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Sanabria-Mazo JP, D'Amico F, Cardeñosa E, Ferrer M, Edo S, Borràs X, McCracken LM, Feliu-Soler A, Sanz A, Luciano JV. Economic Evaluation of Videoconference Group Acceptance and Commitment Therapy and Behavioral Activation Therapy for Depression Versus Usual Care Among Adults With Chronic Low Back Pain Plus Comorbid Depressive Symptoms. THE JOURNAL OF PAIN 2024; 25:104472. [PMID: 38242333 DOI: 10.1016/j.jpain.2024.01.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Abstract
Chronic pain and depression are frequently comorbid conditions associated with significant health care and social costs. This study examined the cost-utility and cost-effectiveness of videoconference-based group forms of Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD), as a complement to treatment-as-usual (TAU), for patients with chronic low back pain (CLBP) plus depressive symptoms, compared to TAU alone. A trial-based economic evaluation (n = 234) was conducted from a governmental and health care perspective with a time horizon of 12 months. Primary outcomes were the Brief Pain Inventory-Interference Scale (BPI-IS) and Quality Adjusted Life Year. Compared to TAU, ACT achieved a significant reduction in total costs (d = .47), and BATD achieved significant reductions in indirect (d = .61) and total costs (d = .63). Significant improvements in BPI-IS (d = .73 and d = .66, respectively) and Quality Adjusted Life Year scores (d = .46 and d = .28, respectively) were found in ACT and BATD compared to TAU. No significant differences in costs and outcomes were found between ACT and BATD. In the intention-to-treat analyses, from the governmental and health care perspective, no significant differences in cost reduction and incremental effects were identified in the comparison between ACT, BATD, and TAU. However, in the complete case analysis, significant incremental effects of ACT (∆BPI-IS = -1.57 and -1.39, respectively) and BATD (∆BPI-IS = -1.08 and -1.04, respectively) compared with TAU were observed. In the per-protocol analysis, only the significant incremental effects of ACT (∆BPI-IS = -1.68 and -1.43, respectively) compared to TAU were detected. In conclusion, ACT and BATD might be efficient options in the management of CLBP plus comorbid depression symptoms as compared to usual care. However, no clear difference was found in the comparison between the 2 active therapies regarding cost-effectiveness or cost-utility. PERSPECTIVE: The economic evaluation of psychological therapies for the management of complex conditions can be used in decision-making and resource allocation. This study provides evidence that ACT and BATD are more effective and involve a greater reduction in costs than usual care in the management of CLBP plus comorbid depressive symptoms. TRIAL NUMBER: NCT04140838.
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Affiliation(s)
- Juan P Sanabria-Mazo
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Francesco D'Amico
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Eugenia Cardeñosa
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Basic Health Area (ABS) Maria Bernades, Direcció d'Atenció Primària Metropolitana Sud, Institut Català de la Salut, Viladecans, Spain
| | - Montse Ferrer
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Institut de Recerca Hospital del Mar, Barcelona, Spain
| | - Sílvia Edo
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Xavier Borràs
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | | | - Albert Feliu-Soler
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Antoni Sanz
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Juan V Luciano
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
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Patel KH, Chrisinger B. Effectiveness of primary care interventions in conjointly treating comorbid chronic pain and depression: a systematic review and meta-analysis. Fam Pract 2024; 41:234-245. [PMID: 37530738 DOI: 10.1093/fampra/cmad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Chronic pain and depression are highly comorbid, but the lack of consensus on the best treatment strategies puts patients at high risk of suboptimal care-coordination as well as health and social complications. Therefore, this study aims to quantitatively assesses how effective different primary care interventions have been in treating the comorbid state of chronic pain and depression. In particular, this study evaluates both short-term outcomes-based specifically on measures of chronic pain and depression during an intervention itself-and long-term outcomes or measures of pain and depression in the months after conclusion of the formal study intervention. METHODS This study is a systematic review and meta-analysis of randomised-controlled trials (RCTs) enrolling patients with concurrent chronic pain and depression. Intensity and severity of pain and depression symptoms were the primary outcomes. The main inclusion criteria were RCTs that: (i) enrolled patients diagnosed with depression and chronic pain, (ii) occurred in primary care settings, (iii) reported baseline and post-intervention outcomes for chronic pain and depression, (iv) lasted at least 8 weeks, and (v) used clinically validated outcome measures. Risk of bias was appraised with the Risk of Bias 2 tool, and GRADE guidelines were used to evaluate the quality of evidence. RESULTS Of 692 screened citations, 7 multicomponent primary care interventions tested across 891 patients were included. Meta-analyses revealed significant improvements in depression at post-intervention (SMD = 0.44, 95% CI [0.17, 0.71], P = 0.0014) and follow-up (SMD = 0.41, 95% CI [0.01, 0.81], P = 0.0448). Non-significant effects were observed for chronic pain at post-intervention (SMD = 0.27, 95% CI [-0.08, 0.61], P = 0.1287) and follow-up (SMD = 0.13, 95% CI [-0.3, 0.56], P = 0.5432). CONCLUSIONS Based on the results of the meta-analysis, primary care interventions largely yielded small to moderate positive effects for depressive symptoms and no significant effects on pain. In one study, stepped-care to be more effective in treatment of comorbid chronic pain and depression than other interventions both during the intervention and upon post-intervention follow-up. As such, depression appears more amenable to treatment than pain, but the number of published RCTs assessing both conditions is limited. More research is needed to further develop optimal treatment strategies.
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Affiliation(s)
- Krishna H Patel
- Department of Social Policy Intervention, University of Oxford, Oxford, United Kingdom
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Benjamin Chrisinger
- Department of Social Policy Intervention, University of Oxford, Oxford, United Kingdom
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Ma R, Romano E, Ashworth M, Smith TO, Vancampfort D, Scott W, Gaughran F, Stewart R, Stubbs B. The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review. THE JOURNAL OF PAIN 2024; 25:104421. [PMID: 37952860 DOI: 10.1016/j.jpain.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Abstract
Chronic pain (CP) and mental illness (MI) are leading causes of years lived with disability and commonly co-occur. However, it remains unclear if available interventions are effective in improving pain outcomes in patients with co-existing CP and MI. This systematic review synthesised evidence for the effectiveness of interventions to improve pain outcomes for people with comorbid CP and clinically diagnosed MI. Ten electronic databases were searched from inception until May 2023. Randomised controlled trials (RCTs) were included if they evaluated interventions for CP-related outcomes among people with comorbid CP and clinically diagnosed MI. Pain-related and mental health outcomes were reported as primary and secondary outcomes, respectively. 26 RCTs (2,311 participants) were included. Four trials evaluated the effectiveness of cognitive-behavioural therapy, 6 mindfulness-based interventions, 1 interpersonal psychotherapy, 5 body-based interventions, 5 multi-component interventions, and 5 examined pharmacological-based interventions. Overall, there was considerable heterogeneity in sample characteristics and interventions, and included studies were generally of poor quality with insufficient trial details being reported. Despite the inconsistency in results, preliminary evidence suggests interventions demonstrating a positive effect on CP may include cognitive-behavioural therapy for patients with depression (with a small to medium effect size) and multi-component intervention for people with substance use disorders (with a small effect size). Despite the high occurrence/burden of CP and MI, there is a relative paucity of RCTs investigating interventions and none in people with severe MI. More rigorously designed RCTs are needed to further support our findings. PERSPECTIVE: This systematic review presents current evidence evaluating interventions for CP-related and MH outcomes for people with comorbid CP and clinically diagnosed MI. Our findings could potentially help clinicians identify the most effective treatments to manage these symptoms for this vulnerable patient group.
