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Simon GE, Moise N, Mohr DC. Management of Depression in Adults: A Review. JAMA 2024; 332:141-152. [PMID: 38856993 DOI: 10.1001/jama.2024.5756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Importance Approximately 9% of US adults experience major depression each year, with a lifetime prevalence of approximately 17% for men and 30% for women. Observations Major depression is defined by depressed mood, loss of interest in activities, and associated psychological and somatic symptoms lasting at least 2 weeks. Evaluation should include structured assessment of severity as well as risk of self-harm, suspected bipolar disorder, psychotic symptoms, substance use, and co-occurring anxiety disorder. First-line treatments include specific psychotherapies and antidepressant medications. A network meta-analysis of randomized clinical trials reported cognitive therapy, behavioral activation, problem-solving therapy, interpersonal therapy, brief psychodynamic therapy, and mindfulness-based psychotherapy all had at least medium-sized effects in symptom improvement over usual care without psychotherapy (standardized mean difference [SMD] ranging from 0.50 [95% CI, 0.20-0.81] to 0.73 [95% CI, 0.52-0.95]). A network meta-analysis of randomized clinical trials reported 21 antidepressant medications all had small- to medium-sized effects in symptom improvement over placebo (SMD ranging from 0.23 [95% CI, 0.19-0.28] for fluoxetine to 0.48 [95% CI, 0.41-0.55] for amitriptyline). Psychotherapy combined with antidepressant medication may be preferred, especially for more severe or chronic depression. A network meta-analysis of randomized clinical trials reported greater symptom improvement with combined treatment than with psychotherapy alone (SMD, 0.30 [95% CI, 0.14-0.45]) or medication alone (SMD, 0.33 [95% CI, 0.20-0.47]). When initial antidepressant medication is not effective, second-line medication treatment includes changing antidepressant medication, adding a second antidepressant, or augmenting with a nonantidepressant medication, which have approximately equal likelihood of success based on a network meta-analysis. Collaborative care programs, including systematic follow-up and outcome assessment, improve treatment effectiveness, with 1 meta-analysis reporting significantly greater symptom improvement compared with usual care (SMD, 0.42 [95% CI, 0.23-0.61]). Conclusions and Relevance Effective first-line depression treatments include specific forms of psychotherapy and more than 20 antidepressant medications. Close monitoring significantly improves the likelihood of treatment success.
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Affiliation(s)
- Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Goetz TG, Wolk CB. A formative evaluation to inform integration of psychiatric care with other gender-affirming care. BMC PRIMARY CARE 2024; 25:239. [PMID: 38965459 PMCID: PMC11225323 DOI: 10.1186/s12875-024-02472-8] [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: 11/27/2023] [Accepted: 06/10/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Transgender, non-binary, and/or gender expansive (TNG) individuals experience disproportionately high rates of mental illness and unique barriers to accessing psychiatric care. Integrating TNG-specific psychiatric care with other physical health services may improve engagement, but little published literature describes patient and clinician perspectives on such models of care. Here we present a formative evaluation aiming to inform future projects integrating psychiatric care with physical health care for TNG individuals. METHODS In this qualitative pre-implementation study, semi-structured interview guides were developed informed by the Consolidated Framework for Implementation Research to ensure uniform inclusion and sequencing of topics and allow for valid comparison across interviews. We elicited TNG patient (n = 11) and gender-affirming care clinician (n = 10) needs and preferences regarding integrating psychiatric care with other gender-affirming clinical services. We conducted a rapid analysis procedure, yielding a descriptive analysis for each participant group, identifying challenges of and opportunities in offering integrated gender-affirming psychiatric care. RESULTS Participants unanimously preferred integrating psychiatry within primary care instead of siloed service models. All participants preferred that patients have access to direct psychiatry appointments (rather than psychiatrist consultation with care team only) and all gender-affirming care clinicians wanted increased access to psychiatric consultations. The need for flexible, tailored care was emphasized. Facilitators identified included taking insurance, telehealth, clinician TNG-competence, and protecting time for clinicians to collaborate and obtain consultation. CONCLUSIONS This health equity pre-implementation project engaged TNG patients and gender-affirming care clinicians to inform future research exploring integration of mental health care with primary care for the TNG community and suggests utility of such a model of care.
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Affiliation(s)
- Teddy G Goetz
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA.
