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Berry OO, Kaufman P, Weiss M, Fitelson E, Monk C. Co-location of specialized mental health services in an intimate partner violence advocacy organization. MEDICINE, SCIENCE, AND THE LAW 2024; 64:138-149. [PMID: 37606565 DOI: 10.1177/00258024231195496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Historically, services for intimate partner violence (IPV) survivors predominantly focused on advocacy, resulting in service gaps for IPV survivors who need mental health care. When mental health services are offered, there are several barriers that limit treatment engagement. To address these gaps, a novel, integrated care model, comprised of psychiatrists, clinical psychologists, and social workers were embedded into the five New York City (NYC) Family Justice Centers (FJCs), to provide free co-located mental health care to adult survivors of IPV alongside the existing advocacy, social, and legal services. This article reports on the evaluation of the Health + Hospitals Family Justice Center Mental Health Program (FJCMHP) via: (i) seven focus groups with FJC clients and staff and Health + Hospitals (H+H) clinicians; and (ii) de-identified online surveys completed by 53 FJC clients and 130 FJC staff. Clients reported increased access to care, with 67.2% seeing a mental health clinician within two weeks of a request, and improvement in symptom relief, including sleep, mood, irritability, reduction in thoughts of self-harm, improved relationships with others, especially their children, and improved self-efficacy in parenting skills. Additionally, FJC staff reported satisfaction with the FJCMHP model, and increased understanding of clients' mental health needs. The evaluation results highlight the feasibility and tolerability of integrated mental health services in a non-medical setting. The evaluation also identifies areas for improvement, as well as the strengths of an integrated, multidisciplinary mental health service program for IPV survivors co-located in a non-medical, advocacy setting.
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Affiliation(s)
- Obianuju O Berry
- Office of Behavioral Health, NYC Health + Hospitals, New York, NY, USA
- Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, USA
| | - Phyllis Kaufman
- Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, USA
| | - Marina Weiss
- Center for Innovation in Mental Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Elizabeth Fitelson
- Department of Psychiatry, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Catherine Monk
- Department of Psychiatry, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
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Köbler P, Krauss-Köstler EK, Stein B, Ficker JH, Wilhelm M, Dechêne A, Waller C. Specialized Biopsychosocial Care in Inpatient Somatic Medicine Units-A Pilot Study. Front Public Health 2022; 10:844874. [PMID: 35493384 PMCID: PMC9039260 DOI: 10.3389/fpubh.2022.844874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Specialized biopsychosocial care concepts are necessary to overcome the dualism between physical and psychosocial treatment in acute care hospitals. For patients with complex and chronic comorbid physical and mental health problems, neither standardized psychiatric/psychosomatic nor somatic care units alone are appropriate to their needs. The “Nuremberg Integrated Psychosomatic Acute Unit” (NIPA) has been developed to integrate treatment of both, psychosocial and physical impairments, in an acute somatic care setting. Method NIPA has been established in inpatient internal medical wards for respiratory medicine, oncology and gastroenterology. One to two patients per ward are regularly enrolled in the NIPA treatment while remaining in the same inpatient bed after completion of the somatic care. In a naturalistic study design, we evaluated treatment effects by assessment of symptom load at admission and at discharge using the Patient Health Questionnaire (PHQ) and the Generalized Anxiety Disorder Scale-7 (GAD-7). Furthermore, we assessed the severity of morbidity using diagnosis data during treatment. At discharge, we measured satisfaction with treatment through the Patient Satisfaction Questionnaire (ZUF-8). Results Data from 41 NIPA patients were analyzed (18–87 years, 76% female). Seventy-eight percent suffered from at least moderate depression and 49% from anxiety disorders. Other diagnoses were somatoform pain disorder, somatoform autonomic dysfunction, eating disorder and posttraumatic stress disorder. Hypertension, chronic lung diseases and musculoskeletal disorders as well as chronic oncological and cardiac diseases were the most common somatic comorbidities. Treatment resulted in a significant reduction of depressive mood (admission: M = 10.9, SD = 6.1, discharge: M = 7.6, SD = 5.3, d = 0.58, p = 0.001), anxiety (admission: M = 10.6, SD = 4.9, discharge: M = 7.3, SD = 4.1, d = 0.65, p< 0.001) and stress (admission: M = 6.0, SD = 3.6, discharge: M = 4.1, SD = 2.5, d = 0.70, p< 0.001). Somatic symptom burden was reduced by NIPA treatment (admission: M = 10.9, SD = 5.8, discharge: M = 9.6, SD = 5.5, d = 0.30), albeit not statistically significant (p = 0.073) ZUF-8 revealed that 89% reported large or full satisfaction and 11% partial dissatisfaction with treatment. Discussion NIPA acute care is bridging the gap for patients in need of psychosocial treatment with complex somatic comorbidity. Further long-term evaluation will show whether psychosocial NIPA care is able to reduce the course of physical illness and hospital costs by preventing hospitalization and short-term inpatient re-admissions.
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Affiliation(s)
- Paul Köbler
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Eva K Krauss-Köstler
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Joachim H Ficker
- Department of Internal Medicine 3, Respiratory Medicine, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Martin Wilhelm
- Department of Internal Medicine 5, Oncology/Hematology, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Alexander Dechêne
- Department of Internal Medicine 6, Gastroenterology, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
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Davidsen AS, Davidsen J, Jønsson ABR, Nielsen MH, Kjellberg PK, Reventlow S. Experiences of barriers to trans-sectoral treatment of patients with severe mental illness. A qualitative study. Int J Ment Health Syst 2020; 14:87. [PMID: 33292415 PMCID: PMC7706214 DOI: 10.1186/s13033-020-00419-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 11/19/2020] [Indexed: 01/11/2023] Open
Abstract
Background Patients with severe mental illness (SMI) have shorter life expectancy than people without SMI, mainly due to overmortality from physical diseases. They are treated by professionals in three different health and social care sectors with sparse collaboration between them, hampering coherent treatment. Previous studies have shown difficulties involved in establishing such collaboration. As the preparatory phase of an intervention to improve physical health of people with SMI and increase collaboration across sector borders, we explored different actors’ experiences of barriers for collaboration. Method We collected qualitative data from patients, professionals in general practice, psychiatry and social psychiatry involved in the treatment of these patients. Data consisted of notes from meetings and observations, interviews, focus groups and workshops. Analysis was by Interpretative Phenomenological Analysis. Results The study revealed many obstacles to collaboration and coherent treatment, including the consultation structures in general practice, sectors being subject to different legislation, and incompatible IT systems. Professionals in general practice and social psychiatry felt that they were left with the responsibility for actions taken by hospital psychiatry without opportunity to discuss their concerns with psychiatrists. There were also cultural differences between health care and social psychiatry, expressed in ideology and language. Social psychiatry had an existential approach to recovery, whereas the views of health professionals were linked to symptom control and based on outcomes. Meanwhile, patients were left in limbo between these separate ideologies with no leadership in place to promote dialogue and integrate treatments between the sectors. Conclusion Many obstacles to integrated trans-sectoral treatment of patients with SMI seem related to a lack of an overriding leadership and organizational support to establish collaboration and remove barriers related to legislation and IT. However, professional and ideological barriers also contribute. Psychiatry does not consider general practice to be part of the treatment team although general practitioners are left with responsibility for decisions taken in psychiatry; and different ideologies and treatment principles in psychiatry and municipal social psychiatry hamper the dialogue between them. There is a need to rethink the organization to avoid that the three sectors live autonomous lives with different cultures and lack of collaboration.
