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Reilly S, Hobson-Merrett C, Gibbons B, Jones B, Richards D, Plappert H, Gibson J, Green M, Gask L, Huxley PJ, Druss BG, Planner CL. Collaborative care approaches for people with severe mental illness. Cochrane Database Syst Rev 2024; 5:CD009531. [PMID: 38712709 PMCID: PMC11075124 DOI: 10.1002/14651858.cd009531.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND Collaborative care for severe mental illness (SMI) is a community-based intervention that promotes interdisciplinary working across primary and secondary care. Collaborative care interventions aim to improve the physical and/or mental health care of individuals with SMI. This is an update of a 2013 Cochrane review, based on new searches of the literature, which includes an additional seven studies. OBJECTIVES To assess the effectiveness of collaborative care approaches in comparison with standard care (or other non-collaborative care interventions) for people with diagnoses of SMI who are living in the community. SEARCH METHODS We searched the Cochrane Schizophrenia Study-Based Register of Trials (10 February 2021). We searched the Cochrane Common Mental Disorders (CCMD) controlled trials register (all available years to 6 June 2016). Subsequent searches on Ovid MEDLINE, Embase and PsycINFO together with the Cochrane Central Register of Controlled Trials (with an overlap) were run on 17 December 2021. SELECTION CRITERIA Randomised controlled trials (RCTs) where interventions described as 'collaborative care' were compared with 'standard care' for adults (18+ years) living in the community with a diagnosis of SMI. SMI was defined as schizophrenia, other types of schizophrenia-like psychosis or bipolar affective disorder. The primary outcomes of interest were: quality of life, mental state and psychiatric admissions at 12 months follow-up. DATA COLLECTION AND ANALYSIS Pairs of authors independently extracted data. We assessed the quality and certainty of the evidence using RoB 2 (for the primary outcomes) and GRADE. We compared treatment effects between collaborative care and standard care. We divided outcomes into short-term (up to six months), medium-term (seven to 12 months) and long-term (over 12 months). For dichotomous data we calculated the risk ratio (RR) and for continuous data we calculated the standardised mean difference (SMD), with 95% confidence intervals (CIs). We used random-effects meta-analyses due to substantial levels of heterogeneity across trials. We created a summary of findings table using GRADEpro. MAIN RESULTS Eight RCTs (1165 participants) are included in this review. Two met the criteria for type A collaborative care (intervention comprised of the four core components). The remaining six met the criteria for type B (described as collaborative care by the trialists, but not comprised of the four core components). The composition and purpose of the interventions varied across studies. For most outcomes there was low- or very low-certainty evidence. We found three studies that assessed the quality of life of participants at 12 months. Quality of life was measured using the SF-12 and the WHOQOL-BREF and the mean endpoint mental health component scores were reported at 12 months. Very low-certainty evidence did not show a difference in quality of life (mental health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.03, 95% CI -0.26 to 0.32; 3 RCTs, 227 participants). Very low-certainty evidence did not show a difference in quality of life (physical health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.08, 95% CI -0.18 to 0.33; 3 RCTs, 237 participants). Furthermore, in the medium term (at 12 months) low-certainty evidence did not show a difference between collaborative care and standard care in mental state (binary) (RR 0.99, 95% CI 0.77 to 1.28; 1 RCT, 253 participants) or in the risk of being admitted to a psychiatric hospital at 12 months (RR 5.15, 95% CI 0.67 to 39.57; 1 RCT, 253 participants). One study indicated an improvement in disability (proxy for social functioning) at 12 months in the collaborative care arm compared to usual care (RR 1.38, 95% CI 0.97 to 1.95; 1 RCT, 253 participants); we deemed this low-certainty evidence. Personal recovery and satisfaction/experience of care outcomes were not reported in any of the included studies. The data from one study indicated that the collaborative care treatment was more expensive than standard care (mean difference (MD) international dollars (Int$) 493.00, 95% CI 345.41 to 640.59) in the short term. Another study found the collaborative care intervention to be slightly less expensive at three years. AUTHORS' CONCLUSIONS This review does not provide evidence to indicate that collaborative care is more effective than standard care in the medium term (at 12 months) in relation to our primary outcomes (quality of life, mental state and psychiatric admissions). The evidence would be improved by better reporting, higher-quality RCTs and the assessment of underlying mechanisms of collaborative care. We advise caution in utilising the information in this review to assess the effectiveness of collaborative care.
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Affiliation(s)
- Siobhan Reilly
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Charley Hobson-Merrett
- Primary Care Plymouth, University of Plymouth, Plymouth, UK
- National Institute for Health Research Applied Research Collaboration South West Peninsula, Plymouth, UK
| | | | - Ben Jones
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Debra Richards
- Primary Care Plymouth, University of Plymouth, Plymouth, UK
| | - Humera Plappert
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | | | - Maria Green
- Pennine Health Care NHS Foundation Trust, Bury, UK
| | - Linda Gask
- Health Sciences Research Group, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter J Huxley
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Benjamin G Druss
- Department of Health Policy and Management, Emory University, Atlanta, USA
| | - Claire L Planner
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
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Kilbourne AM, Geng E, Eshun-Wilson I, Sweeney S, Shelley D, Cohen DJ, Kirchner JE, Fernandez ME, Parchman ML. How does facilitation in healthcare work? Using mechanism mapping to illuminate the black box of a meta-implementation strategy. Implement Sci Commun 2023; 4:53. [PMID: 37194084 PMCID: PMC10190070 DOI: 10.1186/s43058-023-00435-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/06/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Healthcare facilitation, an implementation strategy designed to improve the uptake of effective clinical innovations in routine practice, has produced promising yet mixed results in randomized implementation trials and has not been fully researched across different contexts. OBJECTIVE Using mechanism mapping, which applies directed acyclic graphs that decompose an effect of interest into hypothesized causal steps and mechanisms, we propose a more concrete description of how healthcare facilitation works to inform its further study as a meta-implementation strategy. METHODS Using a modified Delphi consensus process, co-authors developed the mechanistic map based on a three-step process. First, they developed an initial logic model by collectively reviewing the literature and identifying the most relevant studies of healthcare facilitation components and mechanisms to date. Second, they applied the logic model to write vignettes describing how facilitation worked (or did not) based on recent empirical trials that were selected via consensus for inclusion and diversity in contextual settings (US, international sites). Finally, the mechanistic map was created based on the collective findings from the vignettes. FINDINGS Theory-based healthcare facilitation components informing the mechanistic map included staff engagement, role clarification, coalition-building through peer experiences and identifying champions, capacity-building through problem solving barriers, and organizational ownership of the implementation process. Across the vignettes, engagement of leaders and practitioners led to increased socialization of the facilitator's role in the organization. This in turn led to clarifying of roles and responsibilities among practitioners and identifying peer experiences led to increased coherence and sense-making of the value of adopting effective innovations. Increased trust develops across leadership and practitioners through expanded capacity in adoption of the effective innovation by identifying opportunities that mitigated barriers to practice change. Finally, these mechanisms led to eventual normalization and ownership of the effective innovation and healthcare facilitation process. IMPACT Mapping methodology provides a novel perspective of mechanisms of healthcare facilitation, notably how sensemaking, trust, and normalization contribute to quality improvement. This method may also enable more efficient and impactful hypothesis-testing and application of complex implementation strategies, with high relevance for lower-resourced settings, to inform effective innovation uptake.