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Affiliation(s)
- Ruimin Ma
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Eugenia Romano
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Mark Ashworth
- Department of Population Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Toby O Smith
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; Physiotherapy and Psychomotor Therapy Unit, University Psychiatric Centre KU Leuven, Kortenberg, Belgium
| | - Whitney Scott
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; INPUT Pain Management Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK; National Psychosis Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK; Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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Sanabria-Mazo JP, Colomer-Carbonell A, Fernández-Vázquez Ó, Noboa-Rocamora G, Cardona-Ros G, McCracken LM, Montes-Pérez A, Castaño-Asins JR, Edo S, Borràs X, Sanz A, Feliu-Soler A, Luciano JV. A systematic review of cognitive behavioral therapy-based interventions for comorbid chronic pain and clinically relevant psychological distress. Front Psychol 2023; 14:1200685. [PMID: 38187407 PMCID: PMC10766814 DOI: 10.3389/fpsyg.2023.1200685] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024] Open
Abstract
Objective Chronic pain frequently co-occurs with clinically relevant psychological distress. A systematic review was conducted to identify the efficacy of cognitive behavioral therapy-based interventions for patients with these comorbid conditions. Methods The systematic search was carried out in Medline, PsycINFO, Web of Science, and Scopus up to March 18th, 2023. Four reviewers independently conducted screenings, extraction, and quality assessment. Results Twelve randomized controlled trials and one non-randomized controlled trial involving 1,661 participants that examined the efficacy of Cognitive Behavioral Therapy (nine studies), Mindfulness-based Interventions (three studies), Acceptance and Commitment Therapy (one study), and Behavioral Activation Therapy for Depression (one study) were included. Compared to treatment as usual, six out of eight studies of traditional Cognitive Behavioral Therapy reported significant differences in the reduction of depressive symptoms at post-treatment (d from 1.31 to 0.18) and four out of six at follow-up (d from 0.75 to 0.26); similarly, five out of six reported significant differences in the reduction of anxiety symptoms at post-treatment (d from 1.08 to 0.19) and three out of four at follow-up (d from 1.07 to 0.27). Overall, no significant differences between traditional Cognitive Behavioral Therapy and treatment as usual were reported at post-treatment and follow-up in the studies exploring pain intensity and pain catastrophizing. Conclusion The available evidence suggests that traditional Cognitive Behavioral Therapy may produce significant benefits for the improvement of depression, anxiety, and quality of life, but not for pain intensity and pain catastrophizing. More evidence is needed to determine the effects of MBI, ACT, and BATD. Systematic review registration PROSPERO, CRD42021219921.
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Affiliation(s)
- Juan P. Sanabria-Mazo
- Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ariadna Colomer-Carbonell
- Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Óscar Fernández-Vázquez
- Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Georgina Noboa-Rocamora
- Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Gemma Cardona-Ros
- Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | | | | | - Sílvia Edo
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Xavier Borràs
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Antoni Sanz
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Albert Feliu-Soler
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan V. Luciano
- Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain
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Bouton C, Journeaux M, Jourdain M, Angibaud M, Huon JF, Rat C. Interprofessional collaboration in primary care: what effect on patient health? A systematic literature review. BMC PRIMARY CARE 2023; 24:253. [PMID: 38031014 PMCID: PMC10685527 DOI: 10.1186/s12875-023-02189-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 10/20/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND In a period of change in the organization of primary care, Interprofessional Collaboration (IPC) is presented as one of the solutions to health issues. Although the number of inter-professional interventions grounded in primary care increases in all developed countries, evidence on the effects of these collaborations on patient-centred outcomes is patchy. The objective of our study was to assess the effects of IPC grounded in the primary care setting on patient-centred outcomes. METHODS We conducted a systematic literature review using the PubMed, Embase, PsycINFO and CINAHL databases from 01/01/1995 to 01/03/2021, according to the PRISMA guidelines. Studies reporting the effects of IPC in primary care on patient health outcomes were included. The quality of the studies was assessed using the revised Downs and Black checklist. RESULTS Sixty-five articles concerning 61 interventions were analysed. A total of 43 studies were prospective and randomized. Studies were classified into 3 main categories as follows: 1) studies with patients at cardiovascular risk (28 studies)-including diabetes (18 studies) and arterial hypertension (5 studies); 2) studies including elderly and/or polypathological patients (18 studies); and 3) patients with symptoms of mental or physical disorders (15 studies). The number of included patients varied greatly (from 50 to 312,377). The proportion of studies that reported a positive effect of IPC on patient-centred outcomes was as follows: 23 out of the 28 studies including patients at cardiovascular risk, 8 out of the 18 studies of elderly or polypathological patients, and 11 out of the 12 studies of patients with mental or physical disorders. CONCLUSIONS Evidence suggests that IPC is effective in the management of patients at cardiovascular risk. In elderly or polypathological patients and in patients with mental or physical disorders, the number of studies remains very limited, and the results are heterogeneous. Researchers should be encouraged to perform studies based on comparative designs: it would increase evidence on the positive effect and benefits of IPC on patient variables.
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Affiliation(s)
- Céline Bouton
- Department of General Practice, Faculty of Medicine, University of Nantes, 1, Rue Gaston Veil, 44035, Nantes, France.
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France.
| | - Manon Journeaux
- Department of General Practice, Faculty of Medicine, University of Nantes, 1, Rue Gaston Veil, 44035, Nantes, France
| | - Maud Jourdain
- Department of General Practice, Faculty of Medicine, University of Nantes, 1, Rue Gaston Veil, 44035, Nantes, France
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France
| | - Morgane Angibaud
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France
| | - Jean-François Huon
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France
- Faculty of Pharmacy, University of Nantes, Nantes, France
| | - Cédric Rat
- Department of General Practice, Faculty of Medicine, University of Nantes, 1, Rue Gaston Veil, 44035, Nantes, France
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France
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Solá VP, Montes JM, Calvo ET, Gasull V, Campayo JG, Diez JMO, Berrocoso E, Mico JA, Agüera L. Consensus on the detection and management of patients with depression and pain as an associated somatic symptom. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023:S2950-2853(23)00055-8. [PMID: 37952640 DOI: 10.1016/j.sjpmh.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/13/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Globally, depression is the most common psychiatric disorder and is frequently associated with somatic symptom disorders, including pain as a physical symptom. There is a current need to improve the detection and management of the individuals in which depression and pain coexist. Hence, the aim of this document is to provide recommendations in the diagnosis and management of patients with major depressive disorder (MDD) who have pain as a physical symptom (PPS), in order to reduce the variability of clinical practice. MATERIAL AND METHODS The methodology used is based on the internationally recognized RAND/UCLA consensus method. The scientific committee, consisted of a group of eight multidisciplinary experts, defined 12 clinically relevant questions. After the systematic review of the literature, the scientific committee assessed the evidence and developed recommendations. The panel group with 15 participants validated these recommendations using a single Delphi round. To conclude, there was a final consensus meeting held to redefine with minor modifications the final recommendations. RESULTS The scientific committee developed a total of 19 recommendations on the diagnosis and detection, impact of PPS in MDD, treatment of MDD with associated PPS, use of healthcare resources, additional recommendations, and care coordination of these patients. Globally, a substantial level of agreement (≥80%) was reached on all items during the Delphi round. All the 19 achieved consensus, seven of them (37%) were agreed with unanimity during the Delphi round. The recommendations with higher consensus were in relation to diagnosis, impact of PPS in MDD, treatment and use of healthcare resources. CONCLUSIONS Currently, the evidence base for patients with MDD and PPS is still being developed and this consensus statement aims to bridge that gap by providing practical recommendations.