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Dauber-Decker KL, Serafini MA, Monane R, Grossman Liu L, Sales A, Mizhquiri Barbecho J, Diamond ME, Levy S, King D'A, McGinn T, Bakken S, Moise N. User-Centered Design of a Preference-Driven Patient Activation Tool for Optimizing Depression Treatment in Integrated Primary Care Settings (The Transform DepCare Study). J Gen Intern Med 2024:10.1007/s11606-024-08833-4. [PMID: 38839708 DOI: 10.1007/s11606-024-08833-4] [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: 01/12/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Few patient engagement tools incorporate the complex patient experiences, contexts, and workflows that limit depression treatment implementation. OBJECTIVE Describe a user-centered design (UCD) process for operationalizing a preference-driven patient activation tool. DESIGN Informed by UCD and behavior change/implementation science principles, we designed a preference-driven patient activation prototype for engaging patients in depression treatment. We conducted three usability cycles using different recruitment/implementation approaches: near live/live testing in primary care waiting rooms (V1-2) and lab-based think aloud testing (V3) oversampling older, low-literacy, and Spanish-speaking patients in the community and via EHR algorithms. We elicited clinician and "heuristic" expert input. MAIN MEASURES We administered the system usability scale (SUS) all three cycles and pre-post V3, the patient activation measure, decisional conflict scale, and depression treatment barriers. We employed descriptive statistics and thematically analyzed observer notes and transcripts for usability constructs. RESULTS Overall, 43 patients, 3 clinicians, and 5 heuristic (a usability engineering method for identifying usability problems) experts participated. Among patients, 41.9% were ≥ 65 years old, 79.1% female, 23.3% Black, 62.8% Hispanic, and 55.8% Spanish-speaking and 46.5% had ≤ high school education. We described V1-3 usability (67.2, 77.3, 81.8), treatment seeking (92.3%, 87.5%, 92.9%), likelihood/comfort discussing with clinician (76.9%, 87.5%, 100.0%), and pre vs. post decisional conflict (23.7 vs. 15.2), treatment awareness (71.4% vs. 92.9%), interest in antidepressants (7.1% vs. 14.3%), and patient activation (66.8 vs. 70.9), with fewer barriers pertaining to cost/insurance, access/coordination, and self-efficacy/stigma/treatment efficacy. Key themes included digital literacy, understandability, high acceptability for aesthetics, high usefulness of patient/clinician videos, and workflow limitations. We adapted manual entry/visibility/content; added patient activation and a personalized algorithm; and proposed flexible, care manager delivery leveraging clinic screening protocols. DISCUSSION We provide an example of leveraging UCD to design/adapt a real-world, patient experience and workflow-aligned patient activation tool in diverse populations.
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Affiliation(s)
- Katherine L Dauber-Decker
- Northwell, New Hyde Park, NY, USA
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Maria A Serafini
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachel Monane
- Health Design Lab, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Lisa Grossman Liu
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Alyssa Sales
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer Mizhquiri Barbecho
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Meredith E Diamond
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Sera Levy
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY, USA
| | - D 'Arcy King
- Department of Clinical Psychology, Fielding Graduate University, Santa Barbara, CA, USA
| | - Thomas McGinn
- Medicine Department, Baylor College of Medicine, Houston, TX, USA
| | - Suzanne Bakken
- Columbia University School of Nursing, Columbia University Irving Medical Center, New York, NY, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
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Lally K, Macip-Rodriquez P, Wu C, McGuire H, Pirl W. The Supportive Oncology Collaborative: Expanding upon Collaborative Care to Increase Supportive Care Access in Underserved Populations. J Palliat Med 2024; 27:789-793. [PMID: 38602266 DOI: 10.1089/jpm.2023.0617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Abstract
Background: Access to supportive services in community-based oncology is challenging but essential, particularly for underserved populations. Methods: We developed the Supportive Oncology Collaborative (SOC), built upon the tenets of Collaborative Care, an existing model used to increase access to behavioral health in community settings. Using a population-health-based approach with screening, a registry, and shared care, we added palliative care specialists to a team of social workers and a consulting psychiatrist. We provided integrated psychosocial and palliative care at community-based sites of a large comprehensive cancer center. Results: We implemented the model in 2020 at a community site with a racially and ethnically diverse patient population. Encounters grew from 527 in our first year to 2,130 in 2022. Using screening tools, we identify the highest-risk patients for discussion in team meetings. Discussion: We are expanding the SOC across the Dana-Farber Cancer Institute regional campuses and believe it can increase access to integrated psychosocial and palliative care in cancer centers across the country.
