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Blanchard BE, Bluett EJ, Johnson M, Zimberoff A, Fortney JC. Trauma exposure correlates among patients receiving care in federally qualified health centers. J Trauma Stress 2024. [PMID: 38743483 DOI: 10.1002/jts.23055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 05/16/2024]
Abstract
Over 80% of adults in the general population experience trauma. Rates of patients with posttraumatic stress disorder (PTSD) are high in primary care settings and are likely to be even higher in federally qualified health centers (FQHCs). Trauma exposure has been linked to psychiatric symptoms and physical health comorbidities, though little research has focused on FQHC patients. This study addresses this by examining clinical and sociodemographic correlates of specific trauma types among FQHC patients. We analyzed secondary data from patients who screened positive for PTSD and were receiving health care in FQHCs in a clinical trial (N = 978). Individuals who did versus did not experience a specific trauma type were compared using between-group tests. In the sample, 91.3% of participants were exposed to a DSM-5 Criterion A traumatic event, with 79.6% experiencing two or more trauma types. Witnessing a life-threatening event (57.3%) and physical assault (55.7%) were the most common traumatic experiences. Physical health comorbidities and worse physical health functioning were associated with a higher likelihood of exposure to all trauma types, with effect sizes larger than PTSD, ds = 0.78-1.35. Depressive and anxiety symptoms were also associated with a higher likelihood of experiencing nearly all trauma types to a lesser magnitude. People of color, OR = 2.45, and individuals experiencing financial inequities, OR = 1.73, had higher odds of experiencing serious accidents as well as other trauma types. The findings highlight the need for trauma-informed care, including routine trauma and PTSD screening, for FQHC patients.
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Affiliation(s)
- Brittany E Blanchard
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ellen J Bluett
- Family Medicine Residency of Western Montana, University of Montana, Missoula, Montana, USA
| | - Morgan Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
- Veterans Affairs (VA) Health Systems Research Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
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Blanchard BE, Johnson M, Campbell SB, Reed DE, Chen S, Heagerty PJ, Marx BP, Kaysen D, Fortney JC. Minimal important difference metrics and test-retest reliability of the PTSD Checklist for DSM-5 with a primary care sample. J Trauma Stress 2023; 36:1102-1114. [PMID: 37845820 PMCID: PMC10754254 DOI: 10.1002/jts.22975] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 10/18/2023]
Abstract
The PTSD Checklist for DSM-5 (PCL-5) is a measure of posttraumatic stress disorder (PTSD) symptom severity that is widely used for clinical and research purposes. Although previous work has examined metrics of minimal important difference (MID) of the PCL-5 in veteran samples, no work has identified PCL-5 MID metrics among adults in primary care in the United States. In this secondary analysis, data were evaluated from primary care patients (N = 971) who screened positive for PTSD and participated in a large clinical trial in federally qualified health centers in three U.S. states. Participants primarily self-identified as women (70.2%) and White (70.3%). We calculated test-retest reliability using clinic registry data and multiple distribution- and anchor-based metrics of MID using baseline and follow-up survey data. Test-retest reliability (Pearson's r, Spearman's ρ, intraclass correlation coefficient) ranged from adequate to excellent (.79-.94), with the shortest time lag demonstrating the highest reliability estimate. The MID for the PCL-5 was estimated using multiple approaches. Distribution-based approaches indicated an MID range of 8.5-12.5, and anchor-based approaches indicated an MID range of 9.8-11.7. Taken together, the MID metrics indicate that PCL-5 change scores of 9-12 likely reflect real change in PTSD symptoms and indicate at least an MID for patients, whereas PCL-5 change scores of 5 or less likely are not reliable. These findings can help inform clinicians using the PCL-5 in similar populations to track patient responses to treatment and help researchers interpret PCL-5 score changes in clinical trials.
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Affiliation(s)
- Brittany E. Blanchard
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Morgan Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Sarah B. Campbell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
- VA Health Services Research and Development Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - David E. Reed
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, USA
| | - Shiyu Chen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Patrick J. Heagerty
- Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington, USA
| | - Brian P. Marx
- VA Boston Healthcare System, National Center for PTSD, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - John C. Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
- VA Health Services Research and Development Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
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Cerimele JM, Blanchard BE, Johnson M, Russo J, Bauer AM, Veith RC, Unützer J, Fortney JC. Effectiveness of Collaborative Care and Colocated Specialty Care for Bipolar Disorder in Primary Care: A Secondary Analysis of a Randomized Clinical Trial. J Acad Consult Liaison Psychiatry 2023; 64:349-356. [PMID: 36764483 PMCID: PMC10688610 DOI: 10.1016/j.jaclp.2023.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Individuals with bipolar disorder commonly present for treatment in primary care settings. Collaborative care and colocated specialty care models can improve quality of care and outcomes, though it is unknown which model is more effective. OBJECTIVE To compare 12-month treatment outcomes for primary care patients with bipolar disorder randomized to treatment with collaborative care or colocated specialty care. METHODS We conducted a secondary analysis of 191 patients diagnosed with bipolar disorder treated for 12 months during a comparative effectiveness trial in 12 Federally Qualified Health Centers in three states. Characteristics and outcomes were assessed at enrollment and 12 months. The primary outcome was mental health quality of life scores (Veterans RAND 12-Item Health Survey Mental Health Component Summary), and secondary outcomes included depression and anxiety symptom scores, euthymic mood state, and recovery. T-tests and multiple linear and logistic regression models were used. RESULTS Among participants (mean age: 40 years; 73% women), the Veterans RAND 12-Item Health Survey Mental Health Component Summary increased in both arms over 12 months (baseline: collaborative care 21.99, SD 10.78; colocated specialty 24.15, SD 12.05; 12-month collaborative care 30.63, SD 13.33; colocated specialty 34.16, SD 12.65). The mean Mental Health Component Summary change did not differ by arm (collaborative care: MΔ = 9.09; colocated specialty: MΔ = 10.73; t = -0.67, P = 0.50). Secondary outcomes also improved at 12 months compared to baseline measured by the Hopkins Symptoms Checklist (MΔ = -0.75; SD = 0.85), Generalized Anxiety Disorder-7 (MΔ = -3.92; SD = 6.48), and Recovery Assessment Scale (MΔ = 0.37; SD = 0.65) and did not differ significantly by arm. The proportion of participants with euthymic mood state increased from 11% to 25% with no statistically significant difference by arm. CONCLUSIONS The effectiveness of collaborative care and that of colocated specialty care were similar. Both were associated with substantial improvements in mental health quality of life and symptom reduction.