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Affiliation(s)
- Víctor Pérez Solá
- Institut de Neuropsiquiatria i Addiccions, Parc de salut mar, Barcelona, Spain; CIBERSAM, Madrid, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain.
| | - José Manuel Montes
- Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Universidad de Alcalá, Alcala de Henares, CIBERSAM, Spain
| | - Eva Trillo Calvo
- Medicina de Familia, Centro de Salud Campo de Belchite, Belchite, Zaragoza, Spain
| | - Vicente Gasull
- Medicina de Familia, Centro de Salud Torrent II, Valencia, Spain
| | | | - Jose Manuel Olivares Diez
- Servicio de Psiquiatría del Area Sanitaria de Vigo, Director del Area de Neurociencias, Instituto de Investigación Sanitaria Galicia Sur (IISGS, Cibersam), Spain
| | - Esther Berrocoso
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychology, University of Cadiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA), Spain
| | - Juan Antonio Mico
- Departamento de Neurociencias, Farmacología y Psiquiatría, Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Universidad de Cádiz, Cádiz, Spain
| | - Luis Agüera
- Servicio de Psiquiatría del Hospital Universitario 12 de Octubre, Madrid, Spain; Associate Professor of the Faculty of Medicine, Universidad Complutense, Madrid, Spain
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Chung H, Patel U, Stein D, Collado K, Blackmore M. Medicaid Costs and Utilization of Collaborative Versus Colocation Care for Patients With Depression. Psychiatr Serv 2023; 74:1132-1136. [PMID: 37221885 DOI: 10.1176/appi.ps.20220604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The authors examined cost and utilization metrics for racially diverse Medicaid primary care patients with depression receiving care through either a collaborative care model (CoCM) of integration or the standard colocation model. METHODS Data from a retrospective cohort of Medicaid patients screening positive for clinically significant depression during January 2016-December 2017 were analyzed to assess health care costs and selected utilization measures. Seven primary care clinics providing CoCM were compared with 16 clinics providing colocated behavioral health care. Data for the first year and second year after a patient received an initial Patient Health Questionnaire-9 score ≥10 were analyzed. RESULTS In the first year, compared with patients receiving colocated care (N=3,061), CoCM patients (N=4,315) had significantly lower odds of emergency department (ED) visits (OR=0.95) and medical specialty office visits (OR=0.92), with slightly higher odds of primary care provider (PCP) visits (OR=1.03) and behavioral health office visits (OR=1.03). In year 2, CoCM patients (N=2,623) had significantly lower odds of inpatient medical admissions (OR=0.87), ED visits (OR=0.84), medical specialty office visits (OR=0.89), and PCP visits (OR=0.94) than the colocated care patients (N=1,838). The two groups did not significantly differ in total cost in both years. CONCLUSIONS Access to CoCM treatment in primary care for racially diverse Medicaid patients with depression was associated with more positive health care utilization outcomes than for those accessing colocated treatment. As organizations continue to seek opportunities to integrate behavioral health care into primary care, consideration of health care costs and utilization may be helpful in the selection and implementation of integration models.
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Affiliation(s)
- Henry Chung
- Department of Psychiatry and Behavioral Sciences (Chung, Blackmore) and Department of Social and Family Medicine (Patel), Albert Einstein College of Medicine, Bronx, New York City; Optum Tri-State, Chappaqua, New York (Stein); Montefiore Care Management Organization, Yonkers, New York (Chung, Collado)
| | - Urvashi Patel
- Department of Psychiatry and Behavioral Sciences (Chung, Blackmore) and Department of Social and Family Medicine (Patel), Albert Einstein College of Medicine, Bronx, New York City; Optum Tri-State, Chappaqua, New York (Stein); Montefiore Care Management Organization, Yonkers, New York (Chung, Collado)
| | - Dana Stein
- Department of Psychiatry and Behavioral Sciences (Chung, Blackmore) and Department of Social and Family Medicine (Patel), Albert Einstein College of Medicine, Bronx, New York City; Optum Tri-State, Chappaqua, New York (Stein); Montefiore Care Management Organization, Yonkers, New York (Chung, Collado)
| | - Kayla Collado
- Department of Psychiatry and Behavioral Sciences (Chung, Blackmore) and Department of Social and Family Medicine (Patel), Albert Einstein College of Medicine, Bronx, New York City; Optum Tri-State, Chappaqua, New York (Stein); Montefiore Care Management Organization, Yonkers, New York (Chung, Collado)
| | - Michelle Blackmore
- Department of Psychiatry and Behavioral Sciences (Chung, Blackmore) and Department of Social and Family Medicine (Patel), Albert Einstein College of Medicine, Bronx, New York City; Optum Tri-State, Chappaqua, New York (Stein); Montefiore Care Management Organization, Yonkers, New York (Chung, Collado)
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Heavey SC, Bleasdale J, Rosenfeld EA, Beehler GP. Collaborative Care Models to Improve Pain and Reduce Opioid Use in Primary Care: a Systematic Review. J Gen Intern Med 2023; 38:3021-3040. [PMID: 37580632 PMCID: PMC10593691 DOI: 10.1007/s11606-023-08343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/17/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Collaborative care management (CCM) is an empirically driven model to overcome fractured medical care and improve health outcomes. While CCM has been applied across numerous conditions, it remains underused for chronic pain and opioid use. Our objective was to establish the state of the science for CCM approaches to addressing pain-related outcomes and opioid-related behaviors through a systematic review. METHODS We identified peer-reviewed articles from Cochrane, Embase, PsycINFO, and PubMed databases from January 1, 1995, to October 31, 2022. Abstracts and full-text articles were screened for study inclusion, resulting in 18 studies for the final review. In addition, authors used the Patient-Centered Integrated Behavioral Health Care Principles and Tasks Checklist as a tool for assessing the reported CCM components within and across studies. We conducted this systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. RESULTS Several CCM trials evidenced statistically significant improvements in pain-related outcomes (n = 11), such as pain severity and pain-related activity interference. However, effect sizes varied considerably across studies and some effects were not clinically meaningful. CCM had some success in targeting opioid-related behaviors (n = 4), including reduction in opioid prescription dose. Other opioid-related work focused on CCM to facilitate buprenorphine treatment for opioid use disorder (n = 2), including improved odds of receiving treatment and greater prevalence of abstinence from opioids and alcohol. Uniquely, several interventions used CCM to target mental health as a way to address pain (n = 10). Generally, there was moderate alignment with the CCM model. CONCLUSIONS CCM shows promise for improving pain-related outcomes, as well as facilitating buprenorphine for opioid use disorder. More robust research is needed to determine which aspects of CCM best support improved outcomes and how to maximize the effectiveness of such interventions.
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Affiliation(s)
- Sarah Cercone Heavey
- Department of Community Health & Health Behavior, School of Public Health & Health Professions, State University of New York at Buffalo, Buffalo, NY, 14214, USA.
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY, USA.
| | - Jacob Bleasdale
- Department of Community Health & Health Behavior, School of Public Health & Health Professions, State University of New York at Buffalo, Buffalo, NY, 14214, USA
| | - Eve A Rosenfeld
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, Palo Alto, CA, USA
- Deparment of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Gregory P Beehler
- Department of Community Health & Health Behavior, School of Public Health & Health Professions, State University of New York at Buffalo, Buffalo, NY, 14214, USA
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY, USA
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9
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Sanabria-Mazo JP, Colomer-Carbonell A, Borràs X, Castaño-Asins JR, McCracken LM, Montero-Marin J, Pérez-Aranda A, Edo S, Sanz A, Feliu-Soler A, Luciano JV. Efficacy of Videoconference Group Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD) for Chronic Low Back Pain (CLBP) Plus Comorbid Depressive Symptoms: A Randomized Controlled Trial (IMPACT Study). THE JOURNAL OF PAIN 2023; 24:1522-1540. [PMID: 37105508 DOI: 10.1016/j.jpain.2023.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023]
Abstract
This study examined the efficacy of adding a remote, synchronous, group, videoconference-based form of acceptance and commitment therapy (ACT) or behavioral activation therapy for depression (BATD) to treatment-as-usual (TAU) in 234 patients with chronic low back pain (CLBP) plus comorbid depressive symptoms. Participants were randomly assigned to ACT, BATD, or TAU. Compared to TAU, ACT produced a significant reduction in pain interference at posttreatment (d = .64) and at follow-up (d = .73). BATD was only superior to TAU at follow-up (d = .66). A significant reduction in pain catastrophizing was reported by patients assigned to ACT and BATD at posttreatment (d = .45 and d = .59, respectively) and at follow-up (d = .59, in both) compared to TAU. Stress was significantly reduced at posttreatment by ACT in comparison to TAU (d = .69). No significant between-group differences were found in depressive or anxiety symptoms. Clinically relevant number needed to treat (NNT) values for reduction in pain interference were obtained at posttreatment (ACT vs TAU = 4) and at follow-up (ACT vs TAU = 3; BATD vs TAU = 5). In both active therapies, improvements in pain interference at follow-up were significantly related to improvements at posttreatment in psychological flexibility. These findings suggest that new forms of cognitive-behavioral therapy are clinically useful in improving pain interference and pain catastrophizing. Further research on evidence-based change processes is required to understand the therapeutic needs of patients with chronic pain and comorbid conditions. TRIAL NUMBER: NCT04140838. PERSPECTIVE: Group videoconference-based ACT and BATD showed greater efficacy than TAU for reducing pain interference and pain catastrophizing in patients with CLBP plus clinically relevant depression. Psychological flexibility appeared to be the main contributor to treatment effects for both ACT and BATD.