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Affiliation(s)
- Kate Lally
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Perla Macip-Rodriquez
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Carrie Wu
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Hilary McGuire
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Dana-Farber Cancer Institute Merrimack Valley, Methuen, Massachusetts, USA
| | - William Pirl
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Lam RW, Kennedy SH, Adams C, Bahji A, Beaulieu S, Bhat V, Blier P, Blumberger DM, Brietzke E, Chakrabarty T, Do A, Frey BN, Giacobbe P, Gratzer D, Grigoriadis S, Habert J, Ishrat Husain M, Ismail Z, McGirr A, McIntyre RS, Michalak EE, Müller DJ, Parikh SV, Quilty LS, Ravindran AV, Ravindran N, Renaud J, Rosenblat JD, Samaan Z, Saraf G, Schade K, Schaffer A, Sinyor M, Soares CN, Swainson J, Taylor VH, Tourjman SV, Uher R, van Ameringen M, Vazquez G, Vigod S, Voineskos D, Yatham LN, Milev RV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023 : Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024:7067437241245384. [PMID: 38711351 DOI: 10.1177/07067437241245384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) last published clinical guidelines for the management of major depressive disorder (MDD) in 2016. Owing to advances in the field, an update was needed to incorporate new evidence and provide new and revised recommendations for the assessment and management of MDD in adults. METHODS CANMAT convened a guidelines editorial group comprised of academic clinicians and patient partners. A systematic literature review was conducted, focusing on systematic reviews and meta-analyses published since the 2016 guidelines. Recommendations were organized by lines of treatment, which were informed by CANMAT-defined levels of evidence and supplemented by clinical support (consisting of expert consensus on safety, tolerability, and feasibility). Drafts were revised based on review by patient partners, expert peer review, and a defined expert consensus process. RESULTS The updated guidelines comprise eight primary topics, in a question-and-answer format, that map a patient care journey from assessment to selection of evidence-based treatments, prevention of recurrence, and strategies for inadequate response. The guidelines adopt a personalized care approach that emphasizes shared decision-making that reflects the values, preferences, and treatment history of the patient with MDD. Tables provide new and updated recommendations for psychological, pharmacological, lifestyle, complementary and alternative medicine, digital health, and neuromodulation treatments. Caveats and limitations of the evidence are highlighted. CONCLUSIONS The CANMAT 2023 updated guidelines provide evidence-informed recommendations for the management of MDD, in a clinician-friendly format. These updated guidelines emphasize a collaborative, personalized, and systematic management approach that will help optimize outcomes for adults with MDD.
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Affiliation(s)
- Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Camelia Adams
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Venkat Bhat
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Pierre Blier
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | | | - Elisa Brietzke
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - André Do
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - David Gratzer
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Jeffrey Habert
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Alexander McGirr
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbour, MI, USA
| | - Lena S Quilty
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nisha Ravindran
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Johanne Renaud
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | | | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Gayatri Saraf
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Kathryn Schade
- Office of Research Services, Huron University, London, ON, Canada
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Jennifer Swainson
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Smadar V Tourjman
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Michael van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Gustavo Vazquez
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Simone Vigod
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daphne Voineskos
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
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Smith AC, Vohs JL, Butler M, Paul A, Holmes EG. Retrospective descriptive analysis of an urban pediatric collaborative care program. Gen Hosp Psychiatry 2024:S0163-8343(24)00086-0. [PMID: 38729862 DOI: 10.1016/j.genhosppsych.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE The prevalence of mental health conditions in pediatric patients in the United States is approximately 15%. Concerningly, nearly half go untreated, with lower treatment rates among children of color. Collaborative care can increase access to care and has an emerging evidence base for pediatrics. We present retrospective results from a collaborative care program that accepted referrals for a variety of conditions. METHODS Pediatric patients seen in an academic, urban collaborative care program from July 2019 to December 2021 were tracked in a registry. Demographics, presenting problem(s), symptoms, treatment, and discharge dispositions were examined. Descriptive data were analyzed, including changes in reported symptoms via paired t-tests. RESULTS Three hundred nineteen patients were seen. Racial and ethnic diversity in our clinic's population was similar to that of the surrounding community, with half belonging to a minoritized racial or ethnic group. Symptom comparisons demonstrated clinically and statistically significant improvements from intake to discharge. CONCLUSION Collaborative care can improve access to care and outcomes for a diverse pediatric population. Our clinic served racial and ethnic patient populations that were representative of the demographics of the metropolitan area. Further study is necessary to determine if collaborative care increases access for these underserved groups.