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Affiliation(s)
- Joseph M Cerimele
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA.
| | - Brittany E Blanchard
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Morgan Johnson
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Joan Russo
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Amy M Bauer
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Richard C Veith
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Jürgen Unützer
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - John C Fortney
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA; Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA
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Hoeft TJ, Hall JD, Solberg LI, Takamine LH, Danna MN, Fortney JC, Shushan S, Cohen DJ. Clinician Experiences With Telepsychiatry Collaborative Care for Posttraumatic Stress Disorder and Bipolar Disorder. Psychiatr Serv 2022:appips202100595. [PMID: 36444528 DOI: 10.1176/appi.ps.202100595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) and bipolar disorder are common in primary care. Evidence supports collaborative care in primary care settings to treat depression and anxiety, and recent studies have evaluated its effectiveness in treating complex conditions such as PTSD and bipolar disorder. This study aimed to examine how primary care clinicians experience collaborative care for patients with these more complex psychiatric disorders. METHODS The authors conducted semistructured interviews with 22 primary care clinicians participating in a pragmatic trial that included telepsychiatry collaborative care (TCC) to treat patients with PTSD or bipolar disorder in rural or underserved areas. Analysis utilized a constant comparative method to identify recurring themes. RESULTS Clinicians reported that TCC improved their confidence in managing medications for patients with PTSD or bipolar disorder and supported their ongoing learning and skill development. Clinicians also reported improvements in patient engagement in care. Care managers were crucial to realizing these benefits by fostering communication within the clinical team while engaging patients through regular outreach. Clinicians valued TCC because it included and supported them in improving the care of patients' mental health conditions, which opened opportunities for clinicians to enhance care and address co-occurring general medical conditions. Overall, benefits of the TCC model outweighed its minimal burdens. CONCLUSIONS Clinicians found that TCC supported their care of patients with PTSD or bipolar disorder. This approach has the potential to extend the reach of specialty mental health care and to support primary care clinicians treating patients with these more complex psychiatric disorders.
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Affiliation(s)
- Theresa J Hoeft
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - Jennifer D Hall
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - Leif I Solberg
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - Linda H Takamine
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - Maria N Danna
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - Stephanie Shushan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - Deborah J Cohen
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
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Wu T, Hu J, Davydow D, Huang H, Spottswood M, Huang H. Demystifying borderline personality disorder in primary care. Front Med (Lausanne) 2022; 9:1024022. [PMID: 36405597 PMCID: PMC9668888 DOI: 10.3389/fmed.2022.1024022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
Borderline personality disorder (BPD) is a common mental health diagnosis observed in the primary care population and is associated with a variety of psychological and physical symptoms. BPD is a challenging disorder to recognize due to the limitations of accurate diagnosis and identification in primary care settings. It is also difficult to treat due to its complexity (e.g., interpersonal difficulties and patterns of unsafe behaviors, perceived stigma) and healthcare professionals often feel overwhelmed when treating this population. The aim of this article is to describe the impact of BPD in primary care, review current state of knowledge, and provide practical, evidence-based treatment approaches for these patients within this setting. Due to the lack of evidence-based pharmacological treatments, emphasis is placed on describing the framework for treatment, identifying psychotherapeutic opportunities, and managing responses to difficult clinical scenarios. Furthermore, we discuss BPD treatment as it relates to populations of special interest, including individuals facing societal discrimination and adolescents. Through this review, we aim to highlight gaps in current knowledge around managing BPD in primary care and provide direction for future study.
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Affiliation(s)
- Tina Wu
- Warren Alpert Medical School, Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
- *Correspondence: Tina Wu,
| | - Jennifer Hu
- Duke University Hospital, Durham, NC, United States
- Jennifer Hu,
| | | | - Heather Huang
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Margaret Spottswood
- Community Health Centers of Burlington, Burlington, VT, United States
- Department of Psychiatry, University of Vermont College of Medicine, Burlington, VT, United States
| | - Hsiang Huang
- Cambridge Health Alliance, Cambridge, MA, United States
- Harvard Medical School, Boston, MA, United States
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Severe J, Pfeiffer PN, Palm-Cruz K, Hoeft T, Sripada R, Hawrilenko M, Chen S, Fortney J. Clinical Predictors of Engagement in Teleintegrated Care and Telereferral Care for Complex Psychiatric Disorders in Primary Care: a Randomized Trial. J Gen Intern Med 2022; 37:3361-3367. [PMID: 35106719 PMCID: PMC9550945 DOI: 10.1007/s11606-021-07343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Telepsychiatry Collaborative Care (TCC) and Telepsychiatry/Telepsychology Enhanced Referral (TER) expand the reach of specialty mental health services to underserved populations. OBJECTIVE Assess clinical predictors of treatment engagement for complex psychiatric conditions in TCC-in which remote specialists consult with primary care teams via an onsite care manager who also provides brief psychotherapy-and TER, in which remote specialists provide direct telehealth treatment. DESIGN A randomized pragmatic trial from twenty-four primary care clinics without onsite psychiatrists or psychologists. PARTICIPANTS A total of 1,004 adult patients screened positive for posttraumatic stress disorder (PTSD)and/or bipolar disorder were randomized to receive TCC or TER for 1 year. MAIN MEASURES Psychotherapy engagement was measured by the number of sessions completed, and pharmacotherapy engagement by the medication adherence item from the Schizophrenia Care and Assessment Program Health Questionnaire (SCAP-HQ). KEY RESULTS Engagement in TCC psychotherapy visits was greater compared to TER. There was no association between the PTSD symptom severity and treatment engagement. The internal state scale (ISS) activation subscale, an indicator of mania, was associated with reduced odds of initiating psychotherapy (odds ratio [OR] = 0.70; 95% CI, 0.59 to 0.84) but not the number of sessions attended once psychotherapy started. The Drug Abuse Screening Test-10(DAST-10) score was associated with receipt of fewer psychotherapy sessions (incidence ratio rate [IRR] = 0.88; 95% CI, 0.81 to 0.95). The number of physical health comorbidities was associated with greater engagement in psychotherapy (IRR = 1.11, 95% CI, 1.03 to 1.19) and pharmacotherapy (OR = 1.54; 95% CI, 1.27 to 1.87). None of the findings varied by intervention group. CONCLUSIONS Both teleintegrated and telereferral care offer an opportunity to treat patients with complex psychiatric conditions. While there was no difference in clinical characteristics predicting engagement, onsite care managers engaged patients in more psychotherapy sessions than remote therapists. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02738944.
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Affiliation(s)
- Jennifer Severe
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA.
| | - Paul N Pfeiffer
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
- Department of Veterans Affairs, Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Katherine Palm-Cruz
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Theresa Hoeft
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Rebecca Sripada
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
- Department of Veterans Affairs, Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Matthew Hawrilenko
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Shiyu Chen
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - John Fortney
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
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Cerimele JM, Johnson M, Blanchard BE, Russo J, Unützer J, Fortney JC. Bipolar disorder in primary care: Medication treatment by co-located psychiatrists versus primary care clinicians supported by psychiatrists. Gen Hosp Psychiatry 2022; 78:108-110. [PMID: 35985201 PMCID: PMC10686540 DOI: 10.1016/j.genhosppsych.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare medication treatment of individuals with bipolar disorder in two primary care-based integrated care models. METHODS Participants were randomized to 12-months of treatment with direct care by co-located psychiatrists in primary care, or collaborative care (primary care clinicians supported by psychiatrists). Medication data at initial and last treatment visits were extracted from the clinical registry for 191 patients diagnosed with bipolar disorder. RESULTS Participants receiving no medication treatment decreased from 28% to 11% (direct co-located) (χ2 = 10.9, p < .001) and 39% to 17% (collaborative care; χ2 = 16.9, p < .001). Last visit medication prescriptions for antipsychotic medication (approximately one-half of participants) increased significantly compared to initial visit and did not differ between arms. Anticonvulsant mood-stabilizing medication (approximately one-third of participants in both arms) was higher than lithium prescription (approximately 6% of participants) at last visit. CONCLUSION Similar patterns of medication treatment were observed in participants with bipolar disorder receiving either direct care from psychiatrists, or medication treatment by primary care clinicians supported by psychiatrists.