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Affiliation(s)
- Juan P Sanabria-Mazo
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Ariadna Colomer-Carbonell
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Xavier Borràs
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | | | | | - Jesus Montero-Marin
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Adrián Pérez-Aranda
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain; Institute of Health Research of Aragon (IIS Aragon), Miguel Servet University Hospital, Zaragoza, Spain
| | - Sílvia Edo
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Antoni Sanz
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Albert Feliu-Soler
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Juan V Luciano
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain.
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10
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Bonanni R, Gino Grillo S, Cariati I, Tranquillo L, Iundusi R, Gasbarra E, Tancredi V, Tarantino U. Osteosarcopenia and Pain: Do We Have a Way Out? Biomedicines 2023; 11:biomedicines11051285. [PMID: 37238956 DOI: 10.3390/biomedicines11051285] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Osteosarcopenia (OSP) is a geriatric syndrome characterized by the coexistence of osteoporosis and sarcopenia and associated with an increased risk of fragility fractures, disability, and mortality. For patients with this syndrome, musculoskeletal pain represents the most significant challenge since, in addition to limiting the individual's functionality and promoting disability, it has a huge psychological burden involving anxiety, depression, and social withdrawal. Unfortunately, the molecular mechanisms involved in the development and persistence of pain in OSP have not yet been fully elucidated, although immune cells are known to play a key role in these processes. Indeed, they release several molecules that promote persistent inflammation and nociceptive stimulation, resulting in the gating of ion channels responsible for the generation and propagation of the noxious stimulus. The adoption of countermeasures to counteract the OSP progression and reduce the algic component appears to be necessary, providing patients with a better quality of life and greater adherence to treatment. In addition, the development of multimodal therapies, based on an interdisciplinary approach, appears to be crucial, combining the use of anti-osteoporotic drugs with an educational programme, regular physical activity, and proper nutrition to eliminate risk factors. Based on this evidence, we conducted a narrative review using the PubMed and Google Scholar search engines to summarize the current knowledge on the molecular mechanisms involved in the pain development in OSP and the potential countermeasures to be taken. The lack of studies addressing this topic highlights the need to conduct new research into the resolution of an ever-expanding social problem.
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Affiliation(s)
- Roberto Bonanni
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Sonia Gino Grillo
- Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Viale Oxford 81, 00133 Rome, Italy
| | - Ida Cariati
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Lucia Tranquillo
- Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Viale Oxford 81, 00133 Rome, Italy
| | - Riccardo Iundusi
- Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Viale Oxford 81, 00133 Rome, Italy
| | - Elena Gasbarra
- Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Viale Oxford 81, 00133 Rome, Italy
| | - Virginia Tancredi
- Department of Systems Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133 Rome, Italy
- Centre of Space Bio-Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133 Rome, Italy
- Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Viale Oxford 81, 00133 Rome, Italy
- Centre of Space Bio-Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133 Rome, Italy
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11
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Tomé-Pires C, Aragonès E, Rambla C, López-Cortacans G, Sánchez-Rodríguez E, Caballero A, Miró J. Perceived barriers, facilitators and usefulness of a psychoeducational intervention for individuals with chronic musculoskeletal pain and depression in primary care. Front Psychol 2023; 14:1099419. [PMID: 37179874 PMCID: PMC10167008 DOI: 10.3389/fpsyg.2023.1099419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/03/2023] [Indexed: 05/15/2023] Open
Abstract
Background and aims Self-management interventions have the potential to improve patient' pain condition as they involve tasks aimed at managing symptoms and reducing interference with activities, mood and relationships due to pain. However, research on factors that facilitate or hinder pain self-management has overlooked patients with both chronic musculoskeletal pain and depression in primary care settings, also leaving unattended patient views on the usefulness of such programs. Thus, the main aim of this study was to gather meaningful information to help promoting adequate self-management. Specifically, it attempts to identify patients' perceptions of barriers and facilitators of group-based psychoeducational intervention and to explore its perceived usefulness in promoting self-management. Method This qualitative study explored perceived barriers and facilitators of a psychoeducational intervention for the management of chronic musculoskeletal pain and depression previously tested in a Randomized Control Trial. We conducted focus groups and individual interviews with fifteen adult patients with both chronic musculoskeletal pain and depression recruited from primary care centres in Tarragona province (Catalonia, Spain). A content thematic analysis was carried out to examine the data. This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Results Findings revealed that perceived barriers included lack of motivation, time constraints, pain, depression, ineffectiveness of pain-relief strategies and activity avoidance. Facilitators were having a supportive family/friends, the positive effects of self-management, high motivation, being a proactive patient. Peer support and identification, the positive effect of sessions, and free expression were highlighted as key elements of the psychoeducational intervention. Conclusion The psychoeducational intervention was perceived as useful in promoting self-management practices. Barriers and facilitators in using self-management strategies were related, mainly, to internal personal characteristics of the patients being similar among different cultural backgrounds and distinct chronic conditions. Implications These findings can help to guide clinicians in the development and implementation of more effective pain self-management interventions for patients with chronic pain and depression by attending to their needs and preferences.
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Affiliation(s)
- Catarina Tomé-Pires
- Department of Psychology, Psychology Research Centre, Autonomous University of Lisbon, Lisbon, Portugal
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Enric Aragonès
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Concepción Rambla
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Germán López-Cortacans
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment, Universitat Rovira i Virgili (URV), Tarragona, Spain
- Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili (URV), Tarragona, Spain
- Chair in Pediatric Pain Universitat Rovira i Virgili (URV)—Fundación Grünenthal, Catalonia, Spain
| | - Antonia Caballero
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Jordi Miró
- Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment, Universitat Rovira i Virgili (URV), Tarragona, Spain
- Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili (URV), Tarragona, Spain
- Chair in Pediatric Pain Universitat Rovira i Virgili (URV)—Fundación Grünenthal, Catalonia, Spain
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12
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Rambla C, Aragonès E, Pallejà-Millán M, Tomé-Pires C, López-Cortacans G, Sánchez-Rodríguez E, Miró J. Short and long-term predictors of pain severity and interference in primary care patients with chronic musculoskeletal pain and depression. BMC Musculoskelet Disord 2023; 24:270. [PMID: 37020278 PMCID: PMC10074832 DOI: 10.1186/s12891-023-06357-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/22/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Chronic pain and depression are frequent comorbidities in primary care. Depression among other psychosocial factors play a role in the clinical course of chronic pain. OBJECTIVE To study the short and long-term predictive factors of severity and interference of chronic pain in primary care patients with chronic musculoskeletal pain and major depression. METHODS Longitudinal study of a cohort of 317 patients. The outcomes are severity and functional interference of pain (Brief Pain Inventory) measured at 3 and 12 months. We performed multivariate linear regression models to estimate the effects the explanatory baseline variables on the outcomes. RESULTS 83% participants were women; average age was 60.3 years (SD = 10.2). In multivariate models, baseline pain severity predicted pain severity at 3 months (β = 0.53; 95% CI = 0.37-0.68) and at 12 months (β = 0.48; 95% CI = 0.29-0.67). Also, pain > 2 years of evolution predicted long term pain severity (β = 0.91; CI95%=0.11-1.71). Baseline pain interference predicted interference at 3 and 12 months (β = 0.27; 95%CI = 0.11-0.43 and β = 0.21; 95%CI = 0.03-0.40, respectively). Baseline pain severity predicted interference at 3 and 12 months (β = 0.26; 95%CI = 0.10-0.42 and β = 0.20; 95%CI = 0.02-0.39, respectively). Pain > 2 years predicted greater severity and greater interference at 12 months (β = 0.91; CI95%=0.11-1.71, and β = 1.23; CI95%=0.41-2.04). Depression severity predicted more interference at 12 months (β = 0.58; CI95%=0.04-1.11). Occupational status as active worker predicted less interference throughout the follow-up (β=-0.74; CI95%=-1.36 to -0.13 and β=-0.96; CI95%=-1.71 to -0.21, at 3 and 12 months). Currently working also predicts less pain severity at 12 months (β=-0.77; CI95%=1.52 - 0.02). With regard to the psychological variables, pain catastrophizing predicted pain severity and interference at three months (β = 0.03; 95% CI = 0.00-0.05 and β = 0.03; 95% CI = 0.00-0.05), but not at long term. CONCLUSION In a sample of adults with chronic pain and depression, this primary care study has identified prognostic factors that independently predict the severity and functional interference of pain. If confirmed in new studies, these factors should be targeted for individualized interventions. TRIAL REGISTRATION ClinicalTrials.gov (NCT02605278), registered 16/11/2015.
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Affiliation(s)
- Concepció Rambla
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain
- Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Enric Aragonès
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain.
- Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain.
- Centre d'Atenció Primària Constantí, Carrer dels Horts, 6, Constantí, 43120, Tarragona, Spain.
| | | | - Catarina Tomé-Pires
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain
- Psychology Research Center (CIP), Autonomous University of Lisbon, Lisboa, Portugal
| | - Germán López-Cortacans
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain
- Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
| | - Jordi Miró
- Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
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13
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Li M, Tang H, Liu X. Primary care team and its association with quality of care for people with multimorbidity: a systematic review. BMC PRIMARY CARE 2023; 24:20. [PMID: 36653754 PMCID: PMC9850572 DOI: 10.1186/s12875-023-01968-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Multimorbidity is posing an enormous burden to health systems, especially for primary healthcare system. While primary care teams (PCTs) are believed to have potentials to improve quality of primary health care (PHC), less is known about their impact on the quality of care for people with multimorbidity. We assessed the characteristics of PCTs and their impact on the quality of care for people with multimorbidity and the mechanisms. METHODS: We searched PubMed, MEDLINE, EMBASE, ProQuest for published studies from January 2000 to October 2021 for studies in English. Following through PRISMA guidelines, two reviewers independently abstracted data and reconciled by consensus with a third reviewer. Titles, abstracts, and full texts were evaluated to identify relevant studies. Studies were categorized by types of interventions, the impact of interventions on outcome measures, and mechanisms of interventions. RESULTS: Seventeen studies (13 RCT, 3 cohort studies, and 1 non-randomized trial) were identified. PCTs were summarized into three types-upward PCTs, downward PCTs and traditional PCTs according to the skill mix. The upward PCTs included primary care workers and specialists from upper-level hospitals, downward PCTs involving primary care workers and lay health workers, and traditional PCTs involving physicians and care managers. PCTs improved patients' mental and psychological health outcomes greatly, and also improved patients' perceptions towards care including satisfaction with care, sense of improvement, and patient-centeredness. PCTs also improved the process of care and changed providers' behaviors. However, PCTs showed mixed effects on clinical outcome measures. CONCLUSIONS PCTs have improved mental and psychological health outcomes, the process of care, patients' care experiences, and satisfaction towards care for patients with multimorbidity. The effect of PCTs on clinical outcomes and changes in patient behaviors need to be further explored.
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Affiliation(s)
- Mingyue Li
- grid.11135.370000 0001 2256 9319Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China ,grid.11135.370000 0001 2256 9319China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Beijing, 100191 China
| | - Haoqing Tang
- grid.11135.370000 0001 2256 9319Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China ,grid.11135.370000 0001 2256 9319China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Beijing, 100191 China
| | - Xiaoyun Liu
- grid.11135.370000 0001 2256 9319China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Beijing, 100191 China
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14
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Onwumere J, Stubbs B, Stirling M, Shiers D, Gaughran F, Rice AS, C de C Williams A, Scott W. Pain management in people with severe mental illness: an agenda for progress. Pain 2022; 163:1653-1660. [PMID: 35297819 PMCID: PMC9393797 DOI: 10.1097/j.pain.0000000000002633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/31/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text.
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Affiliation(s)
- Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, United Kingdom
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Mary Stirling
- Involvement Register Member of South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Service User Member of Oxleas NHS Foundation Trust, London, United Kingdom
- Mind and Body Expert Advisory Group, King's Health Partners, London, United Kingdom
- Patient Governor of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, United Kingdom
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
- Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Fiona Gaughran
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Andrew S.C. Rice
- Pain Research Group, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Amanda C de C Williams
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Whitney Scott
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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15
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Kappelin C, Carlsson AC, Wachtler C. Specific content for collaborative care: a systematic review of collaborative care interventions for patients with multimorbidity involving depression and/or anxiety in primary care. Fam Pract 2022; 39:725-734. [PMID: 34546354 PMCID: PMC9295603 DOI: 10.1093/fampra/cmab079] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In primary care (PC) many patients suffer from multimorbidity involving depression and/or anxiety. Collaborative care (CC) has shown promising results for patients with depression, anxiety, and multimorbidity involving depression. However, specific content in CC for patients with multimorbidity involving depression and/or anxiety is unknown. OBJECTIVE (i) To examine the effect of CC interventions in patients with multimorbidity involving depression and/or anxiety compared with usual care; (ii) to identify specific content of CC. METHODS We conducted a systematic literature review of randomized controlled trial studies evaluating CC models for adults with multimorbidity involving depression and/or anxiety in PC settings. PubMed, CINAHL, Web of Science, and PsycInfo were searched in December 2019. We conducted a qualitative synthesis using an existing framework and developed a new framework to map the content for each studied intervention. RESULTS We identified 1,447 studies. Twelve publications were included. Eleven had medium-to-high quality of CC for patients with multimorbidity involving depression. Specific content of CC in these studies is: A stepped care model, involving medication and psychotherapy delivered by a nurse or psychologist Care Manager (CM) focusing on problem-solving techniques; follow-up including monitoring of symptoms and function, and relapse prevention strategies; scheduled CM supervision. CONCLUSIONS Specific content for CC for patients with multimorbidity involving depression is identified from current research. Research gaps were found regarding CC for patients with multimorbidity and anxiety, depression and anxiety, and depression and/or anxiety and more than 2 diseases.
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Affiliation(s)
- Caroline Kappelin
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Huddinge, Sweden
| | - Axel C Carlsson
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Huddinge, Sweden.,Academic Primary Healthcare Centre, Stockholm, Sweden
| | - Caroline Wachtler
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Huddinge, Sweden
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16
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Costa F, Janela D, Molinos M, Moulder R, Bento V, Lains J, Scheer J, Yanamadala V, Cohen S, Dias Correia F. Depression and work productivity: insights from a longitudinal cohort study on digital care programs for Musculoskeletal conditions. J Med Internet Res 2022; 24:e38942. [PMID: 35714099 PMCID: PMC9361146 DOI: 10.2196/38942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Comorbidity between musculoskeletal (MSK) pain and depression is highly common and associated with greater symptom burden and greater loss of work productivity. Multimodal care programs tackling both physical and mental health components may maximize productivity recovery and return to work. Digital delivery of such programs can facilitate access, ensure continuity of care, and enhance patient engagement. OBJECTIVE Assess the impact of a completely remote multimodal digital care program (DCP) for MSK pain on mental health and work-related outcomes stratified by baseline depression levels. METHODS The present study is an ad-hoc analysis of an interventional, single-arm, cohort study of individuals with MSK pain undergoing a DCP. Three subgroups with different baseline depression severity levels were created based on the Patient Health Questionnaire (PHQ-9): cluster 1 (<5: minimal depression); cluster 2 (5-10: mild depression) and cluster 3 (≥10: moderate depression). The mean change between baseline and end-of-program (8-12 weeks) on depression, anxiety, fear-avoidance beliefs, work productivity and activity impairment and adherence was assessed across subgroups. Outcome changes were analyzed by latent growth curve analysis. RESULTS From a total of 7785 eligible participants, 6137 (78.8%) were included in Cluster 1, 1158 (14.9%) in cluster 2 and 490 (6.3%) in cluster 3. Significant improvements in depression and anxiety scores were observed in clusters 2 and 3 but not cluster 1, with average end-of-the program scores in clusters 2 and 3 below the initially defined cluster thresholds (5 and 10 for clusters 2 and 3, respectively). All clusters reported significant improvements in productivity impairment scores (mean changes from -16.82, 95%CI -20.32 to -13.42 in cluster 1 to -20.10, 95%CI -32.64 to -7.57 in cluster 3). Higher adherence was associated with higher improvements in depression in clusters 2 and 3, and with greater recovery in activities of daily living in cluster 3. Overall patient satisfaction was 8.59/10.0 (SD 1.74). CONCLUSIONS A multimodal DCP was able to promote improvements in productivity impairment scores comparable to those previously reported in the literature, even in participants with comorbid depression and anxiety. These results reinforce the need to follow a biopsychosocial framework to optimize outcomes in patients with MSK pain. CLINICALTRIAL ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946.
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Affiliation(s)
- Fabíola Costa
- SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, US
| | - Dora Janela
- SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, US
| | - Maria Molinos
- SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, US
| | - Robert Moulder
- Institute for Cognitive Science, University of Colorado, Boulder, US
| | - Vírgilio Bento
- SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, US
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, PT.,Faculty of Medicine, Coimbra University, Coimbra, PT
| | - Justin Scheer
- Department of Neurological Surgery, University of California, San Francisco, US
| | - Vijay Yanamadala
- Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, US.,Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, US.,SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, US
| | - Steven Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, US.,Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Maryland, USA, Bethesda, US
| | - Fernando Dias Correia
- SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, US.,Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, PT
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17
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Chronic Pain in Musculoskeletal Diseases: Do You Know Your Enemy? J Clin Med 2022; 11:jcm11092609. [PMID: 35566735 PMCID: PMC9101840 DOI: 10.3390/jcm11092609] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 02/06/2023] Open
Abstract
Musculoskeletal pain is a condition that characterises several diseases and represents a constantly growing issue with enormous socio-economic burdens, highlighting the importance of developing treatment algorithms appropriate to the patient’s needs and effective management strategies. Indeed, the algic condition must be assessed and treated independently of the underlying pathological process since it has an extremely negative impact on the emotional and psychic aspects of the individual, leading to isolation and depression. A full understanding of the pathophysiological mechanisms involved in nociceptive stimulation and central sensitization is an important step in improving approaches to musculoskeletal pain. In this context, the bidirectional relationship between immune cells and neurons involved in nociception could represent a key point in the understanding of these mechanisms. Therefore, we provide an updated overview of the magnitude of the musculoskeletal pain problem, in terms of prevalence and costs, and summarise the role of the most important molecular players involved in the development and maintenance of pain. Finally, based on the pathophysiological mechanisms, we propose a model, called the “musculoskeletal pain cycle”, which could be a useful tool to counteract resignation to the algic condition and provide a starting point for developing a treatment algorithm for the patient with musculoskeletal pain.
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18
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Teaming in Interdisciplinary Chronic Pain Management Interventions in Primary Care: a Systematic Review of Randomized Controlled Trials. J Gen Intern Med 2022; 37:1501-1512. [PMID: 35239110 PMCID: PMC9086072 DOI: 10.1007/s11606-021-07255-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/28/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND Current pain management recommendations emphasize leveraging interdisciplinary teams. We aimed to identify key features of interdisciplinary team structures and processes associated with improved pain outcomes for patients experiencing chronic pain in primary care settings. METHODS We searched PubMed, EMBASE, and CINAHL for randomized studies published after 2009. Included studies had to report patient-reported pain outcomes (e.g., BPI total pain, GCPS pain intensity, RMDQ pain-related disability), include primary care as an intervention setting, and demonstrate some evidence of teamwork or teaming; specifically, they needed to involve at least two clinicians interacting with each other and with patients in an ongoing process over at least two timepoints. We assessed study quality with the Cochrane Risk of Bias tool. We narratively synthesized intervention team structures and processes, comparing among interventions that reported a clinically meaningful improvement in patient-reported pain outcomes defined by the minimal clinically important difference (MCID). RESULTS We included 13 total interventions in our review, of which eight reported a clinically meaningful improvement in at least one patient-reported pain outcome. No included studies had an overall high risk of bias. We identified the role of a care manager as a common structural feature of the interventions with some clinical effect on patient-reported pain. The team processes involving clinicians varied across interventions reporting clinically improved pain outcomes. However, when analyzing team processes involving patients, six of the interventions with some clinical effect on pain relied on pre-scheduled phone calls for continuous patient follow-up. DISCUSSION Our review suggests that interdisciplinary interventions incorporating teamwork and teaming can improve patient-reported pain outcomes in comparison to usual care. Given the current evidence, future interventions might prioritize care managers and mechanisms for patient follow-up to help bridge the gap between clinical guidelines and the implementation of interdisciplinary, team-based chronic pain care.
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19
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Hohenschurz-Schmidt D, Kleykamp BA, Draper-Rodi J, Vollert J, Chan J, Ferguson M, McNicol E, Phalip J, Evans SR, Turk DC, Dworkin RH, Rice AS. Pragmatic trials of pain therapies: a systematic review of methods. Pain 2022; 163:21-46. [PMID: 34490854 PMCID: PMC8675058 DOI: 10.1097/j.pain.0000000000002317] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/05/2022]
Abstract
ABSTRACT Pragmatic randomised clinical trials aim to directly inform clinical or health policy decision making. Here, we systematically review methods and design of pragmatic trials of pain therapies to examine methods, identify common challenges, and areas for improvement. Seven databases were searched for pragmatic randomised controlled clinical trials that assessed pain treatment in a clinical population of adults reporting pain. All screening steps and data extractions were performed twice. Data were synthesised descriptively, and correlation analyses between prespecified trial features and PRECIS-2 (PRagmatic-Explanatory Continuum Indicator Summary 2) ratings and attrition were performed. Protocol registration: PROSPERO-ID CRD42020178954. Of 57 included trials, only 21% assessed pharmacological interventions, the remainder physical, surgical, psychological, or self-management pain therapies. Three-quarters of the trials were comparative effectiveness designs, often conducted in multiple centres (median: 5; Q1/3: 1, 9.25) and with a median sample size of 234 patients at randomization (Q1/3: 135.5; 363.5). Although most trials recruited patients with chronic pain, reporting of pain duration was poor and not well described. Reporting was comprehensive for most general items, while often deficient for specific pragmatic aspects. Average ratings for pragmatism were highest for treatment adherence flexibility and clinical relevance of outcome measures. They were lowest for patient recruitment methods and extent of follow-up measurements and appointments. Current practice in pragmatic trials of pain treatments can be improved in areas such as patient recruitment and reporting of methods, analysis, and interpretation of data. These improvements will facilitate translatability to other real-world settings-the purpose of pragmatic trials.