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Affiliation(s)
- Amy M. Kilbourne
- Health Services Research & Development, VA Office of Research and Development, US Department of Veterans Affairs and University of Michigan, 810 Vermont Ave, NW, Washington, D.C., 20420 USA
| | - Elvin Geng
- Washington University at St. Louis, St. Louis, MO USA
| | | | | | - Donna Shelley
- New York University School of Global Public Health, New York, New York USA
| | | | - JoAnn E. Kirchner
- Central Arkansas VA Healthcare System and University of Arkansas for Medical Sciences, North Little Rock, AR USA
| | - Maria E. Fernandez
- University of Texas Health Science Center at Houston, School of Public Health, Houston, TX USA
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Tabaei-Aghdaei Z, McColl-Kennedy JR, Coote LV. Goal Setting and Health-Related Outcomes in Chronic Diseases: A Systematic Review and Meta-Analysis of the Literature From 2000 to 2020. Med Care Res Rev 2023; 80:145-164. [PMID: 35904147 DOI: 10.1177/10775587221113228] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Identifying and synthesizing recent empirical research on goal setting among adults with chronic disease is the focus of this article. The article has two phases: Phase 1, a thematic analysis with machine reading of the data and manual thematic analysis, and Phase 2, a quantitative meta-analysis. Qualitative, quantitative, and mixed-method studies are included in Phase 1 (99 papers). Phase 2 includes only quantitative studies (75 papers). Five main themes are identified: (a) the effect of goal characteristics on health-related outcomes, (b) the effect of goal setting on health-related outcomes, (c) the effect of goal achievement on health-related outcomes, (d) goal alignment between patients and health care service providers, and (e) individual and collaborative goal setting of patients and health care service providers. The meta-analysis reveals considerable evidence of an association between goal setting and health-related outcomes.
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Strunz M, Jiménez NP, Gregorius L, Hewer W, Pollmanns J, Viehmann K, Jacobi F. Interventions to Promote the Utilization of Physical Health Care for People with Severe Mental Illness: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:126. [PMID: 36612457 PMCID: PMC9819522 DOI: 10.3390/ijerph20010126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The main contributor to excess mortality in severe mental illness (SMI) is poor physical health. Causes include unfavorable health behaviors among people with SMI, stigmatization phenomena, as well as limited access to and utilization of physical health care. Patient centered interventions to promote the utilization of and access to existing physical health care facilities may be a pragmatic and cost-effective approach to improve health equity in this vulnerable and often neglected patient population. OBJECTIVE/METHODS In this study, we systematically reviewed the international literature on such studies (sources: literature databases, trial-registries, grey literature). Empirical studies (quantitative, qualitative, and mixed methods) of interventions to improve the utilization of and access to medical health care for people with a SMI, were included. RESULTS We identified 38 studies, described in 51 study publications, and summarized them in terms of type, theoretical rationale, outcome measures, and study author's interpretation of the intervention success. CONCLUSIONS Useful interventions to promote the utilization of physical health care for people with a SMI exist, but still appear to be rare, or at least not supplemented by evaluation studies. The present review provides a map of the evidence and may serve as a starting point for further quantitative effectiveness evaluations of this promising type of behavioral intervention.
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Affiliation(s)
| | | | - Lisa Gregorius
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Walter Hewer
- Klinikum Christophsbad, 73035 Göppingen, Germany
| | | | - Kerstin Viehmann
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Frank Jacobi
- Psychologische Hochschule Berlin, 10179 Berlin, Germany
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Bradley T, Campbell E, Dray J, Bartlem K, Wye P, Hanly G, Gibson L, Fehily C, Bailey J, Wynne O, Colyvas K, Bowman J. Systematic review of lifestyle interventions to improve weight, physical activity and diet among people with a mental health condition. Syst Rev 2022; 11:198. [PMID: 36085250 PMCID: PMC9462072 DOI: 10.1186/s13643-022-02067-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with a mental health condition experience an elevated risk of chronic disease and greater prevalence of health and behaviours. Lifestyle interventions aim to reduce this risk by modifying health behaviours such as physical activity and diet. Previous reviews exploring the efficacy of such interventions for this group have typically limited inclusion to individuals with severe mental illness (SMI), with a focus of impact on weight. This review assessed the efficacy of lifestyle interventions delivered in community or outpatient settings to people with any mental health condition, on weight, physical activity and diet. METHODS Eligible studies were randomised or cluster-randomised controlled trials published between January 1999 and February 2019 aiming to improve weight, physical activity or diet, for people with any mental health condition. Two reviewers independently completed study screening, data extraction and assessment of methodological quality. Primary outcome measures were weight, physical activity and diet. Secondary outcome measures were body mass index (BMI), waist circumference, sedentary behaviour and mental health. Where possible, meta-analyses were conducted. Narrative synthesis using vote counting based on direction of effect was used where studies were not amenable to meta-analysis. RESULTS Fifty-seven studies were included (49 SMI only), with 46 contributing to meta-analyses. Meta-analyses revealed significant (< 0.05) effect of interventions on mean weight loss (-1.42 kg), achieving 5% weight loss (OR 2.48), weight maintenance (-2.05 kg), physical activity (IPAQ MET minutes: 226.82) and daily vegetable serves (0.51), but not on fruit serves (0.01). Significant effects were also seen for secondary outcomes of BMI (-0.48 units) and waist circumference (-0.87cm), but not mental health (depression: SMD -0.03; anxiety: SMD -0.49; severity of psychological symptoms: SMD 0.72). Studies reporting sedentary behaviour were not able to be meta-analysed. Most trials had high risk of bias, quality of evidence for weight and physical activity were moderate, while quality of evidence for diet was low. CONCLUSION Lifestyle interventions delivered to people with a mental health condition made statistically significant improvements to weight, BMI, waist circumference, vegetable serves and physical activity. Further high-quality trials with greater consistency in measurement and reporting of outcomes are needed to better understand the impact of lifestyle interventions on physical activity, diet, sedentary behaviour and mental health and to understand impact on subgroups. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019137197.