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Affiliation(s)
- Joseph M Cerimele
- University of Washington School of Medicine, Department of Psychiatry & Behavioral Sciences, United States of America.
| | - Morgan Johnson
- University of Washington School of Medicine, Department of Psychiatry & Behavioral Sciences, United States of America
| | - Brittany E Blanchard
- University of Washington School of Medicine, Department of Psychiatry & Behavioral Sciences, United States of America
| | - Joan Russo
- University of Washington School of Medicine, Department of Psychiatry & Behavioral Sciences, United States of America
| | - Jürgen Unützer
- University of Washington School of Medicine, Department of Psychiatry & Behavioral Sciences, United States of America
| | - John C Fortney
- University of Washington School of Medicine, Department of Psychiatry & Behavioral Sciences, United States of America; Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, United States of America
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8
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Russell SE, Wrobel AL, Skvarc D, Kavanagh BE, Ashton MM, Dean OM, Berk M, Turner A. The Impact of Posttraumatic Stress Disorder on Pharmacologic Intervention Outcomes for Adults With Bipolar Disorder: A Systematic Review. Int J Neuropsychopharmacol 2022; 26:61-69. [PMID: 36037522 PMCID: PMC9850655 DOI: 10.1093/ijnp/pyac057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/05/2022] [Accepted: 08/25/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The prevalence of posttraumatic stress disorder (PTSD) co-occurring in people with bipolar disorder (BD) is high. People with BD and PTSD may experience different outcomes and quality of life after pharmacologic treatment than those with BD alone. This review systematically explores the impact of PTSD on pharmacologic treatment outcomes for adults with BD. METHODS We conducted a systematic search up to November 25, 2021, using MEDLINE Complete, Embase, American Psychological Association PsycInfo, and the Cochrane Central Register of Controlled Trials to identify randomized and nonrandomized studies of pharmacologic interventions for adults with BD that assessed for comorbid PTSD. We used the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool to assess the risk of bias. RESULTS The search identified 5093 articles, and we reviewed 62 full-text articles. Two articles met inclusion criteria (N = 438). One article was an observational study, and the other was a randomized comparative effectiveness trial. The observational study examined lithium response rates and found higher response rates in BD alone compared with BD plus PTSD over 4 years. The randomized trial reported more severe symptoms in the BD plus PTSD group than in those with BD alone following 6 months of quetiapine treatment. There was no significant difference in the lithium treatment group at follow-up. CONCLUSIONS Comorbid PTSD may affect quetiapine and lithium treatment response in those with BD. Because of the high risk of bias and low quality of evidence, however, these results are preliminary. Specific studies exploring comorbid BD and PTSD are required to inform pharmacotherapy selection and guidelines appropriately. (International Prospective Register of Systematic Reviews ID: CRD42020182540).
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Affiliation(s)
- Samantha E Russell
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Anna L Wrobel
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia,Orygen, Parkville, Victoria, Australia
| | - David Skvarc
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia,School of Psychology, Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia
| | - Bianca E Kavanagh
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Melanie M Ashton
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Olivia M Dean
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Michael Berk
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia,Orygen, Parkville, Victoria, Australia,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia,University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Alyna Turner
- Correspondence: Alyna Turner, PhD, Health Education and Research Building (HERB) Level 3, Barwon Health, P.O. Box 281 Geelong VIC 3220 Australia ()
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Shiner B, Gottlieb D, Rice K, Forehand JA, Snitkin M, Watts BV. Evaluating policies to improve access to mental health services in rural areas. J Rural Health 2022; 38:805-816. [PMID: 35538395 DOI: 10.1111/jrh.12674] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The United States Department of Veterans Affairs (VA) has gradually implemented policies to increase access to mental health care outside of VA medical centers. Most notably, this included requirements to offer mental health services at VA-administered community-based clinics in 2008 and increased access to VA-paid care in the community beginning in 2014. Our objective was to understand how mental health service use patterns changed for rural VA patients during this time. METHODS We developed a longitudinal cohort of all rural patients who used VA services between 2002 and 2019 (N = 3,345,862). We examined individual, health care, and contextual predictors of mental health service use as well as modalities of mental health service use during policy-relevant time periods using descriptive statistics. FINDINGS Access to mental health services increased with each policy change. The annual percentage of rural VA patients accessing mental health services increased from 11.4% in the earliest years (2002-2004) to 19.8% in the latest years (2017-2019). The most rapid period of increase followed a requirement for availability of mental health services at VA-administered community clinics. Increasing access to VA-paid care in the community had less effect. By the end of the evaluation, gaps remained in the delivery of care to elderly patients over the age of 75. CONCLUSIONS Rural patients use mental health services when they become available. Access was the highest with a combination of changes to both delivery modalities and payment methods. Continued, and perhaps different efforts are required to address a persistent disparity for older patients.
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Affiliation(s)
- Brian Shiner
- Behavioral Health Services, Veterans Affairs Medical Center, White River Junction, Vermont, USA.,Department of Psychiatry, Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Daniel Gottlieb
- Behavioral Health Services, Veterans Affairs Medical Center, White River Junction, Vermont, USA
| | - Korie Rice
- Behavioral Health Services, Veterans Affairs Medical Center, White River Junction, Vermont, USA
| | - Jenna A Forehand
- Behavioral Health Services, Veterans Affairs Medical Center, White River Junction, Vermont, USA
| | - Meghan Snitkin
- Behavioral Health Services, Veterans Affairs Medical Center, White River Junction, Vermont, USA.,Department of Psychiatry, Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Bradley V Watts
- Behavioral Health Services, Veterans Affairs Medical Center, White River Junction, Vermont, USA.,Department of Psychiatry, Geisel School of Medicine, Hanover, New Hampshire, USA.,Veterans Rural Health Resource Center, White River Junction, Vermont, USA
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10
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LaRocco-Cockburn A, Jakupcak M, Bauer AM, Bowen DJ, Bechtel J, Koconis N, Fortney JC. Care managers' experiences in a collaborative care program for the treatment of bipolar disorder and PTSD in underserved communities. Gen Hosp Psychiatry 2022; 76:16-24. [PMID: 35313202 DOI: 10.1016/j.genhosppsych.2022.03.004] [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: 09/12/2021] [Revised: 02/17/2022] [Accepted: 03/03/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To understand care managers' experiences treating primary care patients with bipolar disorder and PTSD in a telepsychiatry collaborative care (TCC) program, as part of a large pragmatic trial. METHODS We conducted individual qualitative interviews with 12 care managers to evaluate barriers and facilitators to implementation of a previously completed TCC intervention for patients with bipolar disorder and/or PTSD. We used directed and conventional content analysis and Consolidated Framework for Implementation Research (CFIR) constructs to organize care manager experiences. RESULTS Participants described clinical and medication management support from telepsychiatrists and satisfaction with the TCC model as facilitators of success for patients with bipolar disorder and PTSD in underserved communities. Participants also described onboarding of primary care providers and clinic leadership as keys to successful team-care and credited satisfaction with providing Behavioral Activation as essential to sustained delivery of the psychotherapy component of TCC. CONCLUSIONS Participants described high satisfaction with TCC for patients with bipolar disorder and PTSD. Challenges included lack of clinic leadership and PCP engagement. Early and ongoing promotion of integrated care and prioritizing telepsychiatry consultation with patients, behavioral health professionals and PCPs, may improve patient care, provide ongoing training and improve workforce satisfaction.