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Affiliation(s)
- Alyssa C Smith
- Indiana University School of Medicine, Department of Psychiatry, USA.
| | - Jenifer L Vohs
- Indiana University School of Medicine, Department of Psychiatry, USA; Indiana University Health, USA
| | - Melissa Butler
- Indiana University School of Medicine, Department of Psychiatry, USA
| | - Alison Paul
- Indiana University School of Medicine, Department of Psychiatry, USA
| | - Emily G Holmes
- Indiana University School of Medicine, Department of Psychiatry, USA; Indiana University Health, USA
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Yang KG, Blackmore MA, Cook BL, Chung H. Collaborative Care for Depression and Anxiety: Racial-Ethnic Differences in Treatment Engagement and Outcomes. Psychiatr Serv 2024:appips20230482. [PMID: 38693836 DOI: 10.1176/appi.ps.20230482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
OBJECTIVE This study aimed to examine racial-ethnic differences in engagement with and clinical outcomes of a collaborative care model (CoCM) implemented in primary care outpatient clinics in an urban academic medical center. METHODS Adult patients (N=4,911) who screened positive for symptoms of depression, anxiety, or both on the Patient Health Questionnaire-9 or the Generalized Anxiety Disorder-7 scale and who identified as non-Hispanic Black, Hispanic, or non-Hispanic White were offered participation in a CoCM implementation. The primary outcome was treatment engagement, defined as receipt of any follow-up visit, minimally adequate 4-week follow-up (at least one visit), and minimally adequate 16-week follow-up (at least three visits) after initial assessment. Secondary outcomes were response and remission of depression or anxiety. RESULTS After adjustment of analyses for sociodemographic covariates, Black and Hispanic participants were significantly less likely than White participants to have received any or minimally adequate follow-up. Black and Hispanic participants who received any or minimally adequate 16-week follow-up were more likely than White participants to demonstrate depression symptom response and remission of anxiety symptoms. CONCLUSIONS This CoCM implementation appears to have been effective in treating depression and anxiety among Black and Hispanic patients. However, significant disparities in receipt of follow-up care were observed. Efforts must be made to improve the retention of patients from racial-ethnic minority groups in collaborative care.
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Affiliation(s)
- Kelly Guanhua Yang
- Department of Psychiatry, NYU Langone Health, New York City (Yang); Department of Psychiatry and Behavioral Sciences (Blackmore, Chung) and PRIME Center for Health Equity (Cook), Albert Einstein College of Medicine/Montefiore Medical Center, New York City; Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Cook)
| | - Michelle A Blackmore
- Department of Psychiatry, NYU Langone Health, New York City (Yang); Department of Psychiatry and Behavioral Sciences (Blackmore, Chung) and PRIME Center for Health Equity (Cook), Albert Einstein College of Medicine/Montefiore Medical Center, New York City; Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Cook)
| | - Benjamin Lê Cook
- Department of Psychiatry, NYU Langone Health, New York City (Yang); Department of Psychiatry and Behavioral Sciences (Blackmore, Chung) and PRIME Center for Health Equity (Cook), Albert Einstein College of Medicine/Montefiore Medical Center, New York City; Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Cook)
| | - Henry Chung
- Department of Psychiatry, NYU Langone Health, New York City (Yang); Department of Psychiatry and Behavioral Sciences (Blackmore, Chung) and PRIME Center for Health Equity (Cook), Albert Einstein College of Medicine/Montefiore Medical Center, New York City; Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Cook)
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8
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Huang H, Huynh B, Nidey N, Huang H. Meaningful Engagement in Depression and Anxiety Collaborative Care: Associations With Systematic Case Review. J Acad Consult Liaison Psychiatry 2024; 65:254-260. [PMID: 38309684 DOI: 10.1016/j.jaclp.2024.01.006] [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: 10/16/2023] [Revised: 01/16/2024] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Collaborative care (CC) is an evidence-based model of care for treating behavioral health conditions in primary care settings. The CC team consists of a primary care provider, behavioral health care manager (CM), and a consultant psychiatrist who collaborate to create treatment plans. To date, there is limited data on factors associated with meaningful engagement in CC programs. OBJECTIVE To identify the proportion of patients who were meaningfully engaged and to investigate the factors associated with meaningful engagement in a CC program. METHODS Data was collected from a CC program implemented across 27 adult primary care clinics in a Midwestern, U.S. academic medical system. Logistic regression (n = 5218) was used to estimate the odds of receiving meaningful engagement. RESULTS Data was collected from 6437 individuals with 68% being female and a mean age of 45 years old (standard deviation 17.6). Overall, 57% of patients were meaningfully engaged; however, this proportion differed based on demographic and clinical factors. Among modifiable clinical factors, systematic case reviews between the CM and psychiatrist (odds ratio: 10.2, 95% confidence interval: 8.6-12.1) and warm handoffs (odds ratio: 1.3, 95% confidence interval: 1.1-1.5) were associated with a higher likelihood of receiving meaningful engagement. CONCLUSIONS The presence of systematic case reviews between the behavioral health CM and the consultant psychiatrist was highly associated with meaningful engagement. When implementing such programs, high fidelity to the core principles including regularly scheduled systematic case reviews should be pursued.
