Kusier AO, Pedersen PV, Nielsen MBD. Somatic health care professionals' stigmatization of patients with mental disorder: a scoping review. BMC Psychiatry 2021; 21:443. [PMID: 34493245 PMCID: PMC8424966 DOI: 10.1186/s12888-021-03415-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/06/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patients with mental disorders have an increased risk of developing somatic disorders, just as they have a higher risk of dying from them. These patients often report feeling devaluated and rejected by health professionals in the somatic health care system, and increasing evidence shows that disparities in health care provision contribute to poor health outcomes. The aim of this review was to map and synthesize literature on somatic health professionals' stigmatization toward patients with mental disorders. METHODS We conducted a scoping review using Arksey and O'Malley's framework and carried out a systematic search in three databases: Cinahl, MEDLINE, and PsycINFO in May-June 2019. Peer-reviewed articles published in English or Scandinavian languages during 2008-2019 were reviewed according to title, abstract and full-text reading. We organized and analyzed data using NVivo. RESULTS A total of 137 articles meeting the eligibility criteria were reviewed and categorized as observational studies (n = 73) and intervention studies (n = 64). A majority of studies (N = 85) focused on patients with an unspecified number of mental disorders, while 52 studies focused on specific diagnoses, primarily schizophrenia (n = 13), self-harm (n = 13), and eating disorders (n = 9). Half of the studies focused on health students (n = 64), primarily nursing students (n = 26) and medical students (n = 25), while (n = 66) focused on health care professionals, primarily emergency staff (n = 16) and general practitioners (n = 13). Additionally, seven studies focused on both health professionals and students. A detailed characterization of the identified intervention studies was conducted, resulting in eight main types of interventions. CONCLUSIONS The large number of studies identified in this review suggests that stigmatizing attitudes and behaviors toward patients with mental disorders is a worldwide challenge within a somatic health care setting. For more targeted interventions, there is a need for further research on underexposed mental diagnoses and knowledge on whether specific health professionals have a more stigmatizing attitude or behavior toward specific mental disorders.
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Affiliation(s)
- Ida Nielsen Sølvhøj
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455, Copenhagen, Denmark.
| | - Amalie Oxholm Kusier
- grid.10825.3e0000 0001 0728 0170National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Pia Vivian Pedersen
- grid.10825.3e0000 0001 0728 0170National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Maj Britt Dahl Nielsen
- grid.10825.3e0000 0001 0728 0170National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
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20
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Adibelli D, Özkan İ. Self-management of chronic disease in individuals with psychotic disorder: A qualitative study. Perspect Psychiatr Care 2021; 57:702-708. [PMID: 32749720 DOI: 10.1111/ppc.12598] [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: 04/25/2020] [Revised: 07/20/2020] [Accepted: 07/25/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate self-management by individuals with a serious mental illness and an additional chronic disease. DESIGN AND METHODS Heidegger's hermeneutic phenomenological approach was used. The study was carried out with 12 participants with a serious mental illness and an additional chronic disease. RESULTS The participants had a diagnosis of schizophrenia and diabetes (75%). Based on the data, the difficulties faced by the patients in chronic disease management were determined as three themes: (a) personal-related difficulties, (b) family and society-related difficulties, and (c) healthcare system-related difficulties. PRACTICE IMPLICATIONS Nurses' interventions to accurately inform other clinicians and leading professional groups in the community will support individuals with serious mental illnesses to improve their self-management by reducing the burden of stigma.
