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Slanzi CM, MacDonald GA, Nemoianu AT, Salzer MS. Community Participation of Individuals with Mental Illnesses in Rural Areas: Stakeholder Perspectives on Barriers and Facilitators. Community Ment Health J 2024; 60:832-838. [PMID: 38133720 DOI: 10.1007/s10597-023-01217-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
Community inclusion and participation are social determinants of physical and mental health. This study examines activity preferences, barriers to engagement, and potential strategies for facilitating community participation for individuals with serious mental illness living in rural communities. Data for this qualitative study were collected in a series of focus groups with a stakeholders in rural Pennsylvania. Written responses to questions on activities, barriers, facilitators, and solutions were analyzed by members of the research team. The activities that are important to our participants included both those readily accessible in rural areas and those only accessible in more urban areas. Many of the barriers identified aligned with prior research (e.g., poverty, community mobility issues). A number of novel and feasible solutions to overcome barriers were provided at the policy, program, and practice levels, some of which that can be implemented immediately, to increase participation, and improve overall health of people with mental illnesses.
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Affiliation(s)
- Crystal M Slanzi
- Department of Social and Behavioral Sciences, Temple University, 1700 N Broad St., Philadelphia, 19121, USA
| | - Gillian A MacDonald
- Department of Social and Behavioral Sciences, Temple University, 1700 N Broad St., Philadelphia, 19121, USA
| | | | - Mark S Salzer
- Department of Social and Behavioral Sciences, Temple University, 1700 N Broad St., Philadelphia, 19121, USA.
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Katayama ES, Woldesenbet S, Munir MM, Endo Y, Rawicz-Pruszyński K, Khan MMM, Tsilimigras D, Dillhoff M, Cloyd J, Pawlik TM. Effect of Behavioral Health Disorders on Surgical Outcomes in Cancer Patients. J Am Coll Surg 2024; 238:625-633. [PMID: 38420963 DOI: 10.1097/xcs.0000000000000954] [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: 03/02/2024]
Abstract
BACKGROUND Behavioral health disorders (BHDs) can often be exacerbated in the setting of cancer. We sought to define the prevalence of BHD among cancer patients and characterize the association of BHD with surgical outcomes. STUDY DESIGN Patients diagnosed with lung, esophageal, gastric, liver, pancreatic, and colorectal cancer between 2018 and 2021 were identified within Medicare Standard Analytic Files. Data on BHD defined as substance abuse, eating disorder, or sleep disorder were obtained. Postoperative textbook outcomes (ie no complications, prolonged length of stay, 90-day readmission, or 90-day mortality), as well as in-hospital expenditures and overall survival were assessed. RESULTS Among 694,836 cancer patients, 46,719 (6.7%) patients had at least 1 BHD. Patients with BHD were less likely to undergo resection (no BHD: 23.4% vs BHD: 20.3%; p < 0.001). Among surgical patients, individuals with BHD had higher odds of a complication (odds ratio [OR] 1.32 [1.26 to 1.39]), prolonged length of stay (OR 1.36 [1.29 to 1.43]), and 90-day readmission (OR 1.57 [1.50 to 1.65]) independent of social vulnerability or hospital-volume status resulting in lower odds to achieve a TO (OR 0.66 [0.63 to 0.69]). Surgical patients with BHD also had higher in-hospital expenditures (no BHD: $16,159 vs BHD: $17,432; p < 0.001). Of note, patients with BHD had worse long-term postoperative survival (median, no BHD: 46.6 [45.9 to 46.7] vs BHD: 37.1 [35.6 to 38.7] months) even after controlling for other clinical factors (hazard ratio 1.26 [1.22 to 1.31], p < 0.001). CONCLUSIONS BHD was associated with lower likelihood to achieve a postoperative textbook outcome, higher expenditures, as well as worse prognosis. Initiatives to target BHD are needed to improve outcomes of cancer patients undergoing surgery.