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Affiliation(s)
- Heather Huang
- Department of Psychiatry, University of Wisconsin Hospitals and Clinics, Madison, WI.
| | - Brandon Huynh
- Department of Psychiatry, University of Wisconsin Hospitals and Clinics, Madison, WI
| | - Nichole Nidey
- College of Public Health, University of Iowa, Iowa City, IA
| | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA
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McGinty EE, Alegria M, Beidas RS, Braithwaite J, Kola L, Leslie DL, Moise N, Mueller B, Pincus HA, Shidhaye R, Simon K, Singer SJ, Stuart EA, Eisenberg MD. The Lancet Psychiatry Commission: transforming mental health implementation research. Lancet Psychiatry 2024; 11:368-396. [PMID: 38552663 DOI: 10.1016/s2215-0366(24)00040-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 04/19/2024]
Affiliation(s)
| | - Margarita Alegria
- Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rinad S Beidas
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Lola Kola
- College of Medicine, University of Ibadan, Ibadan, Nigeria; Kings College London, London, UK
| | | | | | | | | | - Rahul Shidhaye
- Pravara Institute of Medical Sciences University, Loni, India; Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Sara J Singer
- Stanford University School of Medicine, Stanford, CA, USA
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Kroenke K, Corrigan JD, Ralston RK, Zafonte R, Brunner RC, Giacino JT, Hoffman JM, Esterov D, Cifu DX, Mellick DC, Bell K, Scott SG, Sander AM, Hammond FM. Effectiveness of care models for chronic disease management: A scoping review of systematic reviews. PM R 2024; 16:174-189. [PMID: 37329557 DOI: 10.1002/pmrj.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/14/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To conduct a scoping review of models of care for chronic disease management to identify potentially effective components for management of chronic traumatic brain injury (TBI). METHODS Information sources: Systematic searches of three databases (Ovid MEDLINE, Embase, and Cochrane Database of Systematic Reviews) from January 2010 to May 2021. ELIGIBILITY CRITERIA Systematic reviews and meta-analyses reporting on the effectiveness of the Chronic Care Model (CCM), collaborative/integrated care, and other chronic disease management models. DATA Target diseases, model components used (n = 11), and six outcomes (disease-specific, generic health-related quality of life and functioning, adherence, health knowledge, patient satisfaction, and cost/health care use). SYNTHESIS Narrative synthesis, including proportion of reviews documenting outcome benefits. RESULTS More than half (55%) of the 186 eligible reviews focused on collaborative/integrated care models, with 25% focusing on CCM and 20% focusing on other chronic disease management models. The most common health conditions were diabetes (n = 22), depression (n = 16), heart disease (n = 12), aging (n = 11), and kidney disease (n = 8). Other single medical conditions were the focus of 22 reviews, multiple medical conditions of 59 reviews, and other or mixed mental health/behavioral conditions of 20 reviews. Some type of quality rating for individual studies was conducted in 126 (68%) of the reviews. Of reviews that assessed particular outcomes, 80% reported disease-specific benefits, and 57% to 72% reported benefits for the other five types of outcomes. Outcomes did not differ by the model category, number or type of components, or target disease. CONCLUSIONS Although there is a paucity of evidence for TBI per se, care model components proven effective for other chronic diseases may be adaptable for chronic TBI care.