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Affiliation(s)
- Annette Sofie Davidsen
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Oester Farimagsgade 5, 1014, Copenhagen K, Denmark.
| | - Johan Davidsen
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Oester Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Alexandra Brandt Ryborg Jønsson
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Oester Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Maria Haahr Nielsen
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Oester Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Pia Kürstein Kjellberg
- Department of Health, VIVE-the Danish Center for Social Science Research, Herluf Trollesgade 11, 1052, Copenhagen K, Denmark
| | - Susanne Reventlow
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Oester Farimagsgade 5, 1014, Copenhagen K, Denmark
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McKinnon K, Satriano J, Alves-Bradford JM, Erby W, Jaafar FJ, Simonen EH, Gozzo IS, Robles Huang AN, Sposito JS, Tao Z, Zakoian MJ, Zurita McKinnon A, Cournos F. Three Decades and Counting: HIV Service Provision in Outpatient Mental Health Settings. Psychiatr Serv 2020; 71:726-729. [PMID: 32151215 DOI: 10.1176/appi.ps.201900415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE People with serious mental illness in the United States have higher human immunodeficiency virus (HIV) infection rates than the general U.S. population. This study aimed to assess delivery of HIV services in New York State's outpatient mental health programs. Greater access would enhance efforts to improve HIV prevention and care outcomes. METHODS The authors surveyed directors of licensed outpatient mental health care programs statewide to investigate their HIV service delivery. Data were compared with surveys conducted in 1997 and 2004 in order to examine differences in services between geographic regions and time periods. RESULTS Outpatient mental health programs have improved in the volume and range of HIV services offered, but their provision of preexposure prophylaxis, condoms, HIV testing, and HIV antiretroviral treatment monitoring has lagged. CONCLUSIONS New York's initiative to end the HIV epidemic is not optimized to reach people with serious mental illness in settings designed for their care.
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Affiliation(s)
- Karen McKinnon
- Washington Heights Community Service, New York State Psychiatric Institute (McKinnon, Alves-Bradford); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (McKinnon, Alves-Bradford); Northeast/Caribbean AIDS Education and Training Center (Satriano, Cournos); Columbia University HIV Behavioral Health Training (Erby, Simonen, Gozzo, Robles Huang, Sposito, Tao, Zakoian, Zurita McKinnon); Columbia University Mailman School of Public Health (Jaafar, Cournos), all in New York
| | - James Satriano
- Washington Heights Community Service, New York State Psychiatric Institute (McKinnon, Alves-Bradford); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (McKinnon, Alves-Bradford); Northeast/Caribbean AIDS Education and Training Center (Satriano, Cournos); Columbia University HIV Behavioral Health Training (Erby, Simonen, Gozzo, Robles Huang, Sposito, Tao, Zakoian, Zurita McKinnon); Columbia University Mailman School of Public Health (Jaafar, Cournos), all in New York
| | - Jean-Marie Alves-Bradford
- Washington Heights Community Service, New York State Psychiatric Institute (McKinnon, Alves-Bradford); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (McKinnon, Alves-Bradford); Northeast/Caribbean AIDS Education and Training Center (Satriano, Cournos); Columbia University HIV Behavioral Health Training (Erby, Simonen, Gozzo, Robles Huang, Sposito, Tao, Zakoian, Zurita McKinnon); Columbia University Mailman School of Public Health (Jaafar, Cournos), all in New York
| | - Whitney Erby
- Washington Heights Community Service, New York State Psychiatric Institute (McKinnon, Alves-Bradford); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (McKinnon, Alves-Bradford); Northeast/Caribbean AIDS Education and Training Center (Satriano, Cournos); Columbia University HIV Behavioral Health Training (Erby, Simonen, Gozzo, Robles Huang, Sposito, Tao, Zakoian, Zurita McKinnon); Columbia University Mailman School of Public Health (Jaafar, Cournos), all in New York
| | - Fatima J Jaafar
- Washington Heights Community Service, New York State Psychiatric Institute (McKinnon, Alves-Bradford); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (McKinnon, Alves-Bradford); Northeast/Caribbean AIDS Education and Training Center (Satriano, Cournos); Columbia University HIV Behavioral Health Training (Erby, Simonen, Gozzo, Robles Huang, Sposito, Tao, Zakoian, Zurita McKinnon); Columbia University Mailman School of Public Health (Jaafar, Cournos), all in New York
| | - Elizabeth H Simonen
- Washington Heights Community Service, New York State Psychiatric Institute (McKinnon, Alves-Bradford); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (McKinnon, Alves-Bradford); Northeast/Caribbean AIDS Education and Training Center (Satriano, Cournos); Columbia University HIV Behavioral Health Training (Erby, Simonen, Gozzo, Robles Huang, Sposito, Tao, Zakoian, Zurita McKinnon); Columbia University Mailman School of Public Health (Jaafar, Cournos), all in New York
| | - Izabella S Gozzo
- Washington Heights Community Service, New York State Psychiatric Institute (McKinnon, Alves-Bradford); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (McKinnon, Alves-Bradford); Northeast/Caribbean AIDS Education and Training Center (Satriano, Cournos); Columbia University HIV Behavioral Health Training (Erby, Simonen, Gozzo, Robles Huang, Sposito, Tao, Zakoian, Zurita McKinnon); Columbia University Mailman School of Public Health (Jaafar, Cournos), all in New York
| | - Amy N Robles Huang
- Washington Heights Community Service, New York State Psychiatric Institute (McKinnon, Alves-Bradford); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (McKinnon, Alves-Bradford); Northeast/Caribbean AIDS Education and Training Center (Satriano, Cournos); Columbia University HIV Behavioral Health Training (Erby, Simonen, Gozzo, Robles Huang, Sposito, Tao, Zakoian, Zurita McKinnon); Columbia University Mailman School of Public Health (Jaafar, Cournos), all in New York