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Affiliation(s)
- Erryk S Katayama
- From the Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH (Katayama, Woldesenbet, Munir, Endo, Rawicz-Pruszyński, Khan, Tsilimigras, Dillhoff, Cloyd, Pawlik)
- Division of Surgical Oncology, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH (Katayama)
| | - Selamawit Woldesenbet
- From the Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH (Katayama, Woldesenbet, Munir, Endo, Rawicz-Pruszyński, Khan, Tsilimigras, Dillhoff, Cloyd, Pawlik)
| | - Muhammad Musaab Munir
- From the Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH (Katayama, Woldesenbet, Munir, Endo, Rawicz-Pruszyński, Khan, Tsilimigras, Dillhoff, Cloyd, Pawlik)
| | - Yutaka Endo
- From the Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH (Katayama, Woldesenbet, Munir, Endo, Rawicz-Pruszyński, Khan, Tsilimigras, Dillhoff, Cloyd, Pawlik)
| | - Karol Rawicz-Pruszyński
- From the Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH (Katayama, Woldesenbet, Munir, Endo, Rawicz-Pruszyński, Khan, Tsilimigras, Dillhoff, Cloyd, Pawlik)
- Department of Surgical Oncology, Medical University of Lublin, Poland (Rawicz-Pruszyński)
| | - Muhammad Muntazir Mehdi Khan
- From the Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH (Katayama, Woldesenbet, Munir, Endo, Rawicz-Pruszyński, Khan, Tsilimigras, Dillhoff, Cloyd, Pawlik)
| | - Diamantis Tsilimigras
- From the Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH (Katayama, Woldesenbet, Munir, Endo, Rawicz-Pruszyński, Khan, Tsilimigras, Dillhoff, Cloyd, Pawlik)
| | - Mary Dillhoff
- From the Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH (Katayama, Woldesenbet, Munir, Endo, Rawicz-Pruszyński, Khan, Tsilimigras, Dillhoff, Cloyd, Pawlik)
| | - Jordan Cloyd
- From the Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH (Katayama, Woldesenbet, Munir, Endo, Rawicz-Pruszyński, Khan, Tsilimigras, Dillhoff, Cloyd, Pawlik)
| | - Timothy M Pawlik
- From the Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH (Katayama, Woldesenbet, Munir, Endo, Rawicz-Pruszyński, Khan, Tsilimigras, Dillhoff, Cloyd, Pawlik)
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Katayama ES, Woldesenbet S, Munir MM, Endo Y, Moazzam Z, Lima HA, Shaikh CF, Pawlik TM. Poor Access to Mental Healthcare is Associated with Worse Postoperative Outcomes Among Patients with Gastrointestinal Cancer. Ann Surg Oncol 2024; 31:49-57. [PMID: 37814182 DOI: 10.1245/s10434-023-14374-7] [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] [Received: 04/13/2023] [Accepted: 09/17/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Mental health has an important role in the care of cancer patients, and access to mental health services may be associated with improved outcomes. Thus, poor access to psychiatric services may contribute to suboptimal cancer treatment. We conducted a geospatial analysis to characterize psychiatrist distribution and assess the impact of mental healthcare shortages with surgical outcomes among patients with gastrointestinal cancer. METHODS Medicare beneficiaries with mental illness diagnosed with complex gastrointestinal cancers between 2004 and 2016 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare registry. National Provider Identifier-registered psychiatrist locations were mapped and linked to SEER-Medicare records. Regional access to psychiatric services was assessed relative to textbook outcome, a composite assessment of postoperative complications, prolonged length of stay, 90-day readmission and mortality. RESULTS Among 15,714 patients with mental illness and gastrointestinal cancer, 3937 were classified as having high access to psychiatric services while 3910 had low access. On multivariable logistic regression, areas with low access had higher risk of worse postoperative outcomes. Specifically, individuals residing in areas with low access had increased odds of prolonged length of stay (OR 1.11, 95%CI 1.01-1.22; p = 0.028) and 90-day readmission (OR 1.19, 95%CI 1.08-1.31; p < 0.001), as well as decreased odds of textbook outcome (OR 0.85, 95%CI 0.77-0.93; p < 0.001) and discharge to home (OR 0.89, 95%CI 0.80-0.99; p = 0.028). CONCLUSION Patients with mental illness and lower access to psychiatric services had worse postoperative outcomes. Policymakers and providers should prioritize incorporating mental health screening and access to psychiatric services to address disparities among patients undergoing gastrointestinal surgery.