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Affiliation(s)
- Anna LaRocco-Cockburn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America; LaRocco Counseling, PLLC, 2366 Eastlake Ave E, Suite 234, Seattle, WA 98102, United States of America.
| | - Matthew Jakupcak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America; Lyra Health, 287 Lorton Ave, Burlingame, CA 94010, United States of America.
| | - Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America.
| | - Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, Box 357120, Seattle, WA, United States of America.
| | - Jared Bechtel
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America.
| | - Natalie Koconis
- University of Washington, Institute for Public Health Genetics, in association with the Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America.
| | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America; Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Values-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America.
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11
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Cerimele JM, Russo J, Bauer AM, Hawrilenko M, Pyne JM, Dalack GW, Kroenke K, Unützer J, Fortney JC. The Patient Mania Questionnaire (PMQ-9): a Brief Scale for Assessing and Monitoring Manic Symptoms. J Gen Intern Med 2022; 37:1680-1687. [PMID: 34145517 PMCID: PMC9130397 DOI: 10.1007/s11606-021-06947-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Measurement-based care is an effective clinical strategy underutilized for bipolar disorder partly due to lacking a widely adopted patient-reported manic symptom measure. OBJECTIVE To report development and psychometric properties of a brief patient-reported manic symptom measure. DESIGN Secondary analysis of data collected in a randomized effectiveness trial comparing two treatments for 1004 primary care patients screening positive for bipolar disorder and/or PTSD. PARTICIPANTS Two analytic samples included 114 participants with varied diagnoses and test-retest data, and 179 participants with psychiatrist-diagnosed bipolar disorder who had two or more assessments with the nine-item Patient Mania Questionnaire-9 [PMQ-9]). MAIN MEASURES Internal and test-retest reliability, concurrent validity, and sensitivity to change were assessed. Minimally important difference (MID) was estimated by standard error of measurement (SEM) and by standard deviation (SD) effect sizes. KEY RESULTS The PMQ-9 had high internal reliability (Cronbach's alpha = 0.88) and test-retest reliability (0.85). Concurrent validity correlation with manic symptom measures was high for the Internal State Scale-Activation Subscale (0.70; p<0.0001), and lower for the Altman Mania Rating Scale (0.26; p=0.007). Longitudinally, PMQ-9 was completed at 1511 clinical encounters in 179 patients with bipolar disorder. Mean PMQ-9 score at first and last encounters was 14.5 (SD 6.5) and 10.1 (SD 7.0), a 27% decrease in mean score during treatment, suggesting sensitivity to change. A point estimate of the MID was approximately 3 points (range of 2-4). CONCLUSIONS The PMQ-9 demonstrated excellent test-retest reliability, concurrent validity, internal consistency, and sensitivity to change and was widely used and acceptable to patients and clinicians in a pragmatic clinical trial. Combined with the Patient Health Questionnaire-9 (PHQ-9) measure of depressive symptoms this brief measure could inform measurement-based care for individuals with bipolar disorder in primary care and mental health care settings given its ease of administration and familiar self-report response format.
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Affiliation(s)
- Joseph M Cerimele
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Matt Hawrilenko
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Jeffrey M Pyne
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Gregory W Dalack
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Kurt Kroenke
- Center for Health Services and Outcomes Research, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
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12
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Sripada RK, Walters HM, Ganoczy D, Avallone KM, Cigrang JA, Rauch SAM. Feasibility and Acceptability of Prolonged Exposure in Primary Care (PE-PC) for Posttraumatic Stress Disorder in Federally Qualified Health Centers: A Pilot Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:722-734. [PMID: 35445362 PMCID: PMC9020756 DOI: 10.1007/s10488-022-01195-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 12/05/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder that affects 6% of U.S. adults, yet is treated in only 30% of affected individuals and even fewer low-income individuals. One third of the nation’s low-income individuals are treated in Federally Qualified Health Centers (FQHCs). Most of these facilities lack capacity to provide their patients with first-line, evidence-based treatments for PTSD such as Prolonged Exposure (PE). To address this problem, PE has been adapted for use in a primary care setting and demonstrated efficacy in a brief model for military service members (PE in Primary Care: PE-PC). The effectiveness of this treatment in civilian, low-resource settings such as FQHCs is unknown. This pilot study tested the feasibility and acceptability of PE-PC in 30 Michigan FQHC patients. High rates of therapy participation suggest that the intervention was feasible and acceptable. Semi-structured interview data from 10 patients and 5 FQHC providers indicated that the intervention was helpful and filled a critical need for effective PTSD treatment in the FQHC setting. Interviews also elucidated barriers such as transportation, provider training, and time commitment for patients and providers. These findings set the stage for a full-scale randomized controlled trial to test the effectiveness of PE-PC on PTSD symptoms in this low-resource, high-need setting. Trial registry ClinicalTrials.gov Identifier: NCT03711266. October 18, 2018.
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Affiliation(s)
- Rebecca K Sripada
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, USA. .,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Heather M Walters
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Dara Ganoczy
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, USA
| | | | | | - Sheila A M Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA.,Atlanta VA Medical Center, Atlanta, GA, USA
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13
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Bai Z, Li Y, Yang Y, Xie C, Zhu Z, Xu Y, Bai R. The Effectiveness of Plaza Dancing on Psychological Well-Being and Ill-Being: A Systematic Review and Meta-Analysis. Front Psychol 2022; 13:864327. [PMID: 35496162 PMCID: PMC9051395 DOI: 10.3389/fpsyg.2022.864327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/11/2022] [Indexed: 01/02/2023] Open
Abstract
Evidence suggests that participation in plaza dancing may affect mental health. This study for the first time quantified the relationships between plaza dancing and psychological well-being and ill-being. We systematically searched PubMed, Web of Science, CNKI, Wanfang, and VIP to identify relevant studies published from the databases since their inception to July 25, 2021. The standardized mean differences (SMDs) of pre-to-post intervention data were calculated in the meta-analysis. Subgroup and meta-regression analyses were performed to test the potential moderating effects of age, outcome classification, measurement instruments, district, publication year, total sample size, and the duration, frequency, and length of the square dance intervention. A total of 25 original articles met all the eligibility criteria and were included in the review, and 17 studies were included in the meta-analysis. The meta-analysis revealed that plaza dancing improved psychological well-being (pooled SMD = 0.76; 95% CI: 0.58, 0.95; I 2 = 86.9%) and reduced psychological ill-being (pooled SMD = -0.84; 95% CI: -1.00, -0.68; I 2 = 64.8%). The study participants' age and district did not seem to affect the effectiveness of the plaza dancing intervention. The duration and frequency of plaza dancing affected the association between square dance and psychological well-being (duration, β = -0.044; 95% CI: -0.085, -0.004; frequency, β = 0.122; 95% CI: 0.024, 0.221) and psychological ill-being (duration, β = -0.029; 95% CI: -0.040, -0.018; frequency, β = 0.154; 95% CI: 0.030, 0.278). Plaza dancing has a significant positive effect on psychological well-being and psychological ill-being, and the effects are moderated by intervention modality. Generalizing plaza dancing interventions to promote psychological well-being and prevent or treat psychological ill-being is needed. Systematic Review Registration [www.crd.york.ac.uk/prospero], identifier [CRD42021272016].
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Affiliation(s)
- Zhenggang Bai
- Evidence-Based Research Center of Social Science & Health, Nanjing University of Science & Technology School of Public Affairs, Nanjing, China
| | - Yixuan Li
- Gansu Province Center for Disease Control and Prevention, Lanzhou, China
| | - Yufan Yang
- Evidence-Based Research Center of Social Science & Health, Nanjing University of Science & Technology School of Public Affairs, Nanjing, China
| | - Chengdan Xie
- Evidence-Based Research Center of Social Science & Health, Nanjing University of Science & Technology School of Public Affairs, Nanjing, China
| | - Zhengyun Zhu
- Evidence-Based Research Center of Social Science & Health, Nanjing University of Science & Technology School of Public Affairs, Nanjing, China
| | - Yan Xu
- Evidence-Based Research Center of Social Science & Health, Nanjing University of Science & Technology School of Public Affairs, Nanjing, China
| | - Ruhai Bai
- Evidence-Based Research Center of Social Science & Health, Nanjing University of Science & Technology School of Public Affairs, Nanjing, China
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14
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Blanchard BE, Mata-Greve F, Johnson M, Fortney JC. Knowledge about Treatment (KaT) in Mental Health Services. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2022; 56:81-98. [PMID: 37378000 PMCID: PMC10292725 DOI: 10.1080/07481756.2022.2041439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study developed and psychometrically evaluated a brief measure of mental health treatment knowledge (N = 726). Scores from Knowledge about Treatment (KaT) demonstrated a unidimensional measure with good model fit, internal consistency reliability, convergent and predictive validity, test-retest reliability, and measurement invariance across gender, ethnicity, education, and poverty status.
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Affiliation(s)
- Brittany E. Blanchard
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Felicia Mata-Greve
- Department of Veterans Affairs, Mental Health Service Line, Puget Sound VA Healthcare System, Seattle, WA, USA
| | - Morgan Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - John C. Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Department of Veterans Affairs, Center of Innovation for Veteran-Centered and Value-Driven Care, Puget Sound VA Healthcare System, Seattle, WA, USA
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15
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Meredith LS, Wong E, Osilla KC, Sanders M, Tebeka MG, Han B, Williamson SL, Carton TW. Trauma-informed Collaborative Care for African American Primary Care Patients in Federally Qualified Health Centers: A Pilot Randomized Trial. Med Care 2022; 60:232-239. [PMID: 35157622 PMCID: PMC8867914 DOI: 10.1097/mlr.0000000000001681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND African Americans have nearly double the rate of posttraumatic stress disorder (PTSD) compared with other racial/ethnic groups. OBJECTIVE To understand whether trauma-informed collaborative care (TICC) is effective for improving PTSD among African Americans in New Orleans who receive their care in Federally Qualified Health Centers (FQHCs). DESIGN AND METHOD In this pilot randomized controlled trial, we assigned patients within a single site to either TICC or to enhanced usual care (EUC). We performed intent to treat analysis by nonparametric exact tests for small sample sizes. PARTICIPANTS We enrolled 42 patients from October 12, 2018, through July 2, 2019. Patients were eligible if they considered the clinic their usual source of care, had no obvious physical or cognitive obstacles that would prevent participation, were age 18 or over, self-identified as African American, and had a provisional diagnosis of PTSD. MEASURES Our primary outcome measures were PTSD measured as both a symptom score and a provisional diagnosis based on the PTSD Checklist for DSM-5 (PCL-5). KEY RESULTS Nine months following baseline, both PTSD symptom scores and provisional PTSD diagnosis rates decreased substantially more for patients in TICC than in EUC. The decreases were by 26 points in EUC and 36 points in TICC for symptoms (P=0.08) and 33% in EUC and 57% in TICC for diagnosis rates (P=0.27). We found no effects for mediator variables. CONCLUSIONS TICC shows promise for addressing PTSD in this population. A larger-scale trial is needed to fully assess the effectiveness of this approach in these settings.
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Affiliation(s)
- Lisa S. Meredith
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
- VA HSR&D Center for Healthcare Innovation, Implementation & Policy, 16111 Plummer St, North Hills, CA, USA
| | - Eunice Wong
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
| | | | - Margaret Sanders
- Louisiana Public Health Institute, 1515 Poydras Street, Suite 1200, New Orleans, LA, USA
| | | | - Bing Han
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
| | | | - Thomas W. Carton
- Louisiana Public Health Institute, 1515 Poydras Street, Suite 1200, New Orleans, LA, USA
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16
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Howland M, Chang D, Ratzliff A, Palm-Cruz K. C-L Case Conference: Chronic Psychosis Managed in Collaborative Care. J Acad Consult Liaison Psychiatry 2021; 63:189-197. [PMID: 34902599 DOI: 10.1016/j.jaclp.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Molly Howland
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA.
| | - Denise Chang
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
| | - Anna Ratzliff
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
| | - Katherine Palm-Cruz
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
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17
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Bailey JE, Gurgol C, Pan E, Njie S, Emmett S, Gatwood J, Gauthier L, Rosas LG, Kearney SM, Robler SK, Lawrence RH, Margolis KL, Osunkwo I, Wilfley D, Shah VO. Early Patient-Centered Outcomes Research Experience With the Use of Telehealth to Address Disparities: Scoping Review. J Med Internet Res 2021; 23:e28503. [PMID: 34878986 PMCID: PMC8693194 DOI: 10.2196/28503] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/04/2021] [Accepted: 10/03/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Health systems and providers across America are increasingly employing telehealth technologies to better serve medically underserved low-income, minority, and rural populations at the highest risk for health disparities. The Patient-Centered Outcomes Research Institute (PCORI) has invested US $386 million in comparative effectiveness research in telehealth, yet little is known about the key early lessons garnered from this research regarding the best practices in using telehealth to address disparities. OBJECTIVE This paper describes preliminary lessons from the body of research using study findings and case studies drawn from PCORI seminal patient-centered outcomes research (PCOR) initiatives. The primary purpose was to identify common barriers and facilitators to implementing telehealth technologies in populations at risk for disparities. METHODS A systematic scoping review of telehealth studies addressing disparities was performed. It was guided by the Arksey and O'Malley Scoping Review Framework and focused on PCORI's active portfolio of telehealth studies and key PCOR identified by study investigators. We drew on this broad literature using illustrative examples from early PCOR experience and published literature to assess barriers and facilitators to implementing telehealth in populations at risk for disparities, using the active implementation framework to extract data. Major themes regarding how telehealth interventions can overcome barriers to telehealth adoption and implementation were identified through this review using an iterative Delphi process to achieve consensus among the PCORI investigators participating in the study. RESULTS PCORI has funded 89 comparative effectiveness studies in telehealth, of which 41 assessed the use of telehealth to improve outcomes for populations at risk for health disparities. These 41 studies employed various overlapping modalities including mobile devices (29/41, 71%), web-based interventions (30/41, 73%), real-time videoconferencing (15/41, 37%), remote patient monitoring (8/41, 20%), and store-and-forward (ie, asynchronous electronic transmission) interventions (4/41, 10%). The studies targeted one or more of PCORI's priority populations, including racial and ethnic minorities (31/41, 41%), people living in rural areas, and those with low income/low socioeconomic status, low health literacy, or disabilities. Major themes identified across these studies included the importance of patient-centered design, cultural tailoring of telehealth solutions, delivering telehealth through trusted intermediaries, partnering with payers to expand telehealth reimbursement, and ensuring confidential sharing of private information. CONCLUSIONS Early PCOR evidence suggests that the most effective health system- and provider-level telehealth implementation solutions to address disparities employ patient-centered and culturally tailored telehealth solutions whose development is actively guided by the patients themselves to meet the needs of specific communities and populations. Further, this evidence shows that the best practices in telehealth implementation include delivery of telehealth through trusted intermediaries, close partnership with payers to facilitate reimbursement and sustainability, and safeguards to ensure patient-guided confidential sharing of personal health information.
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Affiliation(s)
- James E Bailey
- Tennessee Population Health Consortium, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Cathy Gurgol
- Patient-Centered Outcomes Research Institute, Washington, DC, United States
| | - Eric Pan
- Westat Inc, Center for Healthcare Delivery Research and Evaluation, Rockville, MD, United States
| | - Shirilyn Njie
- Westat Inc, Center for Healthcare Delivery Research and Evaluation, Rockville, MD, United States
| | - Susan Emmett
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Duke Global Health Institute, Durham, NC, United States
| | - Justin Gatwood
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Lynne Gauthier
- Department of Physical Therapy and Kinesiology, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, United States
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
- Department of Medicine, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
| | - Shannon M Kearney
- Solution Insights & Validation, Highmark Health, Pittsburgh, PA, United States
| | | | - Raymona H Lawrence
- Community Health Behavior and Education, Jiann-Ping College of Public Health, Georgia Southern University, Statesboro, GA, United States
| | | | - Ifeyinwa Osunkwo
- Cancer Care, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States
| | - Denise Wilfley
- Department of Psychiatry, College of Medicine, Washington University in St. Louis, St Louis, MO, United States
| | - Vallabh O Shah
- Department of Internal Medicine and Biochemistry, School of Medicine, University of New Mexico, Albuquerque, NM, United States
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18
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Fortney JC, Bauer AM, Cerimele JM, Pyne JM, Pfeiffer P, Heagerty PJ, Hawrilenko M, Zielinski MJ, Kaysen D, Bowen DJ, Moore DL, Ferro L, Metzger K, Shushan S, Hafer E, Nolan JP, Dalack GW, Unützer J. Comparison of Teleintegrated Care and Telereferral Care for Treating Complex Psychiatric Disorders in Primary Care: A Pragmatic Randomized Comparative Effectiveness Trial. JAMA Psychiatry 2021; 78:1189-1199. [PMID: 34431972 PMCID: PMC8387948 DOI: 10.1001/jamapsychiatry.2021.2318] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/29/2021] [Indexed: 11/14/2022]
Abstract
Importance Only one-third of patients with complex psychiatric disorders engage in specialty mental health care, and only one-tenth receive adequate treatment in primary care. Scalable approaches are critically needed to improve access to effective mental health treatments in underserved primary care settings. Objective To compare 2 clinic-to-clinic interactive video approaches to delivering evidence-based mental health treatments to patients in primary care clinics. Design, Setting, and Participants This pragmatic comparative effectiveness trial used a sequential, multiple-assignment, randomized trial (SMART) design with patient-level randomization. Adult patients treated at 24 primary care clinics without on-site psychiatrists or psychologists from 12 federally qualified health centers in 3 states who screened positive for posttraumatic stress disorder and/or bipolar disorder and who were not already receiving pharmacotherapy from a mental health specialist were recruited from November 16, 2016, to June 30, 2019, and observed for 12 months. Interventions Two approaches were compared: (1) telepsychiatry/telepsychology-enhanced referral (TER), where telepsychiatrists and telepsychologists assumed responsibility for treatment, and (2) telepsychiatry collaborative care (TCC), where telepsychiatrists provided consultation to the primary care team. TER included an adaptive intervention (phone-enhanced referral [PER]) for patients not engaging in treatment, which involved telephone outreach and motivational interviewing. Main Outcomes and Measures Survey questions assessed patient-reported outcomes. The Veterans RAND 12-item Health Survey Mental Component Summary (MCS) score was the primary outcome (range, 0-100). Secondary outcomes included posttraumatic stress disorder symptoms, manic symptoms, depressive symptoms, anxiety symptoms, recovery, and adverse effects. Results Of 1004 included participants, 701 of 1000 (70.1%) were female, 660 of 994 (66.4%) were White, and the mean (SD) age was 39.4 (12.9) years. Baseline MCS scores were 2 SDs below the US mean; the mean (SD) MCS scores were 39.7 (14.1) and 41.2 (14.2) in the TCC and TER groups, respectively. There was no significant difference in 12-month MCS score between those receiving TCC and TER (β = 1.0; 95% CI, -0.8 to 2.8; P = .28). Patients in both groups experienced large and clinically meaningful improvements from baseline to 12 months (TCC: Cohen d = 0.81; 95% CI, 0.67 to 0.95; TER: Cohen d = 0.90; 95% CI, 0.76 to 1.04). For patients not engaging in TER at 6 months, there was no significant difference in 12-month MCS score between those receiving PER and TER (β = 2.0; 95% CI, -1.7 to 5.7; P = .29). Conclusions and Relevance In this comparative effectiveness trial of patients with complex psychiatric disorders randomized to receive TCC or TER, significantly and substantially improved outcomes were observed in both groups. From a health care system perspective, clinical leadership should implement whichever approach is most sustainable. Trial Registration ClinicalTrials.gov Identifier: NCT02738944.