| | - Jonah S Sposito
- Washington Heights Community Service, New York State Psychiatric Institute (McKinnon, Alves-Bradford); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (McKinnon, Alves-Bradford); Northeast/Caribbean AIDS Education and Training Center (Satriano, Cournos); Columbia University HIV Behavioral Health Training (Erby, Simonen, Gozzo, Robles Huang, Sposito, Tao, Zakoian, Zurita McKinnon); Columbia University Mailman School of Public Health (Jaafar, Cournos), all in New York
| | - Ziyi Tao
- Washington Heights Community Service, New York State Psychiatric Institute (McKinnon, Alves-Bradford); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (McKinnon, Alves-Bradford); Northeast/Caribbean AIDS Education and Training Center (Satriano, Cournos); Columbia University HIV Behavioral Health Training (Erby, Simonen, Gozzo, Robles Huang, Sposito, Tao, Zakoian, Zurita McKinnon); Columbia University Mailman School of Public Health (Jaafar, Cournos), all in New York
| | - Martin J Zakoian
- Washington Heights Community Service, New York State Psychiatric Institute (McKinnon, Alves-Bradford); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (McKinnon, Alves-Bradford); Northeast/Caribbean AIDS Education and Training Center (Satriano, Cournos); Columbia University HIV Behavioral Health Training (Erby, Simonen, Gozzo, Robles Huang, Sposito, Tao, Zakoian, Zurita McKinnon); Columbia University Mailman School of Public Health (Jaafar, Cournos), all in New York
| | - Alma Zurita McKinnon
- Washington Heights Community Service, New York State Psychiatric Institute (McKinnon, Alves-Bradford); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (McKinnon, Alves-Bradford); Northeast/Caribbean AIDS Education and Training Center (Satriano, Cournos); Columbia University HIV Behavioral Health Training (Erby, Simonen, Gozzo, Robles Huang, Sposito, Tao, Zakoian, Zurita McKinnon); Columbia University Mailman School of Public Health (Jaafar, Cournos), all in New York
| | - Francine Cournos
- Washington Heights Community Service, New York State Psychiatric Institute (McKinnon, Alves-Bradford); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (McKinnon, Alves-Bradford); Northeast/Caribbean AIDS Education and Training Center (Satriano, Cournos); Columbia University HIV Behavioral Health Training (Erby, Simonen, Gozzo, Robles Huang, Sposito, Tao, Zakoian, Zurita McKinnon); Columbia University Mailman School of Public Health (Jaafar, Cournos), all in New York
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Babajide A, Ortin A, Wei C, Mufson L, Duarte CS. Transition Cliffs for Young Adults with Anxiety and Depression: Is Integrated Mental Health Care a Solution? J Behav Health Serv Res 2020; 47:275-292. [PMID: 31428923 PMCID: PMC7028507 DOI: 10.1007/s11414-019-09670-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Young adulthood is a major transition period, particularly challenging for those with mental disorders. Though the prevalence of depressive and anxiety disorders is especially high, young adults are less likely to receive mental health treatment than younger and older individuals. Reasons for this mental health treatment gap are multifold and range from individual- to system-level factors that must be taken into consideration when addressing young adult mental health needs. Studies in adults and adolescents have shown that integrated care in primary care settings is an effective model of treatment of mental disorders. After providing an overview of the mental health treatment gap in this developmental period, the argument is made for research focused on integrated care models specifically tailored for young adults that takes into consideration the various needs and challenges that they face and addresses the mental health treatment gap in young adulthood.
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Affiliation(s)
- Azeesat Babajide
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Ana Ortin
- Hunter College, City University of New York, 695 Park Avenue, New York, NY, 10065, USA
| | - Chiaying Wei
- New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY, 10032, USA
| | - Laura Mufson
- New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY, 10032, USA
| | - Cristiane S Duarte
- New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY, 10032, USA.
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Rettke H, Petry H, von Känel R, Jordan KD, Ernst J. [Patients with psychiatric comorbidities in the acute hospital - a field of tension with interprofessional need for action - results from a pilot study]. Pflege 2020; 33:85-91. [PMID: 32107967 DOI: 10.1024/1012-5302/a000718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Patients with psychiatric comorbidities in the acute hospital - a field of tension with interprofessional need for action - results from a pilot study Abstract. Background: Psychiatric comorbidities are frequent in patients hospitalized in an acute care hospital. They often remain undetected or, if diagnosed, neglected. As long as the somatic disease can be properly cared for and treated, this usually remains unproblematic. However, the situation can quickly tip over if psychiatric comorbidities interfere with care and treatment leading to a higher level of care and adverse consequences for patients. Aim: We investigated the need for action for this patient group from the nurses' perspective in a Swiss-German university hospital. Method: In two group discussions, nurses described intense situations, followed by an evaluation of determining factors, insights gained and measures taken to control these situations and prevent them. Results: Nurses experience the described situations as stressful and express a great need for action for themselves and for the interprofessional team. Key points are vigilance in everyday clinical practice, specific knowledge acquisition and an easily accessible local support system. Conclusions: In an acute care hospital, psychiatric comorbidities must be taken into account. However, this requires advanced skills and an organizational, interprofessional approach.
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Affiliation(s)
- Horst Rettke
- Zentrum Klinische Pflegewissenschaft, UniversitätsSpital Zürich
| | - Heidi Petry
- Zentrum Klinische Pflegewissenschaft, UniversitätsSpital Zürich
| | - Roland von Känel
- Klinik für Konsiliarpsychiatrie und Psychosomatik, UniversitätsSpital Zürich
| | | | - Jutta Ernst
- Zentrum Klinische Pflegewissenschaft, UniversitätsSpital Zürich
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Ribeiro AF, Martins Pereira S, Gomes B, Nunes R. Do patients, families, and healthcare teams benefit from the integration of palliative care in burn intensive care units? Results from a systematic review with narrative synthesis. Palliat Med 2019; 33:1241-1254. [PMID: 31296110 DOI: 10.1177/0269216319862160] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Burn units are intensive care facilities specialized in the treatment of patients with severe burns. As burn injuries have a major impact in physical, psychosocial, and spiritual health, palliative care can be a strengthening component of integrated care. AIM To review and appraise the existing evidence about the integration of palliative care in burn intensive care units with respect to (1) the concept, model and design and (2) the benefits and outcomes of this integration. DESIGN A systematic review was conducted following PRISMA guidelines. Protocol registered with PROSPERO (CRD42018111676). DATA SOURCES Five electronic databases were searched (PubMed/NLM, Web of Science, MEDLINE/TR, Ovid, and CINAHL/EBSCO) until May 2019. A narrative synthesis of the findings was constructed. Hawker et al.'s tool was used for quality appraisal. RESULTS A total of 299 articles were identified, of which five were included for analysis involving a total of 7353 individuals. Findings suggest that there may be benefits from integrating palliative care in burn units, specifically in terms of patients' comfort, decision-making processes, and family care. Multidisciplinary teams may experience lower levels of burden as result of integrating palliative care in burn units. CONCLUSION This review reflects the challenging setting of burn intensive care units. Evidence from these articles suggests that the integration of palliative care in burn intensive care units improves patients' comfort, decision-making process, and family care. Further research is needed to better understand how the integration of palliative care in burn intensive care units may be fostered and to identify the outcomes of this integration.
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Affiliation(s)
| | - Sandra Martins Pereira
- Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal.,UNESCO Chair in Bioethics, Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal.,Centro de Estudos em Gestão e Economia (CEGE), Porto Católica Business School, Universidade Católica Portuguesa, Porto, Portugal
| | - Barbara Gomes
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal.,Cicely Saunders Institute, King's College London, London, UK
| | - Rui Nunes
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,International Network UNESCO Chair in Bioethics
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8
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Caarls PJ, van Schijndel MA, van den Berk G, Boenink AD, Boerman D, Lijmer JG, Honig A, Terra M, Thijs A, Verwey B, van Waarde JA, van Wijngaarden J, van Busschbach JJ. Factors influencing the admission decision for Medical Psychiatry Units: A concept mapping approach. PLoS One 2019; 14:e0221807. [PMID: 31527872 PMCID: PMC6748432 DOI: 10.1371/journal.pone.0221807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 08/16/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Medical Psychiatry Units (MPUs), also known as Complexity Intervention Units (CIUs), provide care for complex patients suffering from both psychiatric and physical disorders. Because there is no consensus on the indications for admission to an MPU, daily practice and effectiveness research are hampered. This study therefore used a concept mapping approach to investigate which organizational and medical factors determine the decision to admit a patient to an MPU. METHODS The first step of the concept mapping approach was to create a list of factors determining MPU admission from literature. Secondly, clinical experts sorted and ranked these factors. The sorted and ranked data were then analyzed, and a draft conceptual framework was created. A final conceptual MPU admission framework was then drawn during an expert consensus meeting and recommendations for implementation were suggested. RESULTS Thirteen clinical experts defined 90 factors from literature, which were sorted and ranked by 40 experts from 21 Dutch hospitals. This concept mapping approach resulted in a five-cluster solution for an MPU admission framework based on: 1. Staff competencies and organizational pre-requisites; 2. Patient context; 3. Patient characteristics; 4. Medical needs and capabilities; and 5. Psychiatric symptoms and behavioral problems. Furthermore, three inclusion and two exclusion criteria were formulated to help the clinicians decide whether or not to admit patients to an MPU. These criteria can be implemented in daily practice. CONCLUSION Implementing the five criteria derived from this conceptual framework will help make the admission decision for complex patients with psychiatric and physical disorders to an MPU more correct, consistent, and transparent.
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Affiliation(s)
- P. J. Caarls
- Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
- * E-mail:
| | - M. A. van Schijndel
- Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
- Rijnstate Hospital, Arnhem, The Netherlands
| | | | - A. D. Boenink
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - D. Boerman
- Rijnstate Hospital, Arnhem, The Netherlands
| | - J. G. Lijmer
- Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - A. Honig
- Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - M. Terra
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - A. Thijs
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - B. Verwey
- Rijnstate Hospital, Arnhem, The Netherlands
| | | | - J. van Wijngaarden
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
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Shell LP, Newton M, Soltis-Jarrett V, Ragaisis KM, Shea JM. Quality improvement and models of behavioral healthcare integration: Position paper #2 from the International Society of Psychiatric-Mental Health Nurses. Arch Psychiatr Nurs 2019; 33:414-420. [PMID: 31280788 DOI: 10.1016/j.apnu.2019.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/19/2019] [Indexed: 11/27/2022]
Abstract
This is the second article in a series written to present and address the position of the International Society of Psychiatric-Mental Health Nurses (ISPN) related to the notion of behavioral healthcare integration and the role of nurses in the 21st century. The first article addressed assumptions, definitions and roles related to the integration of behavioral healthcare. The purpose of this article is to focus on Integrated Care within the context of recent initiatives that endeavor to improve quality, safety and reduce costs in the US healthcare system also known as the "Triple Aim" (or more recently, the Quadruple Aim). This paper specifically focuses on the role of nurses and nursing practice by: (a) connecting the concept of integrated behavioral healthcare to quality improvement (QI) and the Quadruple Aim, and (b) highlighting examples of models of integration currently in use. Discussion of models of integration compares ways various models reinforce and actualize integration of behavioral health within primary care, in various special populations across the continuum of care, and in both inpatient and community settings. This paper also stresses innovative training programs offering nurses the skills for learning behavioral health integration through online modules and participation in Interprofessional Education (IPE) activities often through simulation approaches. This 2nd manuscript is consistent with the ISPN 2016 Position Paper and reinforces the necessity for all nurses to be educated on both the Quadruple Aim and behavioral health integration to improve patient care and subsequent care outcomes.
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Affiliation(s)
- Lynn P Shell
- Rutgers University School of Nursing, Newark, NJ, United States of America.
| | - Marian Newton
- Retention and Progression, Director Psychiatric Mental Health Nursing Practitioner Program, Shenandoah University, Eleanor Wade Custer School of Nursing, Winchester, VA, United States of America
| | - Victoria Soltis-Jarrett
- Carol Morde Ross Distinguished Professor of Psychiatric-Mental Health Nursing, University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, United States of America
| | - Karen M Ragaisis
- Quinnipiac University School of Nursing, Hamden, CT, United States of America
| | - Joyce M Shea
- Fairfield University, Egan School of Nursing and Health Studies, Fairfield, CT, United States of America
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Ong SE, Koh JJK, Toh SAES, Chia KS, Balabanova D, McKee M, Perel P, Legido-Quigley H. Assessing the influence of health systems on Type 2 Diabetes Mellitus awareness, treatment, adherence, and control: A systematic review. PLoS One 2018; 13:e0195086. [PMID: 29596495 PMCID: PMC5875848 DOI: 10.1371/journal.pone.0195086] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/18/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Type 2 Diabetes Mellitus (T2DM) is reported to affect one in 11 adults worldwide, with over 80% of T2DM patients residing in low-to-middle-income countries. Health systems play an integral role in responding to this increasing global prevalence, and are key to ensuring effective diabetes management. We conducted a systematic review to examine the health system-level factors influencing T2DM awareness, treatment, adherence, and control. METHODS AND FINDINGS A protocol for this study was published on the PROSPERO international prospective register of systematic reviews (PROSPERO 2016: CRD42016048185). Studies included in this review reported the effects of health systems factors, interventions, policies, or programmes on T2DM control, awareness, treatment, and adherence. The following databases were searched on 22 February 2017: Medline, Embase, Global health, LILACS, Africa-Wide, IMSEAR, IMEMR, and WPRIM. There were no restrictions on date, language, or study designs. Two reviewers independently screened studies for eligibility, extracted the data, and screened for risk of bias. Thereafter, we performed a narrative synthesis. A meta-analysis was not conducted due to methodological heterogeneity across different aspects of included studies. 93 studies were included for qualitative synthesis; 7 were conducted in LMICs. Through this review, we found two key health system barriers to effective T2DM care and management: financial constraints faced by the patient and limited access to health services and medication. We also found three health system factors that facilitate effective T2DM care and management: the use of innovative care models, increased pharmacist involvement in care delivery, and education programmes led by healthcare professionals. CONCLUSIONS This review points to the importance of reducing, or possibly eliminating, out-of-pocket costs for diabetes medication and self-monitoring supplies. It also points to the potential of adopting more innovative and integrated models of care, and the value of task-sharing of care with pharmacists. More studies which identify the effect of health system arrangements on various outcomes, particularly awareness, are needed.
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Affiliation(s)
- Suan Ee Ong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Joel Jun Kai Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sue-Anne Ee Shiow Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Dina Balabanova
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- World Heart Federation, Geneva, Switzerland
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Zacharias R, Belcher S, Rodway-Norman M, Guller D, Chawla A, Hough P, Smith WG. Exploration of a new model of care in a psychiatry unit. Healthc Manage Forum 2017; 30:107-110. [PMID: 28929892 DOI: 10.1177/0840470416658906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The model established at Orillia Soldiers Memorial Hospital involves family physicians as the most responsible physician. They act as "admission gatekeeper" for all unattached patients who are admitted to the psychiatry in-patient unit. A PubMed, EBSCO, OVID Medline, Embase, CINAHL, and Web of Science database review of the last 10 years (2006-2016) was undertaken. A satisfaction survey was undertaken. An intensive literature review found this model to be unique. The model has proved to be extremely efficient and cost-effective.
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Affiliation(s)
- R Zacharias
- 1 Mental Health and Addictions Program, Orillia Soldiers Memorial Hospital (OSMH), Orillia, Ontario, Canada
| | - S Belcher
- 1 Mental Health and Addictions Program, Orillia Soldiers Memorial Hospital (OSMH), Orillia, Ontario, Canada
| | - M Rodway-Norman
- 1 Mental Health and Addictions Program, Orillia Soldiers Memorial Hospital (OSMH), Orillia, Ontario, Canada
| | - D Guller
- 1 Mental Health and Addictions Program, Orillia Soldiers Memorial Hospital (OSMH), Orillia, Ontario, Canada
| | - A Chawla
- 1 Mental Health and Addictions Program, Orillia Soldiers Memorial Hospital (OSMH), Orillia, Ontario, Canada
| | - P Hough
- 1 Mental Health and Addictions Program, Orillia Soldiers Memorial Hospital (OSMH), Orillia, Ontario, Canada
| | - W G Smith
- 1 Mental Health and Addictions Program, Orillia Soldiers Memorial Hospital (OSMH), Orillia, Ontario, Canada
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Coverdale J, Roberts LW, Balon R, Beresin EV. Pedagogical Implications of Partnerships Between Psychiatry and Obstetrics-Gynecology in Caring for Patients with Major Mental Disorders. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:430-436. [PMID: 26059737 DOI: 10.1007/s40596-015-0364-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Because there are no formal reviews, the authors set out to identify and describe programs that serve female patients with major mental disorders by integrating mental health care with services in obstetrics and gynecology and to describe the pedagogical implications of those programs. METHOD The authors searched PubMed for all articles describing a program in which psychiatry was formally integrated with obstetric or gynecological services, other than standard consultation-liaison programs, in the care of patients with major mental disorders. The search terms used included interdisciplinary, interprofessional, integrated, collaborative care, psychiatry, and obstetrics-gynecology or psychosomatic obstetrics-gynecology. RESULTS The authors found six distinct integrated programs. These included family planning clinics that were integrated into inpatient psychiatry services; inpatient and outpatient psychiatry services for pregnant mentally ill women in close collaboration with obstetric services; a day hospital for pregnant women with psychiatric disorders in an obstetric setting; an interdisciplinary training site providing care for predominantly depressed, low-income, and minority women; a primary care HIV service for women integrated with departments of obstetrics-gynecology and psychiatry; and an obstetrics-gynecology clinic-based collaborative depression care intervention for socially disadvantaged women. Residents' involvement was described in four of the programs. CONCLUSIONS These innovative and integrated programs potentially enhance the care of vulnerable and culturally diverse women with major mental disorders. The authors discuss how these programs may contribute to the education of residents in psychiatry and obstetrics-gynecology.
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Care coordination of multimorbidity: a scoping study. JOURNAL OF COMORBIDITY 2015; 5:15-28. [PMID: 29090157 PMCID: PMC5636034 DOI: 10.15256/joc.2015.5.39] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 03/05/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND A key challenge in healthcare systems worldwide is the large number of patients who suffer from multimorbidity; despite this, most systems are organized within a single-disease framework. OBJECTIVE The present study addresses two issues: the characteristics and preconditions of care coordination for patients with multimorbidity; and the factors that promote or inhibit care coordination at the levels of provider organizations and healthcare professionals. DESIGN The analysis is based on a scoping study, which combines a systematic literature search with a qualitative thematic analysis. The search was conducted in November 2013 and included the PubMed, CINAHL, and Web of Science databases, as well as the Cochrane Library, websites of relevant organizations and a hand-search of reference lists. The analysis included studies with a wide range of designs, from industrialized countries, in English, German and the Scandinavian languages, which focused on both multimorbidity/comorbidity and coordination of integrated care. RESULTS The analysis included 47 of the 226 identified studies. The central theme emerging was complexity. This related to both specific medical conditions of patients with multimorbidity (case complexity) and the organization of care delivery at the levels of provider organizations and healthcare professionals (care complexity). CONCLUSIONS In terms of how to approach care coordination, one approach is to reduce complexity and the other is to embrace complexity. Either way, future research must take a more explicit stance on complexity and also gain a better understanding of the role of professionals as a prerequisite for the development of new care coordination interventions.
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Haregu TN, Setswe G, Elliott J, Oldenburg B. Developing an action model for integration of health system response to HIV/AIDS and noncommunicable diseases (NCDs) in developing countries. Glob J Health Sci 2013; 6:9-22. [PMID: 24373260 PMCID: PMC4825372 DOI: 10.5539/gjhs.v6n1p9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 10/01/2013] [Accepted: 09/24/2013] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Although there are several models of integrated architecture, we still lack models and theories about the integration process of health system responses to HIV/AIDS and NCDs. OBJECTIVE The overall purpose of this study is to design an action model, a systematic approach, for the integration of health system responses to HIV/AIDS and NCDs in developing countries. METHODS An iterative and progressive approach of model development using inductive qualitative evidence synthesis techniques was applied. As evidence about integration is spread across different fields, synthesis of evidence from a broad range of disciplines was conducted. RESULTS An action model of integration having 5 underlying principles, 4 action fields, and a 9-step action cycle is developed. The INTEGRATE model is an acronym of the 9 steps of the integration process: 1) Interrelate the magnitude and distribution of the problems, 2) Navigate the linkage between the problems, 3) Testify individual level co-occurrence of the problems, 4) Examine the similarities and understand the differences between the response functions, 5) Glance over the health system's environment for integration, 6) Repackage and share evidence in a useable form, 7) Ascertain the plan for integration, 8) Translate the plan in to action, 9) Evaluate and Monitor the integration. CONCLUSION Our model provides a basis for integration of health system responses to HIV/AIDS and NCDs in the context of developing countries. We propose that future empirical work is needed to refine the validity and applicability of the model.
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Rethinking the mental health treatment skills of primary care staff: a framework for training and research. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2013; 39:489-502. [PMID: 21915748 DOI: 10.1007/s10488-011-0373-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Health care reforms may offer several opportunities to build the mental health treatment capacity of primary care. Capitalizing on these opportunities requires identifying the types of clinical skills that the primary care team requires to deliver mental health care. This paper proposes a framework that describes mental health skills for primary care receptionists, medical assistants, nurses, nurse practitioners, and physicians. These skills are organized on three levels: cross-cutting skills to build therapeutic alliance; broad-based, brief interventions for major clusters of mental health symptoms; and evidence-based interventions for diagnosis specific disorders. This framework is intended to help inform future mental health training in primary care and catalyze research that examines the impact of such training.
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Bergander B, Erdur L, Kallenbach-Dermutz B, Deter HC. Younger and older chronic somatoform pain patients in psycho-diagnostics, physician-patient relationship and treatment outcome. Biopsychosoc Med 2013; 7:4. [PMID: 23379640 PMCID: PMC3573985 DOI: 10.1186/1751-0759-7-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 02/01/2013] [Indexed: 12/02/2022] Open
Abstract
Introduction Patients with chronic pain are found with highly variable clinical presentation and differing physical complaints. They are seen as a heterogenic group. Based on clinical observations, elderly patients seem to differ from younger patients with chronic pain. We examined whether there were systematic differences between young and old pain patients. Methods As part of a routine evaluation of university hospital care, a newly developed psychosomatic treatment model for chronic somatoform pain disorders was examined. The basis for treatment efficacy was a target-oriented, specific somatic and psychological intervention that included a stable physician-patient relationship. Particular attention was paid to differences in treatment outcome with regard to changes in both physical and psychopathological symptom levels. We hypothesised that younger pain patients had higher psychological burden and benefitted more from our treatment than older pain patients. Results Overall, 179 inpatients (57.5% women) with chronic pain were examined (age between 16 and 79 years). The group as a whole yielded high scores on the somatisation dimension (SCL-90) and showed a considerable amount of psychopathological symptoms, such as depressive mood and anxiety (HADS) and a great emotional instability (FPI-R). Age differences were only found with regards to patients’ degree of aggression (SCl-90): younger patients showed higher aggressive tendencies than older ones (p< 0.05). The treatment offered helped patients in both age groups especially with regard to reduction of depressive mood (HADS, p< 0.01) and anxiety levels (HADS, p< 0.01). Regression analysis showed different age groups and gender as significant predictors of anxiety reduction under therapy (R2=.108; model: p< 0.01). Discussion and conclusion Results show that younger chronic pain patients suffer more from a considerable amount of psychological distress than older ones, but our treatment approach was equally effective in both groups. However, age and gender differences, as well as the patient’s baseline level of anxiety influenced the outcome. These factors need to be studied in future research.
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Affiliation(s)
- Bernd Bergander
- Department of Psychosomatics and Psychotherapy, Charité Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, 12200, Germany.
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Cerimele JM, Katon WJ, Sharma V, Sederer LI. Delivering psychiatric services in primary-care setting. ACTA ACUST UNITED AC 2013; 79:481-9. [PMID: 22786737 DOI: 10.1002/msj.21324] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Psychiatric disorders, particularly depression and anxiety disorders, are common in primary-care settings, though often overlooked or untreated. Depression and anxiety disorders are associated with a poorer course for and complications from common chronic diseases such as diabetes mellitus and coronary heart disease. Integrating psychiatric services into primary-care settings can improve recognition and treatment of psychiatric disorders for large populations of patients. Numerous research studies demonstrate associations between improved recognition and treatment of psychiatric disorders and improved courses of psychiatric disorders, but also with improvements in other chronic diseases such as diabetes. The evidence bases supporting the use of 2 models of integrated care, colocation of psychiatric care and collaborative care, are reviewed. These models' uses in specific populations are also discussed.
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Cerimele JM, Katon WJ. Associations between health risk behaviors and symptoms of schizophrenia and bipolar disorder: a systematic review. Gen Hosp Psychiatry 2013; 35:16-22. [PMID: 23044246 PMCID: PMC3543518 DOI: 10.1016/j.genhosppsych.2012.08.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 08/08/2012] [Accepted: 08/20/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To systematically review the literature to determine if health risk behaviors in patients with schizophrenia or bipolar disorder are associated with subsequent symptom burden or level of functioning. METHOD Using the PRISMA systematic review method we searched PubMed, Cochrane, PsychInfo and EMBASE databases with key words: health risk behaviors, diet, obesity, overweight, BMI, smoking, tobacco use, cigarette use, sedentary lifestyle, sedentary behaviors, physical inactivity, activity level, fitness, sitting AND schizophrenia, bipolar disorder, bipolar illness, schizoaffective disorder, severe and persistent mental illness, and psychotic to identify prospective, controlled studies of greater than 6 months duration. Included studies examined associations between sedentary lifestyle, smoking, obesity, physical inactivity and subsequent symptom severity or functional impairment in patients with schizophrenia or bipolar disorder. RESULTS Eight of the 2130 articles identified met inclusion criteria and included 508 patients with a health risk behavior and 825 controls. Six studies examined tobacco use, and two studies examined weight gain/obesity. Seven studies found that patients with schizophrenia or bipolar illness and at least one health risk behavior had more severe subsequent psychiatric symptoms and/or decreased level of functioning. CONCLUSION Tobacco use and weight gain/obesity may be associated with increased severity of symptoms of schizophrenia and bipolar disorder or decreased level of functioning.
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Affiliation(s)
- Joseph M Cerimele
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Box 356560, Seattle, WA 98195, USA.
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Abstract
BACKGROUND Individuals diagnosed with malignant melanoma face significant practical and psychological challenges, including existential fears and pain and discomfort associated with treatment. To enhance psychological adjustment, patients receive psychosomatic-psychotherapeutic consultation-liaison services (CLS) within the general medical hospital. However, little is known about the use of these services in routine clinical care. METHODS This study includes all patients referred to the CLS of a large German tertiary care hospital between 2005 and 2008 (n=3658). Data were recorded using the CL-BaDo form - a multicenter documentation form for the assessment of clinical characteristics of patients and CLS delivery. Descriptive and inferential statistics were employed to compare patients with melanomas and patients with other dermatological diseases. RESULTS Dermatologists requested CLS more often for other dermatology patients than for patients with melanoma. These two groups also differed in the reasons for referral: patients with melanoma were referred more often for acute coping issues; other dermatology patients were referred more often for unexplained physical symptoms. Additionally, the latter group was diagnosed with more and different mental and behavioral disorders. Patients with melanomas received more psychotherapeutic interventions while admitted to hospital but fewer recommendations for further psychosocial treatment after their hospital stay. CONCLUSION These findings highlight the need for professional psychosocial support in individuals diagnosed with melanoma - especially when first diagnosed or experiencing a recurrence. Dermatologists play a crucial role in identifying their patients' needs and in navigating them toward available support services.
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Affiliation(s)
- Annett Körner
- Department of Educational & Counselling Psychology and Department of Oncology, McGill University Montreal, QC, Canada.
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Cerimele JM, Strain JJ. Integrating primary care services into psychiatric care settings: a review of the literature. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 12. [PMID: 21494334 DOI: 10.4088/pcc.10r00971whi] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Accepted: 05/12/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This review assesses the outcomes of integrating primary care medical services into psychiatric care settings. DATA SOURCES PubMed, the Cochrane database, and PsycINFO were searched using the key words integrated care, family medicine, primary care, and internal medicine in combination with psychiatry or psychiatric clinic and ward to identify reports published between 1980 and December 2009 in English. STUDY SELECTION Four studies evaluating medical care services on a psychiatry ward or in a psychiatry clinic were found. Trials involving psychiatric services in primary care clinics (the medical-psychiatric model) were excluded. DATA EXTRACTION Data describing setting, patient population, intervention, measured outcomes, and discussion points were collected. DATA SYNTHESIS It was learned that several models of integrated care exist, and patients in these integrated groups received more preventive health measures and showed improved scores on the Medical Outcomes Study 36-item Short-Form Health Survey and Behavior and Symptom Identification Scale and reduced rates of specialist referral. CONCLUSIONS These data indicate that placing primary care physicians in psychiatric care settings improves health maintenance, care coordination, and satisfaction with nonpsychiatric medical care. Future studies should further address costs, the training of primary care physicians to deliver care in these settings, and whether this integrated model is more effective in specific populations such as those with schizophrenia.
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Affiliation(s)
- Joseph M Cerimele
- Division of Behavioral Medicine and Consultation Psychiatry, Mount Sinai School of Medicine, New York, New York, USA.
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Zeeck A, von Wietersheim J, Hartmann A, Einsele S, Weiss H, Sammet I, Gaus E, Semm E, Harms D, Eisenberg A, Rahm R, Küchenhoff J. Inpatient or day clinic treatment? Results of a multi-site-study. PSYCHO-SOCIAL MEDICINE 2009; 6:Doc03. [PMID: 19911075 PMCID: PMC2775197 DOI: 10.3205/psm000059] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: This naturalistic study aimed to identify criteria which are of relevance for making a decision as to whether inpatient or day hospital treatment is indicated. Methods: In 567 patients who were consecutively admitted to 10 departments of psychosomatic medicine (day hospital or inpatient setting) in Germany, symptom severity at admission and discharge was measured (Symptom-Check-List-90-R, Global Assessment of Functioning). Before admission, clinicians rated aspects that might be important for differential indication (Rating Scale of Indication Criteria). A regression analysis was conducted to reveal relationships between outcome in each setting and possible predictors (criteria of relevance). Results: At admission inpatients and day clinic patients already showed some differences referring to aspects clinicians used to select patients for each setting. Good outcome in day hospital patients was associated with a high motivation and higher burdens at home, whereas reduced drive and loss of interest was correlated with a less favourable course. Inpatients did less well if their symptoms were triggered by situations at home and if they showed a high potential for regression. Conclusion: Results give first hints for criteria which are relevant for making a decision between inpatient and day hospital treatment in psychosomatic medicine.
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Affiliation(s)
- Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Germany
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Minkman MMN, Ligthart SA, Huijsman R. Integrated dementia care in The Netherlands: a multiple case study of case management programmes. HEALTH & SOCIAL CARE IN THE COMMUNITY 2009; 17:485-494. [PMID: 19694030 DOI: 10.1111/j.1365-2524.2009.00850.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The number of dementia patients is growing, and they require a variety of services, making integrated care essential for the ability to continue living in the community. Many healthcare systems in developed countries are exploring new approaches for delivering health and social care. The purpose of this study was to describe and analyse a new approach in extensive case management programmes concerned with long-term dementia care in The Netherlands. The focus is on the characteristics, and success and failure factors of these programmes.A multiple case study was conducted in eight regional dementia care provider networks in The Netherlands. Based on a literature study, a questionnaire was developed for the responsible managers and case managers of the eight case management programmes. During 16 semistructured face-to-face interviews with both respondent groups, a deeper insight into the dementia care programmes was provided. Project documentation for all the cases was studied. The eight programmes were developed independently to improve the quality and continuity of long-term dementia care. The programmes show overlap in terms of their vision, tasks of case managers, case management process and the participating partners in the local dementia care networks. Differences concern the targeted dementia patient groups as well as the background of the case managers and their position in the local dementia care provider network. Factors for success concern the expert knowledge of case managers, investment in a strong provider network and coherent conditions for effective inter-organizational cooperation to deliver integrated care. When explored, caregiver and patient satisfaction was high. Further research into the effects on client outcomes, service use and costs is recommended in order to further analyse the impact of this approach in long-term care. To facilitate implementation, with a focus on joint responsibilities of the involved care providers, policy recommendations are to develop incentives for collaborative financial contracts between insurers and providers.
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Armitage GD, Suter E, Oelke ND, Adair CE. Health systems integration: state of the evidence. Int J Integr Care 2009; 9:e82. [PMID: 19590762 PMCID: PMC2707589 DOI: 10.5334/ijic.316] [Citation(s) in RCA: 198] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 04/23/2009] [Accepted: 04/24/2009] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Integrated health systems are considered a solution to the challenge of maintaining the accessibility and integrity of healthcare in numerous jurisdictions worldwide. However, decision makers in a Canadian health region indicated they were challenged to find evidence-based information to assist with the planning and implementation of integrated healthcare systems. METHODS A systematic literature review of peer-reviewed literature from health sciences and business databases, and targeted grey literature sources. RESULTS Despite the large number of articles discussing integration, significant gaps in the research literature exist. There was a lack of high quality, empirical studies providing evidence on how health systems can improve service delivery and population health. No universal definition or concept of integration was found and multiple integration models from both the healthcare and business literature were proposed in the literature. The review also revealed a lack of standardized, validated tools that have been systematically used to evaluate integration outcomes. This makes measuring and comparing the impact of integration on system, provider and patient level challenging. DISCUSSION AND CONCLUSION Healthcare is likely too complex for a one-size-fits-all integration solution. It is important for decision makers and planners to choose a set of complementary models, structures and processes to create an integrated health system that fits the needs of the population across the continuum of care. However, in order to have evidence available, decision makers and planners should include evaluation for accountability purposes and to ensure a better understanding of the effectiveness and impact of health systems integration.
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Affiliation(s)
- Gail D Armitage
- Health Systems and Workforce Research Unit, Alberta Health Services - Calgary (formerly Calgary Health Region), 10301 Southport Lane SW, Calgary, Alberta, Canada T2W 1S7
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Minkman M, Ahaus K, Fabbricotti I, Nabitz U, Huijsman R. A quality management model for integrated care: results of a Delphi and Concept Mapping study. Int J Qual Health Care 2008; 21:66-75. [PMID: 18945745 DOI: 10.1093/intqhc/mzn048] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The objective of this study is to identify the elements and clusters of a quality management model for integrated care. DESIGN In order to develop the model a combination of three methods were applied. A literature study was conducted to identify elements of integrated care. In a Delphi study experts commented and prioritized 175 elements in three rounds. During a half-a-day session with the expert panel, Concept Mapping was used to cluster the elements, position them on a map and analyse their content. Multi-dimensional statistical analyses were applied to design the model. PARTICIPANTS Thirty-one experts, with an average of 8.9 years of experience working in research, managing improvement projects or running integrated care programmes. RESULTS The literature study resulted in 101 elements of integrated care. Based on criteria for inclusion and exclusion, 89 unique elements were determined after the three Delphi rounds. By using Concept Mapping the 89 elements were grouped into nine clusters. The clusters were labelled as: 'Quality care', 'Performance management', 'Interprofessional teamwork', 'Delivery system', 'Roles and tasks', 'Patient-centeredness', 'Commitment', 'Transparent entrepreneurship' and 'Result-focused learning'. CONCLUSION The identified elements and clusters provide a basis for a comprehensive quality management model for integrated care. This model differs from other quality management models with respect to its general approach to multiple patient categories, its broad definition of integrated care and its specification into nine different clusters. The model furthermore accentuates conditions for effective collaboration such as commitment, clear roles and tasks and entrepreneurship. The model could serve evaluation and improvement purposes in integrated care practice. To improve external validity, replication of the study in other countries is recommended.
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Affiliation(s)
- Mirella Minkman
- Vilans, Centre of Excellence in Long-term Care, Catharijnesingel 47, 3511 GC Utrecht, The Netherlands.
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Huyse FJ, Stiefel FC. Controversies in consultation-liaison psychiatry. J Psychosom Res 2007; 62:257-8. [PMID: 17270584 DOI: 10.1016/j.jpsychores.2006.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 07/31/2006] [Accepted: 07/31/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Frits J Huyse
- Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
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