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Affiliation(s)
| | - Bethea A. Kleykamp
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Jerry Draper-Rodi
- Research Center, University College of Osteopathy, London, United Kingdom
| | - Jan Vollert
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, United Kingdom
| | - Jessica Chan
- Faculty of Medicine, Imperial College, London, United Kingdom
| | - McKenzie Ferguson
- Department of Pharmacy Practice, Southern Illinois University Edwardsville, Edwardsville, IL, United States
| | - Ewan McNicol
- Department of Pharmacy Practice, MCPHS University, Boston, MA, United States
| | - Jules Phalip
- European School of Osteopathy, Maidstone, United Kingdom
| | - Scott R. Evans
- Department of Biostatistics and Bioinformatics, Biostatistics Center, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Dennis C. Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Robert H. Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Andrew S.C. Rice
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, United Kingdom
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20
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Grigoroglou C, van der Feltz-Cornelis C, Hodkinson A, Coventry PA, Zghebi SS, Kontopantelis E, Bower P, Lovell K, Gilbody S, Waheed W, Dickens C, Archer J, Blakemore A, Adler DA, Aragones E, Björkelund C, Bruce ML, Buszewicz M, Carney RM, Cole MG, Davidson KW, Gensichen J, Grote NK, Russo J, Huijbregts K, Huffman JC, Menchetti M, Patel V, Richards DA, Rollman B, Smit A, Zijlstra-Vlasveld MC, Wells KB, Zimmermann T, Unutzer J, Panagioti M. Effectiveness of collaborative care in reducing suicidal ideation: An individual participant data meta-analysis. Gen Hosp Psychiatry 2021; 71:27-35. [PMID: 33915444 DOI: 10.1016/j.genhosppsych.2021.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
UNLABELLED To assess whether CC is more effective at reducing suicidal ideation in people with depression compared with usual care, and whether study and patient factors moderate treatment effects. METHOD We searched Medline, Embase, PubMed, PsycINFO, CINAHL, CENTRAL from inception to March 2020 for Randomised Controlled Trials (RCTs) that compared the effectiveness of CC with usual care in depressed adults, and reported changes in suicidal ideation at 4 to 6 months post-randomisation. Mixed-effects models accounted for clustering of participants within trials and heterogeneity across trials. This study is registered with PROSPERO, CRD42020201747. RESULTS We extracted data from 28 RCTs (11,165 patients) of 83 eligible studies. We observed a small significant clinical improvement of CC on suicidal ideation, compared with usual care (SMD, -0.11 [95%CI, -0.15 to -0.08]; I2, 0·47% [95%CI 0.04% to 4.90%]). CC interventions with a recognised psychological treatment were associated with small reductions in suicidal ideation (SMD, -0.15 [95%CI -0.19 to -0.11]). CC was more effective for reducing suicidal ideation among patients aged over 65 years (SMD, - 0.18 [95%CI -0.25 to -0.11]). CONCLUSION Primary care based CC with an embedded psychological intervention is the most effective CC framework for reducing suicidal ideation and older patients may benefit the most.
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Affiliation(s)
- Christos Grigoroglou
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England.
| | | | - Alexander Hodkinson
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Peter A Coventry
- Department of Health Sciences, University of York, York, England
| | - Salwa S Zghebi
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Evangelos Kontopantelis
- Faculty of Biology, Medicine and Health, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, England
| | - Peter Bower
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England; Greater Manchester Mental Health NHS Foundation Trust, Manchester, England
| | - Simon Gilbody
- Department of Health Sciences, Hull York Medical School, HYMS, University of York, York, England
| | - Waquas Waheed
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | | | - Janine Archer
- School of Health and Society, School of Health and Society, University of Salford, England
| | - Amy Blakemore
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England
| | - David A Adler
- Departments of Psychiatry and Medicine, Tufts Medical Center and Tufts University School of Medicine, England
| | - Enric Aragones
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Cecilia Björkelund
- Primary Health Care School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Marta Buszewicz
- Institute of Epidemiology and Health, Faculty of Population and Health Sciences, University College London, London, England
| | - Robert M Carney
- Department of Psychiatry, Washington University in St. Louis (WUSTL), St. Louis, Missouri, USA
| | - Martin G Cole
- Department of Psychiatry, St. Mary's Hospital Center, McGill University, Montreal, Quebec, Canada
| | - Karina W Davidson
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, LMU Klinikum, Ludwig-Maximilians, University Munich Pettenkoferstr. 10, 80336 Munich, Germany
| | - Nancy K Grote
- School of Social Work, University of Washington, Seattle, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Klaas Huijbregts
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jeff C Huffman
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Vikram Patel
- The Pershing Square Professor of Global Health, Harvard Medical School, Boston, MA, USA
| | - David A Richards
- Institute of Health Research, University of Exeter College of Medicine and Health, Exeter, England; Western University of Norway, Bergen, Norway
| | - Bruce Rollman
- Center for Behavioral Health, Media and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Annet Smit
- HAN University of Applied Sciences, Nijmegen, Netherlands
| | | | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA; Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
| | - Thomas Zimmermann
- Department of General Practice / Primary Care, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jurgen Unutzer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Maria Panagioti
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
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21
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Sánchez-Rodríguez E, Aragonès E, Jensen MP, Tomé-Pires C, Rambla C, López-Cortacans G, Miró J. The Role of Pain-Related Cognitions in the Relationship Between Pain Severity, Depression, and Pain Interference in a Sample of Primary Care Patients with Both Chronic Pain and Depression. PAIN MEDICINE 2021; 21:2200-2211. [PMID: 32100028 DOI: 10.1093/pm/pnz363] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aims of this study were twofold: 1) to better understand the associations between pain-related cognitions and pain severity, and psychological and physical function, and 2) to determine the extent to which these cognitions function as mediators in the association between pain severity and depression in a sample of primary care adult patients with chronic pain and depression. DESIGN Cross-sectional design. METHODS Three hundred twenty-eight patients with both depression and chronic pain from primary care centers responded to measures of pain severity, pain interference, depression severity, and pain-related cognitions (including measures of catastrophizing and other pain-related beliefs). We performed three hierarchical regression analyses and two multiple regression analyses. RESULTS The helplessness domain of pain catastrophizing was positively associated with pain severity, depression severity, and pain interference and mediated the relationship between depression and pain severity and vice versa. Beliefs about disability showed a positive association with pain severity, pain interference, and depression severity, and also mediated the relationship between pain severity and depression. Believing in a medical cure was positively associated with pain interference and negatively associated with depression; emotion beliefs were positively associated with pain severity. CONCLUSIONS These findings provide important new information about the associations between several pain-related cognitions and pain severity, depression, and pain interference and the potential mediating roles that these cognitions play in the associations between pain severity and depression in patients with both chronic pain and depression in the primary care setting.
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Affiliation(s)
- Elisabet Sánchez-Rodríguez
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili, Catalonia, Spain
| | - Enric Aragonès
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Catarina Tomé-Pires
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili, Catalonia, Spain.,Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Concepció Rambla
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Germán López-Cortacans
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Jordi Miró
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili, Catalonia, Spain
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22
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Acupuncture for Chronic Pain-Related Depression: A Systematic Review and Meta-Analysis. Pain Res Manag 2021; 2021:6617075. [PMID: PMID: 33680223 PMCID: PMC7925064 DOI: 10.1155/2021/6617075] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 11/17/2022]
Abstract
Objective The aim of this systematic review was to summarize and evaluate the existing evidence on the effectiveness and safety of acupuncture in relieving chronic pain-related depression (CPRD). Methods We searched seven online databases to identify eligible randomized controlled trials (RCTs) of acupuncture for CPRD published before September 2020. We included studies that used acupuncture as the intervention group, with or without a control group, and the control group was treated with conventional drugs. Meta-analysis was performed using RevMan 5.3 software. For outcomes, assessments were performed using the Hamilton Depression Scale (HAMD), Visual Analogue Scale (VAS), and adverse events. Results Eight studies involving 636 participants were identified and included in the meta-analysis. The results showed that single acupuncture treatment and drug treatment have the same effect in improving the HAMD score (MD = -0.14, 95% CI = [-0.88, 0.59], P = 0.71) and alleviating the VAS score (MD = -0.42, 95% CI = [-1.10, -0.27], P = 0.23), but acupuncture treatment is safer (OR = 0.03, 95% CI = [0.01, 0.21], P = 0.0003). In addition, acupuncture combined with drugs (control group) is more beneficial than single-drug treatment in improving the HAMD score (MD = -2.95, 95% CI = [-3.55, -2.36], P < 0.00001) and alleviating the VAS score (MD = -1.06, 95% CI = [-1.65, -0.47], P = 0.0004). Conclusion Acupuncture is an effective and safe treatment for CPRD, and acupuncture combined with drug therapy is more effective than single-drug therapy. Nevertheless, the conclusions were limited due to the low quality and a small number of included studies.