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Affiliation(s)
- Tegan Bradley
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287 Australia
| | - Julia Dray
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Kate Bartlem
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Paula Wye
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Grace Hanly
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Lauren Gibson
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Caitlin Fehily
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Jacqueline Bailey
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Olivia Wynne
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Kim Colyvas
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Jenny Bowman
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
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Menear M, Girard A, Dugas M, Gervais M, Gilbert M, Gagnon MP. Personalized care planning and shared decision making in collaborative care programs for depression and anxiety disorders: A systematic review. PLoS One 2022; 17:e0268649. [PMID: 35687610 PMCID: PMC9187074 DOI: 10.1371/journal.pone.0268649] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/04/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Collaborative care is an evidence-based approach to improving outcomes for common mental disorders in primary care. Efforts are underway to broadly implement the collaborative care model, yet the extent to which this model promotes person-centered mental health care has been little studied. The aim of this study was to describe practices related to two patient and family engagement strategies-personalized care planning and shared decision making-within collaborative care programs for depression and anxiety disorders in primary care. METHODS We conducted an update of a 2012 Cochrane review, which involved searches in Cochrane CCDAN and CINAHL databases, complemented by additional database, trial registry, and cluster searches. We included programs evaluated in a clinical trials targeting adults or youth diagnosed with depressive or anxiety disorders, as well as sibling reports related to these trials. Pairs of reviewers working independently selected the studies and data extraction for engagement strategies was guided by a codebook. We used narrative synthesis to report on findings. RESULTS In total, 150 collaborative care programs were analyzed. The synthesis showed that personalized care planning or shared decision making were practiced in fewer than half of programs. Practices related to personalized care planning, and to a lesser extent shared decision making, involved multiple members of the collaborative care team, with care managers playing a pivotal role in supporting patient and family engagement. Opportunities for quality improvement were identified, including fostering greater patient involvement in collaborative goal setting and integrating training and decision aids to promote shared decision making. CONCLUSION This review suggests that personalized care planning and shared decision making could be more fully integrated within collaborative care programs for depression and anxiety disorders. Their absence in some programs is a missed opportunity to spread person-centered mental health practices in primary care.
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Affiliation(s)
- Matthew Menear
- VITAM Research Centre for Sustainable Health, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Ariane Girard
- VITAM Research Centre for Sustainable Health, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Michèle Dugas
- VITAM Research Centre for Sustainable Health, Quebec, Quebec, Canada
| | - Michel Gervais
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
| | - Michel Gilbert
- Centre National d’Excellence en Santé Mentale, Quebec, Quebec, Canada
| | - Marie-Pierre Gagnon
- VITAM Research Centre for Sustainable Health, Quebec, Quebec, Canada
- Faculty of Nursing, Université Laval, Quebec, Quebec, Canada
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Hagi K, Nosaka T, Dickinson D, Lindenmayer JP, Lee J, Friedman J, Boyer L, Han M, Abdul-Rashid NA, Correll CU. Association Between Cardiovascular Risk Factors and Cognitive Impairment in People With Schizophrenia: A Systematic Review and Meta-analysis. JAMA Psychiatry 2021; 78:510-518. [PMID: 33656533 PMCID: PMC7931134 DOI: 10.1001/jamapsychiatry.2021.0015] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Schizophrenia is associated with cognitive dysfunction and cardiovascular risk factors, including metabolic syndrome (MetS) and its constituent criteria. Cognitive dysfunction and cardiovascular risk factors can worsen cognition in the general population and may contribute to cognitive impairment in schizophrenia. OBJECTIVE To study the association between cognitive dysfunction and cardiovascular risk factors and cognitive impairment in individuals with schizophrenia. DATA SOURCES A search was conducted of Embase, Scopus, MEDLINE, PubMed, and Cochrane databases from inception to February 25, 2020, using terms that included synonyms of schizophrenia AND metabolic adversities AND cognitive function. Conference proceedings, clinical trial registries, and reference lists of relevant publications were also searched. STUDY SELECTION Studies were included that (1) examined cognitive functioning in patients with schizophrenia or schizoaffective disorder; (2) investigated the association of cardiovascular disease risk factors, including MetS, diabetes, obesity, overweight, obesity or overweight, hypertension, dyslipidemia, and insulin resistance with outcomes; and (3) compared cognitive performance of patients with schizophrenia/schizoaffective disorder between those with vs without cardiovascular disease risk factors. DATA EXTRACTION AND SYNTHESIS Extraction of data was conducted by 2 to 3 independent reviewers per article. Data were meta-analyzed using a random-effects model. MAIN OUTCOMES AND MEASURES The primary outcome was global cognition, defined as a test score using clinically validated measures of overall cognitive functioning. RESULTS Twenty-seven studies involving 10 174 individuals with schizophrenia were included. Significantly greater global cognitive deficits were present in patients with schizophrenia who had MetS (13 studies; n = 2800; effect size [ES] = 0.31; 95% CI, 0.13-0.50; P = .001), diabetes (8 studies; n = 2976; ES = 0.32; 95% CI, 0.23-0.42; P < .001), or hypertension (5 studies; n = 1899; ES = 0.21; 95% CI, 0.11-0.31; P < .001); nonsignificantly greater deficits were present in patients with obesity (8 studies; n = 2779; P = .20), overweight (8 studies; n = 2825; P = .41), and insulin resistance (1 study; n = 193; P = .18). Worse performance in specific cognitive domains was associated with cognitive dysfunction and cardiovascular risk factors regarding 5 domains in patients with diabetes (ES range, 0.23 [95% CI, 0.12-0.33] to 0.40 [95% CI, 0.20-0.61]) and 4 domains with MetS (ES range, 0.15 [95% CI, 0.03-0.28] to 0.40 [95% CI, 0.20-0.61]) and hypertension (ES range, 0.15 [95% CI, 0.04-0.26] to 0.27 [95% CI, 0.15-0.39]). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, MetS, diabetes, and hypertension were significantly associated with global cognitive impairment in people with schizophrenia.
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Affiliation(s)
- Katsuhiko Hagi
- Medical Affairs, Sumitomo Dainippon Pharma, Tokyo, Japan
| | - Tadashi Nosaka
- Medical Affairs, Sumitomo Dainippon Pharma, Tokyo, Japan
| | - Dwight Dickinson
- Clinical and Translational Neuroscience Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | | | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore,Department of Psychosis, Institute of Mental Health, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Joseph Friedman
- Department of Psychiatry, Mount Sinai School of Medicine, New York, New York
| | - Laurent Boyer
- Aix-Marseille University, Public Health, Chronic Diseases and Quality of Life, Research Unit, Marseille, France
| | - Mei Han
- School of Medicine, University of Wollongong, Wollongong, Australia,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | | | - Christoph U. Correll
- Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York,Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, New York,Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, New York,Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany
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8
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Smith SN, Liebrecht CM, Bauer MS, Kilbourne AM. Comparative effectiveness of external vs blended facilitation on collaborative care model implementation in slow-implementer community practices. Health Serv Res 2020; 55:954-965. [PMID: 33125166 DOI: 10.1111/1475-6773.13583] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To evaluate the comparative effectiveness of external facilitation (EF) vs external + internal facilitation (EF/IF), on uptake of a collaborative chronic care model (CCM) in community practices that were slower to implement under low-level implementation support. STUDY SETTING Primary data were collected from 43 community practices in Michigan and Colorado at baseline and for 12 months following randomization. STUDY DESIGN Sites that failed to meet a pre-established implementation benchmark after six months of low-level implementation support were randomized to add either EF or EF/IF support for up to 12 months. Key outcomes were change in number of patients receiving the CCM and number of patients receiving a clinically significant dose of the CCM. Moderators' analyses further examined whether comparative effectiveness was dependent on prerandomization adoption, number of providers trained or practice size. Facilitation log data were used for exploratory follow-up analyses. DATA COLLECTION Sites reported monthly on number of patients that had received the CCM. Facilitation logs were completed by study EF and site IFs and shared with the study team. PRINCIPAL FINDINGS N = 21 sites were randomized to EF and 22 to EF/IF. Overall, EF/IF practices saw more uptake than EF sites after 12 months (ΔEF/IF-EF = 4.4 patients, 95% CI = 1.87-6.87). Moderators' analyses, however, revealed that it was only sites with no prerandomization uptake of the CCM (nonadopter sites) that saw significantly more benefit from EF/IF (ΔEF/IF-EF = 9.2 patients, 95% CI: 5.72, 12.63). For sites with prerandomization uptake (adopter sites), EF/IF offered no additional benefit (ΔEF/IF-EF = -0.9; 95% CI: -4.40, 2.60). Number of providers trained and practice size were not significant moderators. CONCLUSIONS Although stepping up to the more intensive EF/IF did outperform EF overall, its benefit was limited to sites that failed to deliver any CCM under the low-level strategy. Once one or more providers were delivering the CCM, additional on-site personnel did not appear to add value to the implementation effort.