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Affiliation(s)
- Erryk S Katayama
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Chanza F Shaikh
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
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Delaney KR. The Future of the Psychiatric Mental Health Nursing Workforce: Using Our Skill Set to Address Incongruities in Mental Health Care Delivery. Issues Ment Health Nurs 2023; 44:933-943. [PMID: 37734065 DOI: 10.1080/01612840.2023.2252498] [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] [Indexed: 09/23/2023]
Abstract
The USA is dealing with well-documented issues around mental health and its treatment. The Psychiatric Mental Health (PMH) workforce is growing and practicing in a variety of roles within the mental health system. How will PMH nurses address instances when the structure of services does not meet the mental health needs of the population? In this piece, I argue that to some degree the future of the PMH workforce will be determined by how well we use our capacity and capabilities to address incongruities in service structure and population needs. Five areas of concern with mental health services are outlined; they all involve factors that can be addressed with innovative approaches and optimum utilization of the PMH workforce. Included are suggestions on how PMH nurses might direct efforts toward these service issues, particularly by using their skill set and presence in the mental health system. Strategies include forging a tighter connection between the work of advanced practice and registered nurses in delivering care. Broadly, these efforts should be directed at building models of patient-centered care that address the needs of populations, reducing disparities, and demonstrating how engagement is a critical lever of effective inpatient and community-based care.
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Affiliation(s)
- Kathleen R Delaney
- Department of Community Mental Health and Systems, Rush College of Nursing, Chicago, Illinois, USA
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Aggarwal R, Balon R, Morreale MK, Guerrero APS, Beresin EV, Louie AK, Coverdale J, Brenner AM. Is It Time to Rethink Psychiatry Residency Training? Part I: Overview. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:117-119. [PMID: 36689094 PMCID: PMC9869309 DOI: 10.1007/s40596-023-01741-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
| | | | | | | | | | | | | | - Adam M Brenner
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Bacolod M, Heissel J, Shen YC. Spatial Analysis of Access to Psychiatrists for US Military Personnel and Their Families. JAMA Netw Open 2023; 6:e2249314. [PMID: 36595295 PMCID: PMC9856908 DOI: 10.1001/jamanetworkopen.2022.49314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Military service members and their families have greater mental health care needs compared with their civilian counterparts. Some communities have inadequate access to psychiatrists for this population. OBJECTIVES To identify geographic variations in the availability of military and civilian psychiatrists within a 30-minute driving time of TRICARE (the US military's health care program) beneficiaries' communities and compare the likelihood of living in areas with inadequate access to psychiatrists for historically underserved and other communities. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study of all zip code communities in the continental US, Hawaii, and Alaska with at least one TRICARE beneficiary between January 1, 2016, and September 30, 2020, combines data from the Defense Health Agency, the National Plan and Provider Enumeration System, and the US Census to estimate a logistic regression to compare differences between communities with and without a psychiatrist shortage. Data were analyzed from September 2021 to November 2022. MAIN OUTCOMES AND MEASURES A community's likelihood of having a shortage of military and civilian psychiatrists within a 30-minute driving time and a community's likelihood of having no psychiatrists. Odds ratios were calculated to estimate likelihood of the outcomes. RESULTS This study includes 39 487 unique communities where 13% of the population is Black and 14% of the population is Hispanic. During the study period, 35% of TRICARE beneficiaries lived in communities with a shortage of both military and civilian psychiatrists, and 6% lived in communities with no access to military or civilian psychiatrists. Low-income communities with high income inequality were 1.64 (95% CI, 1.30-2.07) times more likely to have inadequate access to psychiatrists and 2.59 (95% CI, 1.82-3.69) times more likely to have no access to psychiatrists, compared with reference communities (average income without high income inequality); low-income communities without high income inequality were 1.37 (95% CI, 1.05-1.78) times more likely to have inadequate access to psychiatrists and 1.93 (95% CI, 1.28-2.89) times more likely to have no access to psychiatrists. Rural communities were 6.65 (95% CI, 5.09-8.69) times more likely to have inadequate access to psychiatrists than urban communities. CONCLUSIONS AND RELEVANCE In this cohort study of US communities, 35% of TRICARE beneficiaries lived in communities with inadequate access to psychiatrists. Psychiatric capacity was structurally inequitable along 2 separate dimensions: the income gradient and rurality. Developing targeted strategies for these shortage areas could alleviate disparities.
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Affiliation(s)
- Marigee Bacolod
- Department of Defense Management, Naval Postgraduate School, Monterey, California
| | - Jennifer Heissel
- Department of Defense Management, Naval Postgraduate School, Monterey, California
| | - Yu-Chu Shen
- Department of Defense Management, Naval Postgraduate School, Monterey, California
- National Bureau of Economic Research, Cambridge, Massachusetts
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Graves JM, Abshire DA, Mackelprang JL, Dilley JA, Amiri S, Chacon CM, Mason A. Geographic Disparities in the Availability of Mental Health Services in U.S. Public Schools. Am J Prev Med 2023; 64:1-8. [PMID: 36283908 PMCID: PMC9772127 DOI: 10.1016/j.amepre.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The purpose of this study was to examine geographic variation in the availability of and barriers to school-based mental health services. METHODS A weighted, nationally representative sample of U.S. public schools from the 2017-2018 School Survey on Crime and Safety was used. Schools reported the provision of diagnostic mental health assessments and/or treatment as well as factors that limited the provision of mental health services. Availability of mental health services and factors limiting service provision were examined across rurality, adjusting for school enrollment and grade level. The analysis was conducted in December 2021. RESULTS Half (51.2%) of schools reported providing mental health assessments, and 38.3% reported providing treatment. After adjusting for enrollment and grade level, rural schools were 19% less likely, town schools were 21% less likely, and suburban schools were 11% less likely to report providing mental health assessments than city schools. Only suburban schools were less likely than city schools to provide mental health treatment (incidence rate ratio=0.85; 95% CI=0.72, 1.00). Factors limiting the provision of services included inadequate access to professionals (70.9%) and inadequate funding (77.0%), which were most common among rural schools. CONCLUSIONS Significant inequities in school-based mental health services exist outside of urban areas.
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Affiliation(s)
- Janessa M Graves
- College of Nursing, Washington State University, Spokane, Washington.
| | | | | | - Julia A Dilley
- Program Design and Evaluation Services, Multnomah County/Oregon Public Health Division, Portland, Oregon
| | - Solmaz Amiri
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Christina M Chacon
- College of Nursing, Washington State University, Tri-Cities, Richland, Washington
| | - Anne Mason
- College of Nursing, Washington State University, Spokane, Washington
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Paquet J, Agyapong VIO, Brett-MacLean P, Hibbard K. Interest in Rural Training Experiences in a Canadian Psychiatry Residency Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14512. [PMID: 36361392 PMCID: PMC9658368 DOI: 10.3390/ijerph192114512] [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: 09/18/2022] [Revised: 10/18/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND With the large majority of mental health professionals concentrated in urban settings, people living in rural and remote areas face significant barriers to accessing mental health care. Recognizing that early exposure is associated with future practice in rural and remote locations, we sought to obtain baseline data regarding interest in expanded rural residency training opportunities and academic teaching. METHODS In March 2021, all psychiatry residents at the University of Alberta (UofA) were invited to complete a 19-question survey that included both closed-ended (age, gender, year of study, rural experience, interest in rural training, etc.) and open-ended questions (challenges, barriers, academic training, and other comments). A reflexive thematic analysis using an inductive and semantic approach was completed on the comments. RESULTS 36 residents completed the survey (response rate, 75%). Significant associations were identified between previous rural training experience and interest in rural psychiatry training and practice. Female residents and junior residents were significantly more interested in rural training experiences than their counterparts. Thematic analysis noted concerns with the financial costs of accommodation and transportation, high service burden, continuity of care and isolation from their cohort. Many were interested in academic sessions on the realities of rural practice; approaches to collaborative care; and strategies on culturally relevant care; specifically Indigenous health. CONCLUSIONS The University of Alberta has highlighted a focus on improving equity and accountability; and with a large rural catchment region; the residency program is well positioned to make training adjustments to diversify training. Based on our findings we have incorporated rural rotations for incoming residents and have developed further rural academic content to support our responsiveness and accountability to the rural and northern communities we are committed to serving. Future research should review the impact of rural training exposure in medical specialties on recruitment and retention as well as on healthcare outcomes.