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23
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Söderlund A, von Heideken Wågert P. Adherence to and the Maintenance of Self-Management Behaviour in Older People with Musculoskeletal Pain-A Scoping Review and Theoretical Models. J Clin Med 2021; 10:jcm10020303. [PMID: 33467552 PMCID: PMC7830780 DOI: 10.3390/jcm10020303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
(1) Background: Adherence to and the maintenance of treatment regimens are fundamental for pain self-management and sustainable behavioural changes. The first aim was to study older adults’ (>65 years) levels of adherence to and maintenance of musculoskeletal pain self-management programmes in randomized controlled trials. The second aim was to suggest theoretical models of adherence to and maintenance of a behaviour. (2) Methods: The study was conducted in accordance with the recommendations for a scoping review and the PRISMA-ScR checklist. Capability, motivation and opportunity were used to categorize the behavioural change components in the theoretical models. (3) Results: Among the four studies included, components targeting adherence were reported in one study, and maintenance was reported in two studies. Adherence was assessed by the treatment attendance rates, and maintenance was assessed by the follow-up data of outcome measures. For adherence, the capability components were mostly about education and the supervision, grading and mastery of exercise to increase self-efficacy. The motivation components included the readiness to change, self-monitoring and goal setting; and the opportunity components included booster sessions, feedback and social support. For maintenance, the capability components consisted of identifying high-risk situations for relapse and problem-solving skills. The motivation components included self-regulation and self-efficacy for problem solving, and the opportunity components included environmental triggers and problem solving by using social support. (4) Conclusion: There are several behavioural change components that should be used to increase older adults’ levels of adherence to and maintenance of a pain self-management behaviour.
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24
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John JR, Jani H, Peters K, Agho K, Tannous WK. The Effectiveness of Patient-Centred Medical Home-Based Models of Care versus Standard Primary Care in Chronic Disease Management: A Systematic Review and Meta-Analysis of Randomised and Non-Randomised Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6886. [PMID: 32967161 PMCID: PMC7558011 DOI: 10.3390/ijerph17186886] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/14/2020] [Accepted: 09/18/2020] [Indexed: 12/20/2022]
Abstract
Patient-centred care by a coordinated primary care team may be more effective than standard care in chronic disease management. We synthesised evidence to determine whether patient-centred medical home (PCMH)-based care models are more effective than standard general practitioner (GP) care in improving biomedical, hospital, and economic outcomes. MEDLINE, CINAHL, Embase, Cochrane Library, and Scopus were searched to identify randomised (RCTs) and non-randomised controlled trials that evaluated two or more principles of PCMH among primary care patients with chronic diseases. Study selection, data extraction, quality assessment using Joanna Briggs Institute (JBI) appraisal tools, and grading of evidence using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach were conducted independently. A quantitative synthesis, where possible, was pooled using random effects models and the effect size estimates of standardised mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals were reported. Of the 13,820 citations, we identified 78 eligible RCTs and 7 quasi trials which included 60,617 patients. The findings suggested that PCMH-based care was associated with significant improvements in depression episodes (SMD -0.24; 95% CI -0.35, -0.14; I2 = 76%) and increased odds of remission (OR 1.79; 95% CI 1.46, 2.21; I2 = 0%). There were significant improvements in the health-related quality of life (SMD 0.10; 95% CI 0.04, 0.15; I2 = 51%), self-management outcomes (SMD 0.24; 95% CI 0.03, 0.44; I2 = 83%), and hospital admissions (OR 0.83; 95% CI 0.70, 0.98; I2 = 0%). In terms of biomedical outcomes, with exception to total cholesterol, PCMH-based care led to significant improvements in blood pressure, glycated haemoglobin, and low-density lipoprotein cholesterol outcomes. The incremental cost of PCMH care was identified to be small and significantly higher than standard care (SMD 0.17; 95% CI 0.08, 0.26; I2 = 82%). The quality of individual studies ranged from "fair" to "good" by meeting at least 60% of items on the quality appraisal checklist. Additionally, moderate to high heterogeneity across studies in outcomes resulted in downgrading the included studies as moderate or low grade of evidence. PCMH-based care has been found to be superior to standard GP care in chronic disease management. Results of the review have important implications that may inform patient, practice, and policy-level changes.
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Affiliation(s)
- James Rufus John
- Translational Health Research Institute, Western Sydney University, Sydney, NSW 2560, Australia; (H.J.); (K.A.); (W.K.T.)
- Rozetta Institute, Level 4, 55 Harrington Street, Sydney, NSW 2000, Australia
| | - Hir Jani
- Translational Health Research Institute, Western Sydney University, Sydney, NSW 2560, Australia; (H.J.); (K.A.); (W.K.T.)
| | - Kath Peters
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW 2560, Australia;
| | - Kingsley Agho
- Translational Health Research Institute, Western Sydney University, Sydney, NSW 2560, Australia; (H.J.); (K.A.); (W.K.T.)
- School of Science and Health, Western Sydney University, Sydney, NSW 2560, Australia
| | - W. Kathy Tannous
- Translational Health Research Institute, Western Sydney University, Sydney, NSW 2560, Australia; (H.J.); (K.A.); (W.K.T.)
- School of Business, Western Sydney University, Sydney, NSW 2150, Australia
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25
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Aragonès E, Sánchez-Iriso E, López-Cortacans G, Tomé-Pires C, Rambla C, Sánchez-Rodríguez E. Cost-effectiveness of a collaborative care program for managing major depression and chronic musculoskeletal pain in primary care: Economic evaluation alongside a randomized controlled trial. J Psychosom Res 2020; 135:110167. [PMID: 32554105 DOI: 10.1016/j.jpsychores.2020.110167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND We designed a collaborative care program for the integrated management of chronic musculoskeletal pain and depression, which frequently coexist in primary care patients. The aim of this study was to evaluate the cost-effectiveness of this program compared with care as usual. METHODS We performed a cost-effectiveness analysis alongside a randomized clinical trial. Results were monitored over a 12-month period. The primary outcome was the incremental cost-effectiveness ratio (ICER). We performed cost-effectiveness analyses from the perspectives of the healthcare system and society using an intention-to-treat approach with imputation of missing values. RESULTS We evaluated 328 patients (167 in the intervention group and 161 in the control group) with chronic musculoskeletal pain and major depression at baseline. From the healthcare system perspective, the mean incremental cost was €234 (p = .17) and the mean incremental effectiveness was 0.009 QALYs (p = .66), resulting in an ICER of €23,989/QALY. Costs from the societal perspective were €235 (p = .16), yielding an ICER of €24,102/QALY. These estimates were associated with a high degree of uncertainty illustrated on the cost-effectiveness plane. CONCLUSIONS Contrary to our expectations, the collaborative care program had no significant effects on health status, and although the additional costs of implementing the program compared with care as usual were not high, we were unable to demonstrate a favorable cost-effectiveness ratio, largely due to the high degree of uncertainty surrounding the estimates.
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Affiliation(s)
- Enric Aragonès
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain.
| | - Eduardo Sánchez-Iriso
- Department of Economics, Public University of Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Germán López-Cortacans
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Catarina Tomé-Pires
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; ISCTE-Lisbon University Institute (ISCTE-IUL), Center for Social Research and Intervention (CIS-IUL), Lisbon, Portugal
| | - Concepción Rambla
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain; Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
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