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Affiliation(s)
- Shawna N Smith
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Celeste M Liebrecht
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mark S Bauer
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Amy M Kilbourne
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Quality Enhancement Research Initiative, U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
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Vigod SN, Fung K, Amartey A, Bartsch E, Felemban R, Saunders N, Guttmann A, Chiu M, Barker LC, Kurdyak P, Brown HK. Maternal schizophrenia and adverse birth outcomes: what mediates the risk? Soc Psychiatry Psychiatr Epidemiol 2020; 55:561-570. [PMID: 31811316 DOI: 10.1007/s00127-019-01814-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 11/28/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Maternal schizophrenia is associated with adverse birth outcomes, but the reasons for this remain unclear. In a population-based cohort of infants born to women with schizophrenia, we determined the occurrence of key perinatal outcomes and explored whether factors identifiable in our datasets explained any elevated risk. METHODS Using population-level health administrative data linked to clinical birth-registry data in Ontario, Canada (2006-2011), we examined the relative risk (RR) of preterm birth (< 37 weeks), small for gestational age (SGA), and Apgar scores < 8 in infants of women with schizophrenia (n = 4279) versus infants of unaffected women (n = 286,147). Generalized estimating equations determined whether reproductive history, maternal health conditions, pregnancy exposures, and complications explained elevated RRs. RESULTS Among infants of women with schizophrenia, risk was higher for prematurity (11.4% vs. 6.9%, aRR 1.64, 95% CI 1.51-1.79), SGA (3.5% vs. 2.5%, aRR 1.40, 95% CI 1.20-1.64), and Apgar score < 8 at 1 (19.0% vs. 12.8%, aRR 1.49, 95% CI 1.40-1.59) and 5 min (5.6% vs. 3.0%, aRR 1.90, 95% CI 1.68-2.16). Smoking, fourfold more common among women with schizophrenia, was the variable that explained the greatest proportion of the elevated aRR for prematurity (9.9%), SGA (28.7%), and Apgar < 8 at 1 and 5 min (9.8%, 5.6%). Illicit substance use, certain reproductive history variables, and pregnancy complications also contributed to the elevated aRR for preterm birth. CONCLUSIONS Elevated risks of preterm birth, SGA, and low Apgar scores in infants of women with schizophrenia are partly explained by potentially modifiable factors such as smoking and illicit drug use, suggesting opportunities for targeted intervention.
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Affiliation(s)
- Simone N Vigod
- Women's College Hospital and Research Institute, 76 Grenville Street Rm. 6336, Toronto, ON, M5S 1B2, Canada. .,University of Toronto, Toronto, ON, Canada. .,ICES, Toronto, ON, Canada.
| | | | | | | | | | - Natasha Saunders
- University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Hospital for Sick Children, Toronto, ON, Canada
| | - Astrid Guttmann
- University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Hospital for Sick Children, Toronto, ON, Canada
| | - Maria Chiu
- University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Lucy C Barker
- Women's College Hospital and Research Institute, 76 Grenville Street Rm. 6336, Toronto, ON, M5S 1B2, Canada.,University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Paul Kurdyak
- University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Hilary K Brown
- Women's College Hospital and Research Institute, 76 Grenville Street Rm. 6336, Toronto, ON, M5S 1B2, Canada.,University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
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10
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Pfeiffer PN, Pope B, Houck M, Benn-Burton W, Zivin K, Ganoczy D, Kim HM, Walters H, Emerson L, Nelson CB, Abraham KM, Valenstein M. Effectiveness of Peer-Supported Computer-Based CBT for Depression Among Veterans in Primary Care. Psychiatr Serv 2020; 71:256-262. [PMID: 31931686 DOI: 10.1176/appi.ps.201900283] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study tested whether computerized cognitive-behavioral therapy for depression supported by a peer specialist with lived experience of depression (PS-cCBT) improves mental health-related outcomes for primary care patients. METHODS In the U.S. Department of Veterans Affairs, primary care patients with a new diagnosis of depression (N=330) were randomly assigned to 3 months of PS-cCBT or a usual-care control condition. Linear mixed-effects models were used to assess differences in depression symptoms, general mental health status, quality of life, and mental health recovery measured at baseline and 3 and 6 months. RESULTS In adjusted analyses, participants who received PS-cCBT experienced 1.4 points' (95% confidence interval [CI]=0.3-2.5, p=0.01) greater improvement in depression symptoms on the Quick Inventory of Depression Symptomatology-Self Report at 3 months, compared with the control group, but no significant difference was noted at 6 months. PS-cCBT recipients also had 2.6 points' (95% CI=0.5-4.8, p=0.02) greater improvement in quality of life at 3 months on the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form and greater improvement in recovery on the Recovery Assessment Scale at 3 months (3.6 points; 95% CI=0.9-6.2, p=0.01) and 6 months (4.5 points; 95% CI=1.2-7.7, p=0.01). CONCLUSIONS PS-cCBT is an effective option for improving short-term depression symptoms and longer-term recovery among primary care patients newly diagnosed as having depression.
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Affiliation(s)
- Paul N Pfeiffer
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - Brooke Pope
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - Marc Houck
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - Wendy Benn-Burton
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - Kara Zivin
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - Dara Ganoczy
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - H Myra Kim
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - Heather Walters
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - Lauren Emerson
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - C Beau Nelson
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - Kristen M Abraham
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
| | - Marcia Valenstein
- U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Pfeiffer, Zivin, Ganoczy, Kim, Walters, Emerson, Nelson, Abraham, Valenstein); Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pfeiffer, Zivin, Walters, Emerson, Nelson, Valenstein); Battle Creek VA Medical Center, Battle Creek, Michigan (Pope, Houck); John D. Dingell VA Medical Center, Detroit (Benn-Burton); Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor (Kim); Department of Psychology, University of Detroit Mercy, Detroit (Abraham)
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11
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Schmit MK, Oller ML, Tapia‐Fuselier JL, Schmit EL. A Holistic Client Functioning Profile Comparison of People With Serious Mental Illness. JOURNAL OF COUNSELING AND DEVELOPMENT 2020. [DOI: 10.1002/jcad.12295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | - Marianna L. Oller
- Department of Counseling and Higher Education, University of North Texas
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12
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Miller CJ, Smith SN, Pugatch M. Experimental and quasi-experimental designs in implementation research. Psychiatry Res 2020; 283:112452. [PMID: 31255320 PMCID: PMC6923620 DOI: 10.1016/j.psychres.2019.06.027] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 01/22/2023]
Abstract
Implementation science is focused on maximizing the adoption, appropriate use, and sustainability of effective clinical practices in real world clinical settings. Many implementation science questions can be feasibly answered by fully experimental designs, typically in the form of randomized controlled trials (RCTs). Implementation-focused RCTs, however, usually differ from traditional efficacy- or effectiveness-oriented RCTs on key parameters. Other implementation science questions are more suited to quasi-experimental designs, which are intended to estimate the effect of an intervention in the absence of randomization. These designs include pre-post designs with a non-equivalent control group, interrupted time series (ITS), and stepped wedges, the last of which require all participants to receive the intervention, but in a staggered fashion. In this article we review the use of experimental designs in implementation science, including recent methodological advances for implementation studies. We also review the use of quasi-experimental designs in implementation science, and discuss the strengths and weaknesses of these approaches. This article is therefore meant to be a practical guide for researchers who are interested in selecting the most appropriate study design to answer relevant implementation science questions, and thereby increase the rate at which effective clinical practices are adopted, spread, and sustained.
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Affiliation(s)
- Christopher J. Miller
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), United States Department of Veterans Affairs, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Corresponding Author: ; (p) 857-364-5688 (fax) 857-364-6140
| | - Shawna N. Smith
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA,Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Marianne Pugatch
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), United States Department of Veterans Affairs, Boston, MA, USA
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13
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Smith SN, Almirall D, Prenovost K, Liebrecht C, Kyle J, Eisenberg D, Bauer MS, Kilbourne AM. Change in Patient Outcomes After Augmenting a Low-level Implementation Strategy in Community Practices That Are Slow to Adopt a Collaborative Chronic Care Model: A Cluster Randomized Implementation Trial. Med Care 2019; 57:503-511. [PMID: 31135692 PMCID: PMC6684247 DOI: 10.1097/mlr.0000000000001138] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Implementation strategies are essential for promoting the uptake of evidence-based practices and for patients to receive optimal care. Yet strategies differ substantially in their intensity and feasibility. Lower-intensity strategies (eg, training and technical support) are commonly used but may be insufficient for all clinics. Limited research has examined the comparative effectiveness of augmentations to low-level implementation strategies for nonresponding clinics. OBJECTIVES To compare 2 augmentation strategies for improving uptake of an evidence-based collaborative chronic care model (CCM) on 18-month outcomes for patients with depression at community-based clinics nonresponsive to lower-level implementation support. RESEARCH DESIGN Providers initially received support using a low-level implementation strategy, Replicating Effective Programs (REP). After 6 months, nonresponsive clinics were randomized to add either external facilitation (REP+EF) or external and internal facilitation (REP+EF/IF). MEASURES The primary outcome was patient 12-item short form survey (SF-12) mental health score at month 18. Secondary outcomes were patient health questionnaire (PHQ-9) depression score at month 18 and receipt of the CCM during months 6 through 18. RESULTS Twenty-seven clinics were nonresponsive after 6 months of REP. Thirteen clinics (N=77 patients) were randomized to REP+EF and 14 (N=92) to REP+EF/IF. At 18 months, patients in the REP+EF/IF arm had worse SF-12 [diff, 8.38; 95% confidence interval (CI), 3.59-13.18] and PHQ-9 scores (diff, 1.82; 95% CI, -0.14 to 3.79), and lower odds of CCM receipt (odds ratio, 0.67; 95% CI, 0.30-1.49) than REP+EF patients. CONCLUSIONS Patients at sites receiving the more intensive REP+EF/IF saw less improvement in mood symptoms at 18 months than those receiving REP+EF and were no more likely to receive the CCM. For community-based clinics, EF augmentation may be more feasible than EF/IF for implementing CCMs.
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Affiliation(s)
- Shawna N Smith
- Department of Psychiatry, University of Michigan Medical School
- Institute for Social Research
| | - Daniel Almirall
- Institute for Social Research
- Department of Statistics, University of Michigan
| | | | - Celeste Liebrecht
- Department of Psychiatry, University of Michigan Medical School
- Quality Enhancement Research Initiative (QUERI), US Department of Veterans Affairs
| | - Julia Kyle
- Department of Psychiatry, University of Michigan Medical School
| | - Daniel Eisenberg
- Department of Health Management and Policy, School of Public Health, University of Michigan Ann Arbor, MI
| | - Mark S Bauer
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research, US Department of Veterans Affairs, Boston Healthcare System and Harvard Medical School, Boston, MA
| | - Amy M Kilbourne
- Department of Psychiatry, University of Michigan Medical School
- Quality Enhancement Research Initiative (QUERI), US Department of Veterans Affairs
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14
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Smith SN, Almirall D, Prenovost K, Goodrich DE, Abraham KM, Liebrecht C, Kilbourne AM. Organizational culture and climate as moderators of enhanced outreach for persons with serious mental illness: results from a cluster-randomized trial of adaptive implementation strategies. Implement Sci 2018; 13:93. [PMID: 29986765 PMCID: PMC6038326 DOI: 10.1186/s13012-018-0787-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/26/2018] [Indexed: 01/05/2023] Open
Abstract
Background Organizational culture and climate are considered key factors in implementation efforts but have not been examined as moderators of implementation strategy comparative effectiveness. We investigated organizational culture and climate as moderators of comparative effectiveness of two sequences of implementation strategies (Immediate vs. Delayed Enhanced Replicating Effective Programs [REP]) combining Standard REP and REP enhanced with facilitation on implementation of an outreach program for Veterans with serious mental illness lost to care at Veterans Health Administration (VA) facilities nationwide. Methods This study is a secondary analysis of the cluster-randomized Re-Engage implementation trial that assigned 3075 patients at 89 VA facilities to either the Immediate or Delayed Enhanced REP sequences. We hypothesized that sites with stronger entrepreneurial culture, task, or relational climate would benefit more from Enhanced REP than Standard REP. Veteran- and site-level data from the Re-Engage trial were combined with site-aggregated measures of entrepreneurial culture and task and relational climate from the 2012 VA All Employee Survey. Longitudinal mixed-effects logistic models examined whether the comparative effectiveness of the Immediate vs. Delayed Enhanced REP sequences were moderated by culture or climate measures at 6 and 12 months post-randomization. Three Veteran-level outcomes related to the engagement with the VA system were assessed: updated documentation, attempted contact by coordinator, and completed contact. Results For updated documentation and attempted contact, Veterans at sites with higher entrepreneurial culture and task climate scores benefitted more from Enhanced REP compared to Standard REP than Veterans at sites with lower scores. Few culture or climate moderation effects were detected for the comparative effectiveness of the full sequences of implementation strategies. Conclusions Implementation strategy effectiveness is highly intertwined with contextual factors, and implementation practitioners may use knowledge of contextual moderation to tailor strategy deployment. We found that facilitation strategies provided with Enhanced REP were more effective at improving uptake of a mental health outreach program at sites with stronger entrepreneurial culture and task climate; Veterans at sites with lower levels of these measures saw more similar improvement under Standard and Enhanced REP. Within resource-constrained systems, practitioners may choose to target more intensive implementation strategies to sites that will most benefit from them. Trial registration ISRCTN: ISRCTN21059161. Date registered: April 11, 2013. Electronic supplementary material The online version of this article (10.1186/s13012-018-0787-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shawna N Smith
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA. .,Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Daniel Almirall
- Institute for Social Research and Department of Statistics, University of Michigan, Ann Arbor, MI, USA
| | - Katherine Prenovost
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Kristen M Abraham
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Psychology, University of Detroit Mercy, Detroit, MI, USA
| | - Celeste Liebrecht
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Amy M Kilbourne
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Health Services Research and Development, Veterans Health Administration, US Department of Veterans, Washington DC, USA
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15
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Rodgers M, Dalton J, Harden M, Street A, Parker G, Eastwood A. Integrated Care to Address the Physical Health Needs of People with Severe Mental Illness: A Mapping Review of the Recent Evidence on Barriers, Facilitators and Evaluations. Int J Integr Care 2018; 18:9. [PMID: 29588643 PMCID: PMC5854169 DOI: 10.5334/ijic.2605] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 11/28/2017] [Indexed: 11/20/2022] Open
Abstract
People with mental health conditions have a lower life expectancy and poorer physical health outcomes than the general population. Evidence suggests this is due to a combination of clinical risk factors, socioeconomic factors, and health system factors, notably a lack of integration when care is required across service settings. Several recent reports have looked at ways to better integrate physical and mental health care for people with severe mental illness (SMI). We built on these by conducting a mapping review that looked for the most recent evidence and service models in this area. This involved searching the published literature and speaking to people involved in providing or using current services. Few of the identified service models were described adequately and fewer still were evaluated, raising questions about the replicability and generalisability of much of the existing evidence. However, some common themes did emerge. Efforts to improve the physical health care of people with SMI should empower staff and service users and help remove everyday barriers to delivering and accessing integrated care. In particular, there is a need for improved communication among professionals and better information technology to support them, greater clarity about who is responsible and accountable for physical health care, and greater awareness of the effects of stigmatisation on the wider culture and environment in which services are delivered.
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Affiliation(s)
- Mark Rodgers
- Centre for Reviews and Dissemination, University of York, Heslington, YO10 5DD, York, UK
| | - Jane Dalton
- Centre for Reviews and Dissemination, University of York, Heslington, YO10 5DD, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, Heslington, YO10 5DD, York, UK
| | - Andrew Street
- Department of Health Policy, London School of Economics and Political Science, WC2A 2AE, London, GB
| | - Gillian Parker
- Social Policy Research Unit, University of York, Heslington, YO10 5DD, York, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination, University of York, Heslington, YO10 5DD, York, UK
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16
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Naslund JA, Aschbrenner KA, Kim SJ, McHugo GJ, Unützer J, Bartels SJ, Marsch LA. Health behavior models for informing digital technology interventions for individuals with mental illness. Psychiatr Rehabil J 2017; 40:325-335. [PMID: 28182469 PMCID: PMC5550360 DOI: 10.1037/prj0000246] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Theoretical models offer valuable insights for designing effective and sustainable behavioral health interventions, yet the application of theory for informing digital technology interventions for people with mental illness has received limited attention. We offer a perspective on the importance of applying behavior theories and models to developing digital technology interventions for addressing mental and physical health concerns among people with mental illness. METHOD In this commentary, we summarize prominent theories of human behavior, highlight key theoretical constructs, and identify opportunities to inform digital health interventions for people with mental illness. We consider limitations with existing theories and models, and examine recent theoretical advances that can specifically guide development of digital technology interventions. RESULTS Established behavioral frameworks including health belief model, theory of planned behavior, transtheoretical model, and social cognitive theory consist of important and overlapping constructs that can inform digital health interventions for people with mental illness. As digital technologies continue to evolve and enable longitudinal data collection, real-time behavior monitoring, and adaptive features tailored to users' changing needs over time, there are new opportunities to broaden our understanding of health behaviors and mechanisms of behavior change. Recent advances include dynamic models of behavior, persuasive system design, the behavioral intervention technology model, and behavioral models for just-in-time adaptive interventions. CONCLUSION AND IMPLICATIONS FOR PRACTICE Behavior theories offer advantages for guiding use of digital technologies. Future researchers must explore how theoretical models can effectively advance efforts to develop, evaluate, and disseminate digital health interventions targeting individuals with mental illness. (PsycINFO Database Record
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Affiliation(s)
- John A. Naslund
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States
- The Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - Kelly A. Aschbrenner
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Sunny Jung Kim
- The Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - Gregory J. McHugo
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Stephen J. Bartels
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Lisa A. Marsch
- The Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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17
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DiNapoli EA, Bramoweth AD, Whiteman KL, Hanusa BH, Kasckow J. Mood Disorders in Middle-Aged and Older Veterans With Multimorbidity. J Aging Health 2017; 29:657-668. [PMID: 27020938 PMCID: PMC5435543 DOI: 10.1177/0898264316641082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study identified the prevalence of and relationship between mood disorders and multimorbidity in middle-aged and older veterans. METHOD Cross-sectional data were obtained from veterans who received primary care services at VA Pittsburgh Healthcare System from January 2007 to December 2011 ( n = 34,786). RESULTS Most veterans had three or more organ systems with chronic disease (95.3%), of which 4.1% had a depressive disorder, 2.5% had an anxiety disorder, and 0.7% had co-occurring depression and anxiety. The odds of having a mood disorder increased with each additional organ system with chronic disease, with odds being the greatest in those with 10 to 13 organ systems with chronic disease. Younger age, female gender, non-married marital status, and having a service connected disability were also significant predictors of having a mood disorder. DISCUSSION These findings suggest a need to integrate mental health assessment and treatment in chronic health care management for veterans.
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Affiliation(s)
- Elizabeth A. DiNapoli
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam D. Bramoweth
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Karen L. Whiteman
- Dartmouth Centers for Health and Aging, Lebanon, NH, USA
- The Dartmouth Institute, Lebanon, NH, USA
| | - Barbara H. Hanusa
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - John Kasckow
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Abstract
Policy is a powerful motivator of clinical change, but implementation success can depend on organizational characteristics. This article used validated measures of organizational resources, culture, and climate to predict uptake of a nationwide Veteran's Health Administration (VA) policy aimed at implementing Re-Engage, a brief care management program that reestablishes contact with veterans with serious mental illness lost to care. Patient care databases were used to identify 2738 veterans lost to care. Local recovery coordinators (LRCs) were to update disposition for 2738 veterans at 158 VA facilities and, as appropriate, facilitate a return to care. Multivariable regression was used to assess organizational culture and climate as predictors of early policy compliance (via LRC presence) and uptake at 6 months. Higher composite climate and culture scores were associated with higher odds of having a designated LRC but were not predictive of higher uptake. Sites with LRCs had significantly higher rates of updated documentation than sites without LRCs.
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Kilbourne AM, Barbaresso MM, Lai Z, Nord KM, Bramlet M, Goodrich DE, Post EP, Almirall D, Bauer MS. Improving Physical Health in Patients With Chronic Mental Disorders: Twelve-Month Results From a Randomized Controlled Collaborative Care Trial. J Clin Psychiatry 2017; 78:129-137. [PMID: 27780336 PMCID: PMC5272777 DOI: 10.4088/jcp.15m10301] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/09/2015] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Persons with chronic mental disorders are disproportionately burdened with physical health conditions. We determined whether Life Goals Collaborative Care compared to usual care improves physical health in patients with mental disorders within 12 months. METHODS This single-blind randomized controlled effectiveness study of a collaborative care model was conducted at a midwestern Veterans Affairs urban outpatient mental health clinic. Patients (N = 293 out of 474 eligible approached) with an ICD-9-CM diagnosis of schizophrenia, bipolar disorder, or major depressive disorder and at least 1 cardiovascular disease risk factor provided informed consent and were randomized (February 24, 2010, to April 29, 2015) to Life Goals (n = 146) or usual care (n = 147). A total of 287 completed baseline assessments, and 245 completed 12-month follow-up assessments. Life Goals included 5 weekly sessions that provided semistructured guidance on managing physical and mental health symptoms through healthy behavior changes, augmented by ongoing care coordination. The primary outcome was change in physical health-related quality of life score (Veterans RAND 12-item Short Form Health Survey [VR-12] physical health component score). Secondary outcomes included control of cardiovascular risk factors from baseline to 12 months (blood pressure, lipids, weight), mental health-related quality of life, and mental health symptoms. RESULTS Among patients completing baseline and 12-month outcomes assessments (N = 245), the mean age was 55.3 years (SD = 10.8; range, 25-78 years), and 15.4% were female. Intent-to-treat analysis revealed that compared to those in usual care, patients randomized to Life Goals had slightly increased VR-12 physical health scores (coefficient = 3.21; P = .01). CONCLUSIONS Patients with chronic mental disorders and cardiovascular disease risk who received Life Goals had improved physical health-related quality of life. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT01487668 and NCT01244854.
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Affiliation(s)
- Amy M. Kilbourne
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA,Author for correspondence: Amy M. Kilbourne, PhD, MPH, VA Center for Clinical Management Research, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI, 48105. Voice: 734-845-3452; fax: 734-222-7503,
| | | | - Zongshan Lai
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kristina M. Nord
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - David E. Goodrich
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Edward P. Post
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel Almirall
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Mark S. Bauer
- VA Center for Healthcare Organization and Implementation Research, Boston, MA, USA, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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DiNapoli EA, Cinna C, Whiteman KL, Fox L, Appelt CJ, Kasckow J. Mental health treatment preferences and challenges of living with multimorbidity from the veteran perspective. Int J Geriatr Psychiatry 2016; 31:1097-104. [PMID: 27442187 PMCID: PMC5839102 DOI: 10.1002/gps.4550] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To explore middle-aged and older veterans' current disease-management practices, mental health treatment preferences, and challenges of living with multiple chronic health conditions (i.e., multimorbidity). METHODS Semi-structured qualitative interviews and self-report measures were collected from 28 middle-aged and older (50 years of age or older) veterans with multimorbidity. RESULTS Our sample of veterans with multimorbidity was, on average, mildly depressed and anxious with elevated stress and disability. Veterans acknowledged the interaction of physical and emotional symptoms, which caused greater difficulty with health care management and daily functioning. Veterans had many concerns regarding their physical and emotional health conditions, such as continued disease progression and the addition of other emotional and physical health complications. Veterans also identified specific self-care approaches for disease management (e.g., medication, healthy lifestyle practices, and psychological stress management techniques), as well as barriers to engaging in care (e.g., money, transportation, and stigma). Participants preferred a combination of medication, psychotherapy, and healthy lifestyle practices for mental health treatment. The majority of participants (88.5%) agreed that these mental health treatments would be beneficial to integrate into disease management for older veterans with multimorbidity. Lastly, veterans provided an array of recommendations for improving Veteran's Administration services and reducing mental health stigma. CONCLUSIONS These findings provide support for patient-centered approaches and integrated mental and physical health self-management in the Veteran's Administration for middle-aged and older veterans with multiple chronic conditions. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Elizabeth A DiNapoli
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Christopher Cinna
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Graduate Center for Social and Public Policy, Duquesne University, Pittsburgh, PA, USA
| | - Karen L Whiteman
- Dartmouth Centers for Health and Aging, Lebanon, NH, USA
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Pittsburgh, PA, USA
| | - Lauren Fox
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Cathleen J Appelt
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Graduate Center for Social and Public Policy, Duquesne University, Pittsburgh, PA, USA
- Department of Sociology, Duquesne University, Pittsburgh, PA, USA
| | - John Kasckow
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- MIRECC and Behavioral Health, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- VA Pittsburgh Center for Health and Equity Promotion, Pittsburgh, PA, USA
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van der Lee A, de Haan L, Beekman A. Schizophrenia in the Netherlands: Continuity of Care with Better Quality of Care for Less Medical Costs. PLoS One 2016; 11:e0157150. [PMID: 27275609 PMCID: PMC4898758 DOI: 10.1371/journal.pone.0157150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/25/2016] [Indexed: 01/31/2023] Open
Abstract
Background Patients with schizophrenia need continuous elective medical care which includes psychiatric treatment, antipsychotic medication and somatic health care. The objective of this study is to assess whether continuous elective psychiatric is associated with less health care costs due to less inpatient treatment. Methods Data concerning antipsychotic medication and psychiatric and somatic health care of patients with schizophrenia in the claims data of Agis Health Insurance were collected over 2008–2011 in the Netherlands. Included were 7,392 patients under 70 years of age with schizophrenia in 2008, insured during the whole period. We assessed the relationship between continuous elective psychiatric care and the outcome measures: acute treatment events, psychiatric hospitalization, somatic care and health care costs. Results Continuous elective psychiatric care was accessed by 73% of the patients during the entire three year follow-up period. These patients received mostly outpatient care and accessed more somatic care, at a total cost of €36,485 in three years, than those without continuous care. In the groups accessing fewer or no years of elective care 34%-68% had inpatient care and acute treatment events, while accessing less somatic care at average total costs of medical care from €33,284 to €64,509. Conclusions Continuous elective mental and somatic care for 73% of the patients with schizophrenia showed better quality of care at lower costs. Providing continuous elective care to the remaining patients may improve health while reducing acute illness episodes.
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Affiliation(s)
- Arnold van der Lee
- Kenniscentrum, Zilveren Kruis Achmea, Leusden, The Netherlands
- Department of Psychiatry, VUmc University Medical Center and GGZIngeest, Amsterdam, The Netherlands
- * E-mail:
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Centre, UvA, Amsterdam, The Netherlands
| | - Aartjan Beekman
- Department of Psychiatry, VUmc University Medical Center and GGZIngeest, Amsterdam, The Netherlands
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Rodgers M, Dalton J, Harden M, Street A, Parker G, Eastwood A. Integrated care to address the physical health needs of people with severe mental illness: a rapid review. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BackgroundPeople with mental health conditions have a lower life expectancy and poorer physical health outcomes than the general population. Evidence suggests that this discrepancy is driven by a combination of clinical risk factors, socioeconomic factors and health system factors.Objective(s)To explore current service provision and map the recent evidence on models of integrated care addressing the physical health needs of people with severe mental illness (SMI) primarily within the mental health service setting. The research was designed as a rapid review of published evidence from 2013–15, including an update of a comprehensive 2013 review, together with further grey literature and insights from an expert advisory group.SynthesisWe conducted a narrative synthesis, using a guiding framework based on nine previously identified factors considered to be facilitators of good integrated care for people with mental health problems, supplemented by additional issues emerging from the evidence. Descriptive data were used to identify existing models, perceived facilitators and barriers to their implementation, and any areas for further research.Findings and discussionThe synthesis incorporated 45 publications describing 36 separate approaches to integrated care, along with further information from the advisory group. Most service models were multicomponent programmes incorporating two or more of the nine factors: (1) information sharing systems; (2) shared protocols; (3) joint funding/commissioning; (4) colocated services; (5) multidisciplinary teams; (6) liaison services; (7) navigators; (8) research; and (9) reduction of stigma. Few of the identified examples were described in detail and fewer still were evaluated, raising questions about the replicability and generalisability of much of the existing evidence. However, some common themes did emerge from the evidence. Efforts to improve the physical health care of people with SMI should empower people (staff and service users) and help remove everyday barriers to delivering and accessing integrated care. In particular, there is a need for improved communication between professionals and better information technology to support them, greater clarity about who is responsible and accountable for physical health care, and awareness of the effects of stigmatisation on the wider culture and environment in which services are delivered.Limitations and future workThe literature identified in the rapid review was limited in volume and often lacked the depth of description necessary to acquire new insights. All members of our advisory group were based in England, so this report has limited information on the NHS contexts specific to Scotland, Wales and Northern Ireland. A conventional systematic review of this topic would not appear to be appropriate in the immediate future, although a more interpretivist approach to exploring this literature might be feasible. Wherever possible, future evaluations should involve service users and be clear about which outcomes, facilitators and barriers are likely to be context-specific and which might be generalisable.FundingThe research reported here was commissioned and funded by the Health Services and Delivery Research programme as part of a series of evidence syntheses under project number 13/05/11. For more information visitwww.nets.nihr.ac.uk/projects/hsdr/130511.
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Affiliation(s)
- Mark Rodgers
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Jane Dalton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Andrew Street
- Centre for Health Economics, University of York, York, UK
| | - Gillian Parker
- Social Policy Research Unit, University of York, York, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination, University of York, York, UK
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Speyer H, Nørgaard HCB, Hjorthøj C, Madsen TA, Drivsholm S, Pisinger C, Gluud C, Mors O, Krogh J, Nordentoft M. Protocol for CHANGE: a randomized clinical trial assessing lifestyle coaching plus care coordination versus care coordination alone versus treatment as usual to reduce risks of cardiovascular disease in adults with schizophrenia and abdominal obesity. BMC Psychiatry 2015; 15:119. [PMID: 26001844 PMCID: PMC4460642 DOI: 10.1186/s12888-015-0465-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Life expectancy in patients with schizophrenia is reduced by 20 years for males and 15 years for females compared to the general population. About 60% of the excess mortality is due to physical illnesses, with cardiovascular disease being the single largest cause of death. METHODS/DESIGN The CHANGE trial is an investigator-initiated, independently funded, randomized, parallel-group, superiority, multi-centre trial with blinded outcome assessment. 450 patients aged 18 years or above, diagnosed with schizophrenia spectrum disorders and increased waist circumference, will be recruited and randomized 1:1:1 to 12-months interventions. We will compare the effects of 1) affiliation to the CHANGE team, offering a tailored, manual-based intervention targeting physical inactivity, unhealthy dietary habits, and smoking, and facilitating contact to their general practitioner to secure medical treatment of somatic comorbidity; versus 2) affiliation to a care coordinator who will secure guideline-concordant monitoring and treatment of somatic comorbidity by facilitating contact to their general practitioner; versus 3) treatment as usual to evaluate the potential add-on effects of lifestyle coaching plus care coordination or care coordination alone to treatment as usual. The primary outcome is the 10-year risks of cardiovascular disease assessed at 12 months after randomization. DISCUSSION The premature mortality observed in this vulnerable population has not formerly been addressed specifically by using composite surrogate outcomes for mortality. The CHANGE trial expands the evidence for interventions aiming to reduce the burden of metabolic disturbances with a view to increase life expectancy. Here, we present the trial design, describe the methodological concepts in detail, and discuss the rationale and challenges of the intermediate outcomes. TRIAL REGISTRATION Clinical Trials.gov NCT01585493 . Date of registration 27(th) of March 2012.
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Affiliation(s)
- Helene Speyer
- Mental Health Centre Copenhagen, Mental Health Services in the Capital Region, DK-2400, Copenhagen, Denmark.
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
| | | | - Carsten Hjorthøj
- Mental Health Centre Copenhagen, Mental Health Services in the Capital Region, DK-2400, Copenhagen, Denmark.
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Thomas Axel Madsen
- Mental Health Centre Copenhagen, Mental Health Services in the Capital Region, DK-2400, Copenhagen, Denmark.
| | - Søren Drivsholm
- Research Department P, Aarhus University Hospital, Risskov, Denmark.
| | - Charlotta Pisinger
- Research Centre for Prevention and Health, Department 84-85, Glostrup University Hospital, Glostrup, Denmark.
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Ole Mors
- Research Department P, Aarhus University Hospital, Risskov, Denmark.
| | - Jesper Krogh
- Mental Health Centre Copenhagen, Mental Health Services in the Capital Region, DK-2400, Copenhagen, Denmark.
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Mental Health Services in the Capital Region, DK-2400, Copenhagen, Denmark.
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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von Esenwein SA, Druss BG. Using electronic health records to improve the physical healthcare of people with serious mental illnesses: a view from the front lines. Int Rev Psychiatry 2014; 26:629-37. [PMID: 25553780 DOI: 10.3109/09540261.2014.987221] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Individuals with serious mental illnesses (SMI) treated in the public mental health sector die decades younger than the general population. Poor quality and fragmentation of care are risk factors underlying the poor health of this population. Integrated electronic health records (EHR) can play a vital role in efforts to improve quality and outcomes of care in patients with SMI. The objective of this paper is to describe the current state of efforts to integrate and improve the mental and physical care of individuals with SMI in the public sector, with an emphasis on the use of electronic health records (EHR). While a range of encouraging initiatives exists throughout the country, technological and medico-legal challenges are providing significant barriers for the successful integration of care and EHRs for many partnering organizations. Furthermore, there is a lack of rigorous research studying the effectiveness and sustainability of these programmes. Recommendations are made for the alleviation of policy barriers and future areas of inquiry.
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Affiliation(s)
- Silke A von Esenwein
- Center for Behavioral Health Policy Studies, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
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