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Affiliation(s)
- Kurt Kroenke
- Department of Medicine, Indiana School of Medicine and Regenstrief Institute, Indianapolis, Indiana, USA
| | - John D Corrigan
- Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus, Ohio, USA
| | - Rick K Ralston
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Robert C Brunner
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | | | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, Texas, USA
| | - Steven G Scott
- Center of Innovation on Disability & Rehab Research (CINDRR), James A Haley Veterans' Hospital, Tampa, Florida, USA
| | - Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, and Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas, USA
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
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11
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Ochoa‐Frongia L, Garcia ME, Bendahan T, Ponce AN, Calderon C, Pumar M, Yee K, Schillinger D, Loewy R, Mangurian C. Bring It Up: An Adapted Collaborative Care Model for Depression in a Safety-Net Primary Care Clinic. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2024; 6:42-50. [PMID: 38854871 PMCID: PMC11154806 DOI: 10.1176/appi.prcp.20230060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 06/11/2024] Open
Abstract
Objective Over 90 clinical trials demonstrate the efficacy of the collaborative care model (CoCM) to treat depression in primary care but there is significant variability in real-world CoCM implementation and scalability. This study aimed to determine the feasibility and effectiveness of an adapted CoCM in a safety-net primary care setting. Methods Bring It Up! (BIU) is a pilot trial comparing an adapted CoCM (intervention group) to usual care (historical controls) for primary care safety-net clinic patients with depression. Inclusion criteria: (1) age ≥18; (2) Patient Health Questionnaire-9 (PHQ-9) score ≥10; and (3) major depressive disorder diagnosis. Patients who completed ≥6 months of treatment upon rolling enrollment (April 1, 2018-October 31, 2019) were included. Historical controls completed ≥6 months of usual care in 2017. BIU included all aspects of CoCM except accountable care and leveraged existing staff rather than a dedicated care manager. The primary outcome was depression remission (PHQ-9 <5) within 6 months. Secondary outcomes included depression response, adherence to treatment guidelines and care coordination process. Data were extracted from the electronic health record. Results Thirty-six patients received the intervention; 41 controls received usual care. Depression remission was achieved in 33.3% of intervention patients and 0% of controls (p = 0.001). Of intervention patients, 44.4% achieved ≥50% reduction in PHQ-9 compared to 4.9% of controls (p = 0.003). Further, 66.7% of intervention patients had guideline-recommended antidepressant medication titration compared to 26.9% of controls (p = 0.003); 94.4% of intervention patients had PHQ-9 repeated compared to 53.7% of controls (p < 0.001). Conclusions An adapted CoCM was feasible and improved depression care in a safety-net clinic.
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Affiliation(s)
- Lisa Ochoa‐Frongia
- Division of General Internal MedicineDepartment of MedicineZuckerberg San Francisco General HospitalUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Maria E. Garcia
- Division of General Internal MedicineDepartment of MedicineMultiethnic Health Equity Research CenterUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Division of General Internal MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Tamara Bendahan
- Department of Psychiatry & Behavioral SciencesWeill Institute for NeurosciencesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Andrea N. Ponce
- Department of Psychiatry & Behavioral SciencesWeill Institute for NeurosciencesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Cristina Calderon
- Department of Psychiatry & Behavioral SciencesWeill Institute for NeurosciencesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Margo Pumar
- Department of Psychiatry & Behavioral SciencesWeill Institute for NeurosciencesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Karen Yee
- Division of General Internal MedicineDepartment of MedicineZuckerberg San Francisco General HospitalUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Dean Schillinger
- Division of General Internal MedicineDepartment of MedicineZuckerberg San Francisco General HospitalUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Rachel Loewy
- Department of Psychiatry & Behavioral SciencesWeill Institute for NeurosciencesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Christina Mangurian
- Department of Psychiatry & Behavioral SciencesWeill Institute for NeurosciencesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
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12
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Petruzzi L, Milano N, Chen Q, Noel L, Golden R, Jones B. Social workers are key to addressing social determinants of health in integrated care settings. SOCIAL WORK IN HEALTH CARE 2024; 63:89-101. [PMID: 38104559 DOI: 10.1080/00981389.2023.2292565] [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: 03/31/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023]
Abstract
Social workers play an important role in assessing social determinants of health (SDH) and providing behavioral health services in integrated care settings. Evidence suggests that integrated care interventions improve quality of life and other patient outcomes. However, the ambiguous role of social workers on the interdisciplinary team, the lack of protocol in SDH screening and intervention, and restrictions due to healthcare reimbursement limit social workers' ability to intervene. Future directions include standardizing integrated care models, evaluating integrated care's efficacy to address SDH, incorporating SDH into interprofessional training including role clarification and reimbursing for SDH assessment and intervention.