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Affiliation(s)
- Derya Adibelli
- Department of Public Health Nursing, Akdeniz University Kumluca Health Science Faculty, Antalya, Turkey
| | - İlknur Özkan
- Department of Internal Medicine Nursing, Health Science Faculty, Akdeniz University Kumluca, Antalya, Turkey
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21
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Kohn L, Christiaens W, Detraux J, De Lepeleire J, De Hert M, Gillain B, Delaunoit B, Savoye I, Mistiaen P, Jespers V. Barriers to Somatic Health Care for Persons With Severe Mental Illness in Belgium: A Qualitative Study of Patients' and Healthcare Professionals' Perspectives. Front Psychiatry 2021; 12:798530. [PMID: 35153863 PMCID: PMC8825501 DOI: 10.3389/fpsyt.2021.798530] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/03/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A huge and still growing mortality gap between people with severe mental illness (SMI) and the general population exists. Physical illnesses, mainly cardiovascular diseases, substantially contribute to the high mortality rates in patients with SMI. Disparities in somatic health care access, utilisation, and provision contribute to these poor physical health outcomes. METHODS A qualitative study, using semi-structured interviews, was set up to explore SMI patients' and healthcare professionals' perspectives on somatic health care in different psychiatric settings of the three Belgian regions (Flanders, Brussels, Wallonia). Interviews were digitally recorded and transcribed prior to qualitative inductive thematic analysis, using Nvivo software. The COnsolidated criteria for REporting Qualitative research (COREQ) were used for reporting methods and findings. RESULTS Collaboration and information flows between psychiatric healthcare professionals, non-psychiatric healthcare professionals, and persons with SMI were troublesome. This seemed to be mainly due to stigma and prejudice and challenging communication and data transfer. Lack of sufficient training and experience to identify and treat somatic health problems in people with SMI (for psychiatrists and psychiatric nurses) and lack of psychiatric knowledge and feeling or sensitivity for psychiatric patients (for non-psychiatric healthcare professionals) further complicated adequate somatic health care. Finally, optimal somatic follow-up of patients with SMI was hampered by organisational problems (unavailability of equipment, unadapted infrastructure, understaffing, hospital pharmacy issues, and insufficient health promotion/lifestyle interventions), patient-related issues (unawareness of physical problems, non-adherence, need for accompaniment) and financial barriers. CONCLUSION There is an urgent need for integrated somatic and mental healthcare systems and a cultural change. Psychiatrists and primary care providers continue to consider the mental and physical health of their patients as mutually exclusive responsibilities due to a lack of sufficient training and experience, poor or absent liaison links, time constraints and organisational and financial barriers. Modifying these aspects will improve the quality of somatic health care for these vulnerable patients.
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Affiliation(s)
- Laurence Kohn
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | | | - Johan Detraux
- Department of Neurosciences, Public Health Psychiatry, University Psychiatric Center, Catholic University of Leuven, Kortenberg, Belgium
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, Catholic University of Leuven, Leuven, Belgium
| | - Marc De Hert
- Department of Neurosciences, Center for Clinical Psychiatry, University Psychiatric Center, Catholic University of Leuven, Kortenberg, Belgium.,Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Benoit Gillain
- Société Royale de Santé Mentale de Belgique, Ottignies, Belgium
| | | | | | | | - Vicky Jespers
- Belgian Health Care Knowledge Centre, Brussels, Belgium
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22
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McGinty EE, Daumit GL. Integrating Mental Health and Addiction Treatment Into General Medical Care: The Role of Policy. Psychiatr Serv 2020; 71:1163-1169. [PMID: 32487007 PMCID: PMC7606646 DOI: 10.1176/appi.ps.202000183] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Interventions that integrate care for mental illness or substance use disorders into general medical care settings have been shown to improve patient outcomes in clinical trials, but efficacious models are complex and difficult to scale up in real-world practice settings. Existing payment policies have proven inadequate to facilitate adoption of effective integrated care models. This article provides an overview of evidence-based models of integrated care, discusses the key elements of such models, considers how existing policies have fallen short, and outlines future policy strategies. Priorities include payment policies that adequately support structural elements of integrated care and incentivize multidisciplinary team formation and accountability for patient outcomes, as well as policies to expand the specialty mental health and addiction treatment workforce and address the social determinants of health that disproportionately influence health and well-being among people with mental illness or substance use disorders.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health (McGinty), and Division of General Internal Medicine, Johns Hopkins School of Medicine (Daumit), Baltimore
| | - Gail L Daumit
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health (McGinty), and Division of General Internal Medicine, Johns Hopkins School of Medicine (Daumit), Baltimore
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Abstract
Individuals diagnosed with schizophrenia or bipolar disorder have a life expectancy 15-20 years shorter than that in the general population. The rate of unnatural deaths, such as suicide and accidents, is high for these patients. Despite this increased proportion of unnatural deaths, physical conditions account for approximately 70% of deaths in patients with either schizophrenia or bipolar disorder, with cardiovascular disease contributing 17.4% and 22.0% to the reduction in overall life expectancy in men and women, respectively. Risk factors for cardiovascular disease, such as smoking, unhealthy diet and lack of exercise, are common in these patients, and lifestyle interventions have been shown to have small effects. Pharmacological interventions to reduce risk factors for cardiovascular disease have been proven to be effective. Treatment with antipsychotic drugs is associated with reduced mortality but also with an increased risk of weight gain, dyslipidaemia and diabetes mellitus. These patients have higher risks of both myocardial infarction and stroke but a lower risk of undergoing interventional procedures compared with the general population. Data indicate a negative attitude from clinicians working outside the mental health fields towards patients with severe mental illness. Education might be a possible method to decrease the negative attitudes towards these patients, thereby improving their rates of diagnosis and treatment.
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LaVigne TW, Laake LM, Ibeziako P. Somatic symptom and related disorders in pediatric patients: Associations with parent psychiatric and substance use histories. Clin Child Psychol Psychiatry 2020; 25:932-944. [PMID: 32515206 DOI: 10.1177/1359104520931579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Parental response to pediatric patients with somatic symptom and related disorders (SSRDs) can impact symptom presentation. However, little is known about the impact of parent psychiatric and substance use disorder (SUD) history on the functional status and medical healthcare utilization of patients with SSRDs. The current study explored the associations between parent psychiatric & SUD history and patient somatic symptoms, functional disability, and hospital course in a medically hospitalized sample of pediatric patients with SSRDs. The electronic medical records of 375 pediatric patients with SSRDs, ages 5 to 18, admitted at a tertiary pediatric hospital were retrospectively reviewed. Parent psychiatric histories were identified in 45.1% of the sample. Parent SUD history and maternal psychiatric history were associated with more patient reported somatization. Parent psychiatric and SUD history were not associated with pediatric patients' level of functional disability or healthcare utilization during admission, including admission length, number of tests, and number of consultations obtained. This study has implications regarding reduction of potential stigma towards parents with psychiatric or SUD histories whose children are hospitalized with SSRDs. While such histories may provide insights regarding somatization presentation of pediatric patients with these disorders, it may not necessarily impact level of functional disability or hospital course.
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Affiliation(s)
- Timothy W LaVigne
- Department of Psychiatry, Boston Children's Hospital & Harvard Medical School, USA.,Division of Pain & Palliative Medicine, Connecticut Children's Medical Center, USA.,Department of Pediatrics, University of Connecticut School of Medicine, USA
| | - Lauren M Laake
- Department of Psychiatry, Boston Children's Hospital & Harvard Medical School, USA
| | - Patricia Ibeziako
- Department of Psychiatry, Boston Children's Hospital & Harvard Medical School, USA
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25
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Momenzadeh A, Shumway M, Dong BJ, Dilley J, Nye J, Mangurian C. Patterns of Prescribing Antiretroviral Therapy Upon Discharge to Psychiatry Inpatients With HIV/AIDS at a Large Urban Hospital. Ann Pharmacother 2020; 55:452-458. [PMID: 32885983 DOI: 10.1177/1060028020954924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND HIV infection is more prevalent among people with severe mental illness (SMI) than in the general population. People with SMI may lack access to recommended antiretroviral therapy (ART), and inpatient psychiatric admissions may be opportunities to ensure that individuals receive recommended treatment. OBJECTIVE To evaluate ART prescription patterns on an inpatient psychiatry service. METHODS In this retrospective, observational study, patient and admission characteristics and ART prescriptions were obtained for 248 HIV-positive inpatients between 2006 and 2012. Receipt of any ART, any recommended ART regimen, and ART with potentially harmful adverse events and drug interactions were examined. General estimating equation models were used to evaluate prescription patterns in relation to patient and admission characteristics. RESULTS ART was prescribed at 39% of discharges and increased by 51% during the study. Prescription was more common in admissions with an AIDS diagnosis and age greater than 29 years and less common in admissions associated with a psychotic diagnosis and shorter inpatient stays. When ART was prescribed, regimens were consistent with guideline recommendations 91% of the time. Prescription of potentially harmful regimens was limited. CONCLUSION AND RELEVANCE In an acute inpatient psychiatry setting in an urban HIV/AIDS epicenter, where psychotic disorders and brief and involuntary admissions were the norm, guideline-recommended ART regimens were prescribed at almost 60% of discharges by the end of the study. Future studies should explore interventions to increase ART for high-risk subpopulations with SMI, including younger individuals or those with brief inpatient psychiatry hospitalizations.
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Affiliation(s)
- Amanda Momenzadeh
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Martha Shumway
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Betty J Dong
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - James Dilley
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Jonathan Nye
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Christina Mangurian
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
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Abstract
OBJECTIVE Behavioral health homes, which provide onsite primary medical care in mental health clinics, face challenges in integrating information across multiple health records. This study tested whether a mobile personal health record application improved quality of medical care for individuals treated in these settings. METHODS This randomized study enrolled 311 participants with a serious mental illness and one or more cardiometabolic risk factors across two behavioral health homes to receive a mobile personal health record application (N=156) or usual care (N=155). A secure mobile personal health record (mPHR) app provided participants in the intervention group with key information about diagnoses, medications, and laboratory test values and allowed them to track health goals. The primary study outcome was a chart-derived composite measure of quality of cardiometabolic and preventive services. RESULTS At 12-month follow-up, participants in the mPHR group maintained high quality of care (70% of indicated services at baseline and at 12-month follow-up), in contrast to a decline in quality for the usual-care group (71% at baseline and 67% at follow-up), resulting in a statistically significant but clinically modest differential impact between the groups. No differences between the study groups were found in secondary self-reported outcomes, including delivery of chronic illness care, patient activation, and quality of life related to mental or general medical health. CONCLUSIONS Use of a mPHR app was associated with a statistically significant but clinically modest differential benefit for quality of medical care among individuals with serious mental illness and comorbid cardiometabolic conditions.
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Affiliation(s)
- Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Jianheng Li
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Stephanie Tapscott
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Cathy A Lally
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
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27
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Stone EM, Daumit GL, Kennedy-Hendricks A, McGinty EE. The Policy Ecology of Behavioral Health Homes: Case Study of Maryland's Medicaid Health Home Program. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:60-72. [PMID: 31506860 PMCID: PMC7040852 DOI: 10.1007/s10488-019-00973-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Behavioral health homes, shown to improve receipt of evidence-based medical services among people with serious mental illness in randomized clinical trials, have had limited results in real-world settings; nonetheless, these programs are spreading rapidly. To date, no studies have considered what set of policies is needed to support effective implementation of these programs. As a first step toward identifying an optimal set of policies to support behavioral health home implementation, we use the policy ecology framework to map the policies surrounding Maryland's Medicaid behavioral health home program. Results suggest that existing policies fail to address important implementation barriers.
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Affiliation(s)
- Elizabeth M Stone
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Rivera-Segarra E, Varas-Díaz N, Santos-Figueroa A. "That's all Fake": Health professionals stigma and physical healthcare of people living with Serious Mental Illness. PLoS One 2019; 14:e0226401. [PMID: 31851706 PMCID: PMC6919598 DOI: 10.1371/journal.pone.0226401] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 11/26/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND People living with a Serious Mental Illness (SMI) die earlier than the general population due to preventable medical conditions. Latinos living with SMI are a particularly vulnerable population with higher prevalence of chronic medical conditions. Stigma has been identified as a factor that fosters health inequities for Latinos/as with SMI, particularly Puerto Ricans. Although personal and social consequences of stigmatization have been well documented, research regarding the role of cultural factors on healthcare interactions is scarce. Furthermore, little research has focused on addressing stigma from the perspective of healthcare professionals. METHODS We investigated this process through a qualitative design using semi-structured individual interviews with 11 healthcare professionals (8 physicians and 3 nurses) in Puerto Rico. We conducted a thematic analysis to analyze the data. RESULTS Following a thematic analysis, we found three main themes and nine sub-themes related to the stigmatization process. Some participants reported perceptions of dangerousness and uneasiness, social distance and inadequate care. Participants also emphasized a lack of medical training regarding SMI within the Puerto Rican context. CONCLUSIONS These findings support the need to develop culturally appropriate public health interventions targeting healthcare professionals in order to address stigma and eliminate health disparities among Latinos/as with SMI.
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Affiliation(s)
- Eliut Rivera-Segarra
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
- * E-mail:
| | - Nelson Varas-Díaz
- Department of Global and Sociocultural Studies, Florida International University, Miami, United States of America
| | - Axel Santos-Figueroa
- Department of Psychology, University of Puerto Rico, Mayagüez Campus, Mayagüez, Puerto Rico
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