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Affiliation(s)
- John C. Fortney
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
- Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington
| | - Amy M. Bauer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Joseph M. Cerimele
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Jeffrey M. Pyne
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock
- Department of Veterans Affairs, Health Services Research and Development, Center for Mental Healthcare and Outcomes Research, Little Rock, Arkansas
| | - Paul Pfeiffer
- University of Michigan Medical School, Ann Arbor
- Department of Veterans Affairs, Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Patrick J. Heagerty
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Matt Hawrilenko
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Melissa J. Zielinski
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Deborah J. Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle
| | - Danna L. Moore
- School of Economic Sciences, Washington State University, Pullman
| | - Lori Ferro
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | | | | | - Erin Hafer
- Community Health Plan of Washington, Seattle
| | | | | | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
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19
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Commiskey P, Armstrong AW, Coker TR, Dorsey ER, Fortney JC, Gaines KJ, Gibbons BM, Nguyen HQ, Singla DR, Szigethy E, Krupinski EA. A Blueprint for the Conduct of Large, Multisite Trials in Telemedicine. J Med Internet Res 2021; 23:e29511. [PMID: 34542417 PMCID: PMC8491114 DOI: 10.2196/29511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
Recent literature supports the efficacy and efficiency of telemedicine in improving various health outcomes despite the wide variability in results. Understanding site-specific issues in the implementation of telemedicine trials for broader replication and generalizability of results is needed. Lessons can be learned from existing trials, and a blueprint can guide researchers to conduct these challenging studies using telemedicine more efficiently and effectively. This viewpoint presents relevant challenges and solutions for conducting multisite telemedicine trials using 7 ongoing and completed studies funded by the Patient-Centered Outcomes Research Institute portfolio of large multisite trials to highlight the challenges in implementing telemedicine trials. Critical issues of ensuring leadership and buy-in, appropriate funding, and diverse and representative trials are identified and described, as well as challenges related to clinical, informatics, regulatory, legal, quality, and billing. The lessons learned from these studies were used to create a blueprint of key aspects to consider for the design and implementation of multisite telemedicine trials.
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Affiliation(s)
- Patricia Commiskey
- Division of Stroke, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - April W Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Earl Ray Dorsey
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, United States
| | - John C Fortney
- Division of Population Health, Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, Department of Veteran's Affairs, Seattle, WA, United States
| | - Kenneth J Gaines
- Division of Stroke, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Brittany M Gibbons
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Huong Q Nguyen
- Division of Health Services Research & Implementation Science, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Daisy R Singla
- Center of Addiction and Mental Health, Toronto, ON, Canada
- Lunenfeld Tanenbaum Research Institute, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eva Szigethy
- Center for High Value Health Care, UPMC Insurances Division, Department of Psychiatry, Medicine, and Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Elizabeth A Krupinski
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
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20
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Howland M, Tennant M, Bowen DJ, Bauer AM, Fortney JC, Pyne JM, Shore J, Cerimele JM. Psychiatrist and Psychologist Experiences with Telehealth and Remote Collaborative Care in Primary Care: A Qualitative Study. J Rural Health 2021; 37:780-787. [PMID: 33022079 PMCID: PMC8518862 DOI: 10.1111/jrh.12523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Availability of mental health services is limited in the rural United States. Two promising models to reach patients with limited access to care are telehealth referral and collaborative care. The objective of this study was to assess telepsychiatrist- and telepsychologist-level facilitators and barriers to satisfaction with and implementation of these 2 telehealth models in rural settings. METHODS Focus groups were held in 2019 using a semistructured interview guide. Participants were off-site telepsychiatrists (N = 10) and telepsychologists (N = 4) for primary care clinics across 3 states (Washington, Michigan, and Arkansas) involved in a recent pragmatic comparative effectiveness trial. Qualitative analysis occurred inductively by 2 independent coders. FINDINGS Participants were satisfied with the models partly owing to good patient rapport and expanding access to care. Teamwork was highlighted as a facilitator in collaborative care and was often related to work with care managers. However, participants described communication with primary care providers as a challenge, especially in the telehealth referral arm. Barriers centered on variability of logistical processes (eg, symptom monitoring, scheduling, electronic medical record processes, and credentialing) among sites. Staff turnover, variable clinic investment, and inadequacy of training were possible explanations for these barriers. CONCLUSIONS Participants described high motivation to provide team-based, remote care for patients, though they experienced operational challenges. Centralized credentialing, scheduling, and record keeping are possible solutions. These findings are important because consulting psychiatrists and psychologists may play a leadership role in the dissemination of these models.
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Affiliation(s)
- Molly Howland
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashington
| | - McKenna Tennant
- Department of Public Health GeneticsUniversity of Washington School of Public HealthSeattleWashington
| | - Deborah J. Bowen
- Department of Bioethics and HumanitiesUniversity of WashingtonSeattleWashington
| | - Amy M. Bauer
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashington
| | - John C. Fortney
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashington
- Department of Veterans Affairs, HSR&D Center of Innovation for Veteran‐Centered and Value‐Driven CareVA Puget Sound Health Care SystemSeattleWashington
- Department of Health ServicesUniversity of Washington School of Public HealthSeattleWashington
| | - Jeffrey M. Pyne
- Department of Psychiatry and Behavioral Sciences, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansas
| | - Jay Shore
- Helen and Arthur E. Johnson Depression Center, Anschutz Medical Campus, Departments of Psychiatry and Family MedicineUniversity of Colorado School of MedicineAuroraColorado
- Centers for American Indian and Alaska Native Health, Colorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraColorado
| | - Joseph M. Cerimele
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashington
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21
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Bechtel JM, Lepoire E, Bauer AM, Bowen DJ, Fortney JC. Care manager perspectives on integrating an mHealth app system into clinical workflows: A mixed methods study. Gen Hosp Psychiatry 2021; 68:38-45. [PMID: 33310012 DOI: 10.1016/j.genhosppsych.2020.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/24/2020] [Accepted: 10/08/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE mHealth can be a valuable means of monitoring symptoms and supporting care for rural patients, but barriers to implementation remain. This study aimed to examine care manager perspectives on the adoption, use and impact of an mHealth system deployed within a pragmatic Collaborative Care trial for rural patients with PTSD and/or Bipolar Disorder. METHOD Sixteen care managers at 12 Federally Qualified Health Centers in 3 states participated in semi-structured interviews. Interviews were transcribed, coded, and thematically analyzed using the Unified Theory of Adoption and Use of Technology as a conceptual framework. App metadata was used to assess the frequency of a care manager reported phenomenon, clinically disengaged app use. RESULTS 4 themes were identified: infrastructural limitations; redundant and incompatible clinical and mHealth workflows; cross platform and web access; and patient engagement and clinically disengaged app use. Most users had a period of consistently submitting symptom measures via the app while disengaged from care for >4 weeks.
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Affiliation(s)
- Jared M Bechtel
- University of Washington, Department of Psychiatry and Behavioral Sciences, USA.
| | - Erin Lepoire
- University of Washington, Department of Psychiatry and Behavioral Sciences, USA
| | - Amy M Bauer
- University of Washington, Department of Psychiatry and Behavioral Sciences, USA
| | - Deborah J Bowen
- University of Washington, Department of Psychiatry and Behavioral Sciences, USA
| | - John C Fortney
- University of Washington, Department of Psychiatry and Behavioral Sciences, USA
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22
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Psychometric Properties of the Assessment of Perceived Access to Care (APAC) Instrument. J Ambul Care Manage 2020; 44:31-45. [PMID: 33165120 DOI: 10.1097/jac.0000000000000358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Valid measures of perceived access are needed to measure whether health care systems are providing adequate access. This research reports on the psychometric properties of the Assessment of Perceived Access to Care (APAC), which was administered to 1004 Community Health Center patients screening positive for psychiatric disorders. Known-group validity was good, with 6 of the 8 hypothesized associations between social determinants of access and perceived access being significant (P < .01). Better access was significantly (P < .01) correlated with more outpatient mental health visits, indicating good convergent validity. The test-retest Pearson correlation coefficient (0.64) was statistically significant (P < .01). The APAC has acceptable psychometric properties.
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23
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Community mental healthcare: new developments and innovative strategies. Curr Opin Psychiatry 2020; 33:491-500. [PMID: 32639361 DOI: 10.1097/yco.0000000000000629] [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] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW The aim of this scoping review was to identify and map the available evidence on recent innovations in community mental healthcare across the globe. RECENT FINDINGS This review highlights the different innovative approaches and strategies being currently used in the field of community mental health. Key approaches found in the reviewed studies include collaborative care with the inclusion of peer workers, growing use of e-health and telepsychiatry, improved reforms on national mental health policies and de-institutionalization, modification of outreach models and mental health promotion in the community. The studies reviewed here suggest that continued innovation and implementation of new models and strategies have the potential to reduce the burden of disease and increase the quality of life for patients with mental health issues. SUMMARY Growing body of evidence shows that integrative care is the new standard of care for people with mental illnesses, with necessity of continuity of care from emergency department to community mental health services. Social determinants of rehabilitation and recovery, and peers support remain a new main topic of research in area of treatment of people with severe mental illnesses. E-health tools are becoming prevalent in the processes of promotion, prevention and treatment in mental healthcare.
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24
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Moring JC, Dondanville KA, Fina BA, Hassija C, Chard K, Monson C, LoSavio ST, Wells SY, Morland LA, Kaysen D, Galovski TE, Resick PA. Cognitive Processing Therapy for Posttraumatic Stress Disorder via Telehealth: Practical Considerations During the COVID-19 Pandemic. J Trauma Stress 2020; 33:371-379. [PMID: 32400911 PMCID: PMC7272815 DOI: 10.1002/jts.22544] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 11/07/2022]
Abstract
The global outbreak of COVID-19 has required mental health providers to rapidly rethink and adapt how they provide care. Cognitive processing therapy (CPT) is a trauma-focused, evidence-based treatment for posttraumatic stress disorder that is effective when delivered in-person or via telehealth. Given current limitations on the provision of in-person mental health treatment during the COVID-19 pandemic, this article presents guidelines and treatment considerations when implementing CPT via telehealth. Based on lessons learned from prior studies and clinical delivery of CPT via telehealth, recommendations are made with regard to overall strategies for adapting CPT to a telehealth format, including how to conduct routine assessments and ensure treatment fidelity.
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Affiliation(s)
- John C. Moring
- Department of Psychiatry and Behavioral SciencesUniversity of Texas Health Science Center at San AntonioSan AntonioTexasUSA
| | - Katherine A. Dondanville
- Department of Psychiatry and Behavioral SciencesUniversity of Texas Health Science Center at San AntonioSan AntonioTexasUSA
| | - Brooke A. Fina
- Department of Psychiatry and Behavioral SciencesUniversity of Texas Health Science Center at San AntonioSan AntonioTexasUSA
| | - Christina Hassija
- Department of PsychologyCalifornia State University San BernardinoSan BernardinoCaliforniaUSA
| | - Kathleen Chard
- Cincinnati VA Medical CenterCincinnatiOhioUSA
- Department of Psychiatry and Behavioral NeuroscienceCollege of MedicineUniversity of CincinnatiCincinnatiOhioUSA
| | | | - Stefanie T. LoSavio
- Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNorth CarolinaUSA
- Durham VA Health Care SystemDurhamNorth CarolinaUSA
| | - Stephanie Y. Wells
- Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNorth CarolinaUSA
- Durham VA Health Care SystemDurhamNorth CarolinaUSA
- VA VISN 6 Mid‐Atlantic Mental Illness Research Education ClinicalCenters of Excellence (MIRECC)DurhamNorth CarolinaUSA
| | - Leslie A. Morland
- Department of Veterans AffairsVA San Diego Care SystemLa JollaCaliforniaUSA
- Department of PsychiatryUniversity of California–San DiegoLa JollaCaliforniaUSA
| | - Debra Kaysen
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - Tara E. Galovski
- Women's Health Sciences DivisionNational Center for PTSDVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of PsychiatryBoston University School of MedicineBostonMAUSA
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNorth CarolinaUSA
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25
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Cerimele JM, LePoire E, Fortney JC, Hawrilenko M, Unützer J, Bauer AM. Bipolar disorder and PTSD screening and telepsychiatry diagnoses in primary care. Gen Hosp Psychiatry 2020; 65:28-32. [PMID: 32447194 DOI: 10.1016/j.genhosppsych.2020.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe clinical diagnoses from telepsychiatrist consultation in safety net primary care settings for adult patients screening positive for bipolar disorder, PTSD, or both. METHODS Patients were administered the PTSD Checklist (PCL-6) and the Composite International Diagnostic Interview 3.0 (CIDI) for bipolar disorder. Positive screening result definitions were PCL-6 score of ≥14 and CIDI positive stem question responses and score of ≥8. Patient characteristics were assessed by survey. Psychiatrists consulted in primary care via telehealth and recorded clinical diagnoses. RESULTS Among 767 patients attending consultation with a telepsychiatrist, 495 (65%) screened PCL-6 positive only, 249 (32%) screened both PCL-6 and CIDI positive, and 23 (3%) screened CIDI positive. Approximately two-thirds screening PCL-6 positive were diagnosed with PTSD, and most had comorbid mood disorder diagnoses, with bipolar disorder diagnosis occurring more often in those screening CIDI positive compared to negative (42% vs. 15%). Positive predictive values were 64.9% for PCL-6 and 43.8% for CIDI. CONCLUSION Most individuals screening positive for PTSD and/or bipolar disorder had two or more psychiatric diagnoses; misclassification exists for both instruments but was greater for CIDI. Psychiatrist consultation early in treatment for individuals screening positive on the PCL-6 and/or CIDI could help clarify diagnoses and improve treatment planning.
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Affiliation(s)
- Joseph M Cerimele
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States of America.
| | - Erin LePoire
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States of America
| | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States of America; Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America; Department of Health Services, University of Washington School of Public Health, Seattle, WA, United States of America
| | - Matt Hawrilenko
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States of America; Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States of America
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