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Affiliation(s)
- Liana Petruzzi
- Population Health Department, Dell Medical School, University of Texas, Austin, Texas, USA
| | - Nicole Milano
- Rutgers School of Social Work, New Brunswick, New Jersey, USA
| | - Qi Chen
- Steve Hicks School of Social Work, University of Texas, Austin, Texas, USA
| | - Lailea Noel
- Steve Hicks School of Social Work, University of Texas, Austin, Texas, USA
| | - Robyn Golden
- Rush University Medical Center, New Brunswick, New Jersey, USA
| | - Barbara Jones
- Steve Hicks School of Social Work, University of Texas, Austin, Texas, USA
- Health Social Work Department, Dell Medical School, University of Texas, Austin, Texas, USA
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13
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Bombardier CH, Fann JR, Ehde DM, Reyes MR, Burns SP, Barber JK, Temkin NR. Collaborative Care Versus Usual Care to Improve Quality of Life, Pain, Depression, and Physical Activity in Outpatients With Spinal Cord Injury: The SCI-CARE Randomized Controlled Clinical Trial. J Neurotrauma 2023; 40:2667-2679. [PMID: 37597201 DOI: 10.1089/neu.2023.0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023] Open
Abstract
Our goal was to test the effectiveness of collaborative care (CC) versus usual care (UC) to improve treatment of pain, depression, physical inactivity, and quality of life in outpatients with spinal cord injury (SCI). We conducted a single blind parallel group randomized controlled trial. The setting was two outpatient SCI rehabilitation clinics within a large academic medical center. Participants were 174 outpatients who were on average 47.7 years old, 76% male, 76% white, 8% Hispanic, 47% tetraplegic, 95% more than 1 year post-SCI, and 45% on Medicare. The intervention consisted of a mental health-trained collaborative care manager (CM) integrated into two SCI rehabilitation medicine clinics and supervised by content experts in pain and mental health treatment. The CM provided assessment, medical care coordination, adherence support, outcome monitoring, and decision support along with brief psychological interventions to the patients via up to 12 in-person or telephone sessions. Among all participants, 61% chose to focus on pain; 31% on physical activity and 8% on depression. The primary outcome was quality of life as measured by the World Health Organization Quality of Life-BREF at the end of treatment (4 months). Secondary outcomes were quality of life at 8 months and pain intensity and interference, depression severity, and minutes per week of moderate to vigorous physical activity at 4 and 8 months. A total of 174 participants were randomized 1:1 to CC (n = 89) versus UC (n = 85). The primary analysis, a mixed-effects linear regression adjusting for time since injury and sex, revealed a non-significant trend for greater improvement in quality of life in CC versus UC at 4 months (p = 0.083). Secondary analyses showed that those receiving CC reported significantly greater improvement in pain interference at 4- and 8-months and in depression at 4-months, but no significant effect on physical activity. We conclude that in an outpatient SCI care setting, CC is a promising model for delivering integrated medical and psychological care and improving management of common, chronic, disabling conditions such and pain and depression.
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Affiliation(s)
- Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Jesse R Fann
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Maria R Reyes
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Stephen P Burns
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington, USA
| | - Jason K Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Nancy R Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
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14
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Cheng AL, Leo AJ, Calfee RP, Dy CJ, Armbrecht MA, Abraham J. Reply to Letter to the Editor: What Are Orthopaedic Patients' and Clinical Team Members' Perspectives Regarding Whether and How to Address Mental Health in the Orthopaedic Care Setting? A Qualitative Investigation of Patients With Neck or Back Pain. Clin Orthop Relat Res 2023; 481:1051-1052. [PMID: 36763511 PMCID: PMC10097568 DOI: 10.1097/corr.0000000000002594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Abby L. Cheng
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ashwin J. Leo
- Washington University School of Medicine, St. Louis, MO, USA
| | - Ryan P. Calfee
- Division of Hand and Wrist, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher J. Dy
- Division of Hand and Wrist, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Melissa A. Armbrecht
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Joanna Abraham
- Department of Anesthesiology & Institute for Informatics, