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Williams NJ, Russo J, Vredevoogd M, Grover T, Green P, Proctor E, Bhat A, Unützer J, Bennett IM. Association of organizational culture and climate with variation in the clinical outcomes of collaborative care for maternal depression in community health centers. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231205891. [PMID: 37936965 PMCID: PMC10576428 DOI: 10.1177/26334895231205891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Organizational factors may help explain variation in the effectiveness of evidence-based clinical innovations through implementation and sustainment. This study tested the relationship between organizational culture and climate and variation in clinical outcomes of the Collaborative Care Model (CoCM) for treatment of maternal depression implemented in community health centers. Method Organizational cultures and climates of 10 community health centers providing CoCM for depression among low-income women pregnant or parenting were assessed using the organizational social context (OSC) measure. Three-level hierarchical linear models tested whether variation in culture and climate predicted variation in improvement in depression symptoms from baseline to 6.5-month post-baseline for N = 468 women with care ±1 year of OSC assessment. Depression symptomology was measured using the Patient Health Questionnaire (PHQ-9). Results After controlling for patient characteristics, case mix, center size, and implementation support, patients served by centers with more proficient cultures improved significantly more from baseline to 6.5-month post-baseline than patients in centers with less proficient cultures (mean improvement = 5.08 vs. 0.14, respectively, p = .020), resulting in a large adjusted effect size of dadj = 0.78. A similar effect was observed for patients served by centers with more functional climates (mean improvement = 5.25 vs. 1.12, p < .044, dadj = 0.65). Growth models indicated that patients from all centers recovered on average after 4 months of care. However, those with more proficient cultures remained stabilized whereas patients served by centers with less proficient cultures deteriorated by 6.5-month post-baseline. A similar pattern was observed for functional climate. Conclusions Variation in clinical outcomes for women from historically underserved populations receiving Collaborative Care for maternal depression was associated with the organizational cultures and climates of community health centers. Implementation strategies targeting culture and climate may improve the implementation and effectiveness of integrated behavioral health care for depression.
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Affiliation(s)
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Melinda Vredevoogd
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Tess Grover
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Phillip Green
- Center for Behavioral Health Research, University of Tennessee, Knoxville, TN, USA
| | - Enola Proctor
- Brown School of Social Work, Washington University, Saint Louis, MO, USA
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Ian M. Bennett
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Wolf F, Freytag A, Schulz S, Lehmann T, Schaffer S, Vollmar HC, Kühlein T, Gensichen J. German general practitioners' self-reported management of patients with chronic depression. BMC Psychiatry 2017; 17:401. [PMID: 29237425 PMCID: PMC5729254 DOI: 10.1186/s12888-017-1564-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 11/30/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patients with chronic depression (persisting symptoms for ≥2 years) are a clinically relevant group with extensive (co)morbidity, high functional impairment and associated costs in primary care. The General Practitioner (GP) is the main health professional attending to these patients. The aim of this study was to examine the GPs' perception on managing patients with chronic depression. METHODS We performed an explorative cross-sectional study with a systematic sample of GPs in central Germany. Source of data was a written questionnaire (46 items). Descriptive analysis was carried out. RESULTS Two hundred twenty (out of 1000; 22%) GPs participated. 93% of the GPs distinguish between care for patients with chronic depression and acute depressive episode. 92% would recommend psychotherapeutic co-treatment to the chronically depressed patient. 52% of GPs would favour a general restraint on antidepressants (ADs) in older chronically depressed patients (≥ 75 years) whereas 40% suggest long-term pharmacotherapy. If severe physical comorbidity is present GPs would be restrictive in prescribing ADs (65%) or would urgently refer to specialist psychiatric services (40%). In case of a comorbid anxiety disorder 66% of the GPs would suggest a combined psycho- und pharmacotherapy. If a substance use disorder coexists 84% would prefer urgent referrals to specialist services. CONCLUSIONS Participating GPs report awareness towards chronic depression in their patients. Physical and mental comorbidity seem to play an important role in GPs' treatment decisions.
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Affiliation(s)
- Florian Wolf
- 0000 0000 8517 6224grid.275559.9Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, D-07743 Jena, Germany
| | - Antje Freytag
- 0000 0000 8517 6224grid.275559.9Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, D-07743 Jena, Germany
| | - Sven Schulz
- 0000 0000 8517 6224grid.275559.9Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, D-07743 Jena, Germany
| | - Thomas Lehmann
- 0000 0000 8517 6224grid.275559.9Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Bachstraße 18, D-07743 Jena, Germany
| | - Susann Schaffer
- 0000 0001 2107 3311grid.5330.5Institute of General Practice, University of Erlangen-Nuremberg, Universitätsstraße 29, D-91054 Erlangen, Germany
| | - Horst Christian Vollmar
- 0000 0000 8517 6224grid.275559.9Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, D-07743 Jena, Germany
| | - Thomas Kühlein
- 0000 0001 2107 3311grid.5330.5Institute of General Practice, University of Erlangen-Nuremberg, Universitätsstraße 29, D-91054 Erlangen, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, D-07743, Jena, Germany. .,Institute of General Practice and Family Medicine, University Hospital of LMU Munich, Pettenkoferstr. 8a/10, D-80336, Munich, Germany.
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Kester R, Unützer J, Hogan D, Huang H. Antipsychotic prescribing patterns in a Medicare Advantage population of older individuals with dementia. J Ment Health 2016; 26:167-171. [DOI: 10.1080/09638237.2016.1244720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rachel Kester
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA,
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA, and
| | | | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA,
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Choi NG, DiNitto DM, Marti CN, Kunik ME. When depression is diagnosed, older adults are as likely as younger adults to be prescribed pharmacotherapy and psychotherapy. Gen Hosp Psychiatry 2016; 43:6-11. [PMID: 27796260 DOI: 10.1016/j.genhosppsych.2016.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 08/02/2016] [Accepted: 08/11/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study examined age group differences in the rates of depression diagnosis and treatment using a national probability sample. METHODS Using data from the 2012 National Ambulatory Medical Care Survey (n=62,723 visits by patients aged 18+ years), we used bivariate and multivariable binary logistic regression analyses to test age group differences in antidepressant medication (ADM) and psychotherapy prescribed/ordered or provided at visits during which depression was diagnosed. RESULTS Visits by older adults were less likely to result in a depression diagnosis than visits by younger individuals: 2.46% and 1.80% in the 65-74 and 75+ age groups, compared to 4.06%, 4.24% and 4.12% in the 18-29, 30-49 and 50-64 age groups, respectively. Of all visits involving diagnosed depression, 65.88% included prescribing/ordering or providing ADM and 19.01% included psychotherapy ordering or providing, without significant age group difference. Prescribing/ordering or providing ADM occurs frequently during visits to physicians regardless of specialty, while psychotherapy was ordered or provided mostly during visits to psychiatrists. CONCLUSIONS During ambulatory care visits in which depression was diagnosed, older adults were as likely as younger adults to be prescribed/provided treatment; however, in more than 30% of visits by depressed older adults neither ADM nor psychotherapy was prescribed.
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Affiliation(s)
- Namkee G Choi
- University of Texas at Austin School of Social Work, Austin, TX, USA.
| | - Diana M DiNitto
- University of Texas at Austin School of Social Work, Austin, TX, USA
| | - C Nathan Marti
- University of Texas at Austin School of Social Work, Austin, TX, USA
| | - Mark E Kunik
- VA Health Services Research and Development Center of Excellence, Baylor College of Medicine, Houston, TX, USA
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Scazufca M, Menezes P, Tabb K, Kester R, Rössler W, Huang H. Identification and treatment of depression of older adults in primary care: findings from the São Paulo Ageing and Health Study. Fam Pract 2016. [PMID: 26219991 PMCID: PMC4931814 DOI: 10.1093/fampra/cmv062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Depression, diabetes and hypertension are major contributors to the global burden of disease; however, the majority of research on depression and co-morbid conditions originates in high-income countries. OBJECTIVE This study examines the depression identification rate and compares treatment rates of depression with those of diabetes and hypertension among elderly individuals served in primary care through the Family Health Program (FHP) in São Paulo, Brazil. METHOD A total of 1558 São Paulo Ageing and Health Study participants (low-income adults ≥65 years old living in São Paulo) registered in the FHP were included for analysis. Chart review was performed for participants with an International Classification of Diseases, 10th edition (ICD-10) depression diagnosis (from survey interview) to verify if depression was recorded for these individuals. Depression, diabetes and hypertension treatment were assessed based on clinical assessments and medication checks. RESULTS Seventy-three participants (4.8%) had ICD-10 depression, 344 (23.2%) had confirmed diabetes and 1207 (79.3%) had confirmed hypertension. The proportion of those identified with depression by medical chart review (n = 63 for individuals whose chart could be found) was 4.8% (n = 3). Nine individuals (12.3%) with ICD-10 depression were treated. Rates of diabetes and hypertension treatment were 72.4% and 77.4%, respectively. CONCLUSION Levels of treatment of depression in older adults receiving care in the FHP is very low compared to treatment rates of diabetes and hypertension. Collaborative care effectiveness trials for the treatment of depression in the FHP are needed to improve the quality of depression care for this population.
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Affiliation(s)
- Marcia Scazufca
- Laboratory of Psychopathology and Psychiatric Therapeutics (LIM-23), Faculty of Medicine, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Paulo Menezes
- Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Karen Tabb
- School of Social Work, University of Illinois, Urbana-Champaign, Champaign, IL, USA
| | - Rachel Kester
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA and
| | - Wulf Rössler
- Department of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Hsiang Huang
- Laboratory of Psychopathology and Psychiatric Therapeutics (LIM-23), Faculty of Medicine, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil, Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA and
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Huang H, Gören JL, Chan YF, Katon W, Russo J, Hogan D, Unützer J. Pharmacologic management of bipolar disorder in a Medicare Advantage population. PSYCHOSOMATICS 2014; 55:572-7. [PMID: 25016355 DOI: 10.1016/j.psym.2014.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 02/13/2014] [Accepted: 02/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to examine patterns of pharmacotherapy for beneficiaries in a high-risk Medicare Advantage program who were diagnosed with bipolar disorder. METHODS This was a cross-sectional study of 2338 Medicare Advantage beneficiaries diagnosed with bipolar disorder. Pharmacotherapy treatment was assessed via receipt of (1) a mood stabilizer or antipsychotic or both (i.e., guideline concordant bipolar care) and (2) unopposed antidepressant (i.e., without prescription of a mood stabilizer or an antipsychotic). Logistic regression was used to examine correlates of bipolar disorder care. RESULTS Among those younger than 65 years of age (n = 1395), 54% received guideline concordant therapy and 29% received unopposed antidepressant therapy. Among those 65 years and older (n = 943), 40% received guideline concordant therapy and 33% received unopposed antidepressant therapy. CONCLUSION Overall, about half of beneficiaries in this Medicare Advantage plan received guideline concordant pharmacotherapy for bipolar disorder, while approximately one-third received an unopposed antidepressant prescription. Antipsychotic medications accounted for most of the monotherapy observed. This study identifies opportunities for further improvements in the pharmacotherapy of bipolar disorder in high-risk Medicare patients.
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Affiliation(s)
- Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA (H.H.).
| | - Jessica L Gören
- Pharmacy Practice/Clinical Pharmacy/Psychiatry, University of RI/CHA/Harvard, Somerville, MA (J.L.G.)
| | - Ya-Fen Chan
- Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA (J.R., W.K., Y.-F.C., J.U.)
| | - Wayne Katon
- Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA (J.R., W.K., Y.-F.C., J.U.)
| | - Joan Russo
- Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA (J.R., W.K., Y.-F.C., J.U.)
| | | | - Jürgen Unützer
- Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA (J.R., W.K., Y.-F.C., J.U.)
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