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Affiliation(s)
- Jacquelyn Paquet
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Vincent I. O. Agyapong
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Pamela Brett-MacLean
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Katharine Hibbard
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
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Roberts LW. Recognizing Rural Health Resource and Education Needs. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1251-1253. [PMID: 36098770 DOI: 10.1097/acm.0000000000004823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Dingle AD, Fernandez F, de Erausquin GA. Developing a Rural Psychiatry Training Program on The Texas-Mexico Border: A Chance for Innovation. Community Ment Health J 2022; 58:1060-1066. [PMID: 34812961 DOI: 10.1007/s10597-021-00914-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/03/2021] [Indexed: 11/29/2022]
Abstract
Creating residencies that produce psychiatrists who are skilled and interested in working in under resourced areas, especially in community and rural settings is challenging. State and private agency collaboration can be an effective approach to enhancing such training. These resources for education have the goals of improving access and services, addressing workforce shortages and improving physician retention. They can provide flexibility to implement innovations that enhance training and address community needs. This article describes the implementation of a psychiatry residency at the University of Texas Rio Grande Valley School of Medicine. Funding was obtained from state and private initiatives. This paper describes the implementation. Feedback was positive at all levels. This program illustrates some of the advantages of utilizing alternate funding in creating high quality residencies that are integral to the community, produce skilled collaborative physicians, provide necessary care that addresses specific community needs and potentially address workforce issues in underserved areas.
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Affiliation(s)
- Arden D Dingle
- Department of Psychiatry, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA.
| | - Francisco Fernandez
- Department of Psychiatry, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA
| | - Gabriel A de Erausquin
- Department of Psychiatry, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA
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Vincenti M, Albanese A, Bope E, Watts BV. The Regional Distribution of Psychiatric Residency Positions Funded by the Department of Veterans Affairs and Its Relationship to Rural Veteran Populations. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:435-440. [PMID: 34787824 PMCID: PMC9349103 DOI: 10.1007/s40596-021-01565-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The authors evaluated the distribution of psychiatry residency positions funded by the Department of Veterans Affairs between 2014 and 2020 with respect to geographic location and hospital patient population rurality. METHODS The authors collected data on psychiatry residency positions from the Veterans Affairs' Office of Academic Affiliations Support Center and data on hospital-level patient rurality from the Veterans Health Administration Support Service Center. They examined the chronological and geospatial relationships between the number of residency positions deployed and the size of the rural patient populations served. RESULTS Between 2014 and 2020, the Department of Veterans Affairs has substantially increased the number of rural hospitals hosting psychiatry residency programs, as well as the number of residency positions at those hospitals. However, several geographic regions serve high numbers of rural veterans with few or no psychiatry resident positions. CONCLUSIONS While the VA efforts to increase psychiatry residency positions in rural areas have been partially successful, additional progress can be made increasing support for psychiatry trainees at Veterans Affairs hospitals and community-based outpatient clinics that serve large portions of the rural veteran population.
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Affiliation(s)
- Matthew Vincenti
- Veterans Rural Health Resource Center, White River Junction, VT, USA.
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Anthony Albanese
- U.S. Department of Veterans Affairs' Office of Academic Affiliations, Washington, DC, USA
| | - Edward Bope
- U.S. Department of Veterans Affairs' Office of Academic Affiliations, Washington, DC, USA
| | - Bradley V Watts
- Veterans Rural Health Resource Center, White River Junction, VT, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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COOK DIANEJ, STRICKLAND MIRANDA, SCHMITTER-EDGECOMBE MAUREEN. Detecting Smartwatch-based Behavior Change in Response to a Multi-domain Brain Health Intervention. ACM TRANSACTIONS ON COMPUTING FOR HEALTHCARE 2022; 3:33. [PMID: 35815157 PMCID: PMC9268550 DOI: 10.1145/3508020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/01/2021] [Indexed: 06/15/2023]
Abstract
In this study, we introduce and validate a computational method to detect lifestyle change that occurs in response to a multi-domain healthy brain aging intervention. To detect behavior change, digital behavior markers (DM) are extracted from smartwatch sensor data and a Permutation-based Change Detection (PCD) algorithm quantifies the change in marker-based behavior from a pre-intervention, one-week baseline. To validate the method, we verify that changes are successfully detected from synthetic data with known pattern differences. Next, we employ this method to detect overall behavior change for n=28 BHI subjects and n=17 age-matched control subjects. For these individuals, we observe a monotonic increase in behavior change from the baseline week with a slope of 0.7460 for the intervention group and a slope of 0.0230 for the control group. Finally, we utilize a random forest algorithm to perform leave-one-subject-out prediction of intervention versus control subjects based on digital marker delta values. The random forest predicts whether the subject is in the intervention or control group with an accuracy of 0.87. This work has implications for capturing objective, continuous data to inform our understanding of intervention adoption and impact.
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Affiliation(s)
- DIANE J. COOK
- School of Electrical Engineering and Computer Science.
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Lister JJ, Lee G, Ellis JD, Pasman E, Agius E, Resko SM. Comorbid Affective and Substance Use Disorders of Medicaid/Medicare Beneficiaries at an Opioid Treatment Program Serving Small Urban and Rural Communities. Front Psychiatry 2022; 13:881821. [PMID: 35586409 PMCID: PMC9108361 DOI: 10.3389/fpsyt.2022.881821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Identify rates and correlates of comorbid affective and substance use disorders among an understudied population, Medicaid/Medicare beneficiaries receiving care at an opioid treatment program serving patients from small urban and rural areas. Examine whether past-year non-medical opioid use status differentiates comorbidity status. Methods A cross-sectional, venue-based design was used to recruit a convenience sample of patients treated with methadone for opioid use disorder. Measures were assessed across three domains: (1) demographic characteristics, (2) opioid use characteristics, and (3) comorbid disorders. Brief validated screeners categorized probable comorbid disorders. Bivariate analyses examined correlates of comorbid disorders and determined variable selection for multivariable analyses. Results In this sample (N = 210; mean age = 38.5 years; female = 62.2%; Non-Hispanic White race/ethnicity = 86.1%), comorbid disorders were common. Rates were as follows: current anxiety (48.1%), depression (41.1%), and PTSD (33.7%), and past-year stimulant (27.6%), marijuana (19.0%), alcohol (14.9%), and sedative (7.6%). In bivariate analyses, past-year non-medical opioid use and a greater accumulation of opioid use consequences were associated with most disorders. When including demographic and opioid use characteristics in multivariable analyses, past-year non-medical opioid use was associated with anxiety, PTSD, stimulant use disorder, and sedative use disorder. Conclusions Few studies have investigated comorbid disorders among this understudied population. This analysis highlights a high burden, especially for affective disorders. Our findings demonstrate that routine, ongoing assessment of non-medical opioid use may be a promising and feasible strategy to detect patients needing integrated care. Future research should investigate whether changes to assessment protocols at opioid treatment programs in small urban and rural settings facilitate care coordination.
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Affiliation(s)
- Jamey J. Lister
- Rutgers University School of Social Work, New Brunswick, NJ, United States
- Wayne State University School of Social Work, Detroit, MI, United States
| | - Guijin Lee
- Wayne State University School of Social Work, Detroit, MI, United States
| | - Jennifer D. Ellis
- Wayne State University School of Social Work, Detroit, MI, United States
- Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, United States
| | - Emily Pasman
- Wayne State University School of Social Work, Detroit, MI, United States
| | - Elizabeth Agius
- Wayne State University School of Social Work, Detroit, MI, United States
| | - Stella M. Resko
- Wayne State University School of Social Work, Detroit, MI, United States
- Wayne State University Merrill Palmer Skillman Institute, Detroit, MI, United States
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Collett D, Temple KM, Wells RD. The Challenges of Providing Preventive Health Care in Rural America. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
PURPOSE OF REVIEW Suicide is a serious public health problem in the United States, and suicide rates have been increasing for more than a decade. Rural areas are more impacted than urban areas, reinforcing that social, cultural, and economic factors contribute to risk. This article reviews recent work about these contributors to suicide and how they may inform prevention efforts. RECENT FINDINGS Current research has shown that suicide is more than a mental health problem with a psychiatric or medical solution. Universal screening and referral by gatekeepers target a large group with a low baseline risk, and there are few treatments proven to reduce death by suicide, as well as a severe shortage of mental health providers in the United States to provide them. Instead, suicide prevention polices can target various other factors that contribute to elevated suicide risk at the population level, including reducing socioeconomic deprivation and access to firearms, both of which are often higher in rural areas. Internet-based interventions also hold promise as they are highly scalable, accessible almost anywhere, and often anonymous. SUMMARY Understanding factors that increase suicide risk guide development of evidence-based policies targeted at high-risk groups. Population-level interventions should be developed in collaboration with the target audience for cultural appropriateness.
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Affiliation(s)
- Amy Barnhorst
- BulletPoints Project
- University of California Firearm Violence Research Center
- Department of Psychiatry and Behavioral Sciences
- Department of Emergency Medicine, University of California, Davis, California, USA
| | - Hilary Gonzales
- BulletPoints Project
- University of California Firearm Violence Research Center
- Department of Emergency Medicine, University of California, Davis, California, USA
| | - Rameesha Asif-Sattar
- BulletPoints Project
- University of California Firearm Violence Research Center
- Department of Emergency Medicine, University of California, Davis, California, USA
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16
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Abstract
The complexities of providing quality perinatal care within rural communities provide significant challenges to providers and policy makers. Provision of healthcare in rural communities is challenging on individual as well as community-based levels. A quality improvement lens is applied to consider key challenges that pertain to patients, providers, place, and policy. Potential solutions from a provider perspective include nurse-midwifery care and inclusion of advanced practice providers in a variety of specialties in addition to creating care models for registered nurses to practice at the top of their scope. To enhance access in the rural place, telehealth and coordination activities are recommended. Finally, policy approaches such as Perinatal Care Collaboratives, Area Health Education Centers, and enhanced financial resources to eliminate socioeconomic disparities will enhance perinatal care in rural communities.
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Affiliation(s)
- Amy J Barton
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora (Drs Barton and Anderson)
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Athanas A, McCorrison J, Campistron J, Bender N, Price J, Smalley S, Schork NJ. Characterizing Emotional State Transitions During Prolonged Use of a Mindfulness and Meditation App: Observational Study. JMIR Ment Health 2021; 8:e19832. [PMID: 33650986 PMCID: PMC7967231 DOI: 10.2196/19832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 09/22/2020] [Accepted: 11/15/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The increasing demand for mental health care, a lack of mental health care providers, and unequal access to mental health care services have created a need for innovative approaches to mental health care. Digital device apps, including digital therapeutics, that provide recommendations and feedback for dealing with stress, depression, and other mental health issues can be used to adjust mood and ultimately show promise to help meet this demand. In addition, the recommendations delivered through such apps can also be tailored to an individual's needs (ie, personalized) and thereby potentially provide greater benefits than traditional "one-size-fits-all" recommendations. OBJECTIVE This study aims to characterize individual transitions from one emotional state to another during the prolonged use of a digital app designed to provide a user with guided meditations based on their initial, potentially negative, emotional state. Understanding the factors that mediate such transitions can lead to improved recommendations for specific mindfulness and meditation interventions or activities (MMAs) provided in mental health apps. METHODS We analyzed data collected during the use of the Stop, Breathe & Think (SBT) mindfulness app. The SBT app prompts users to input their emotional state before and immediately after engaging with MMAs recommended by the app. Data were collected from more than 650,000 SBT users engaging in nearly 5 million MMAs. We limited the scope of our analysis to users with 10 or more MMA sessions that included at least 6 basal emotional state evaluations. Using clustering techniques, we grouped emotions recorded by individual users and then applied longitudinal mixed effect models to assess the associations between individual recommended MMAs and transitions from one group of emotions to another. RESULTS We found that basal emotional states have a strong influence on transitions from one emotional state to another after MMA engagement. We also found that different MMAs impact these transitions, and many were effective in eliciting a healthy transition but only under certain conditions. In addition, we observed gender and age effects on these transitions. CONCLUSIONS We found that the initial emotional state of an SBT app user determines the type of SBT MMAs that will have a favorable effect on their transition from one emotional state to another. Our results have implications for the design and use of guided mental health recommendations for digital device apps.
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Affiliation(s)
- Argus Athanas
- Bioinformatics and Systems Biology, University California San Diego, San Diego, CA, United States
| | - Jamison McCorrison
- Bioinformatics and Systems Biology, University California San Diego, San Diego, CA, United States
| | | | - Nick Bender
- Stop, Breathe & Think, Inc, Los Angeles, CA, United States
| | - Jamie Price
- Stop, Breathe & Think, Inc, Los Angeles, CA, United States
| | - Susan Smalley
- University California Los Angeles, Los Angeles, CA, United States
| | - Nicholas J Schork
- Bioinformatics and Systems Biology, University California San Diego, San Diego, CA, United States
- Department of Quantitative Medicine, The Translational Genomics Research Institute, An Affiliate of the City of Hope National Medical Center, Phoenix, AZ, United States
- The City of Hope/Translational Genomics Research Institute IMPACT Center, Duarte, CA, United States
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18
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Using the Hub and Spoke Model of Telemental Health to Expand the Reach of Community Based Care in the United States. Community Ment Health J 2021; 57:49-56. [PMID: 32653963 DOI: 10.1007/s10597-020-00675-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
Community-based agencies are challenged with providing mental health care services with limited resources. When services are not provided, children are at increased risk for ongoing symptoms. The purpose of this study was to determine the effectiveness of the hub and spoke model of telemental services on the quality of function, access to care, and medication management. A retrospective case controlled design was used to examine study objectives. Five hundred and fifty-seven charts were reviewed for persons aged 6 to 17 from January 1, 2010 to December 31, 2015 and after propensity score matching was applied, 86 remained for analysis. Seventy-nine persons out of 301 (26%) in the comparison group; 43 persons out of 256 (17%) in the treatment group were selected due to having complete records. Results of the T-test suggested that telemental services were not inferior to face to face services. Access to care, analyzed via the Chi-Squared test, increased significantly across geographic regions and among person with different living arrangements. A T-test was conducted to compare medication non-adherence between groups; no statistical significance was noted. Telemental services are a viable option to increase access to community-based care and increase quality of function.
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Morreale MK, Balon R, Coverdale J, Louie AK, Beresin E, Guerrero APS, Aggarwal R, Brenner AM. Supporting the Education of Nurse Practitioners and Physician Assistants in Meeting Shortages in Mental Health Care. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:377-379. [PMID: 32529607 PMCID: PMC7289539 DOI: 10.1007/s40596-020-01256-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/31/2020] [Indexed: 05/31/2023]
Affiliation(s)
| | | | | | | | | | | | | | - Adam M Brenner
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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20
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Chan CH, Gouthro R, Krall E, Lehrmann J. Starting Rural Psychiatric Residencies: a Case Report and Lessons Learned. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:446-450. [PMID: 32367386 DOI: 10.1007/s40596-020-01229-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Affiliation(s)
| | | | - Edward Krall
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jon Lehrmann
- Medical College of Wisconsin, Milwaukee, WI, USA
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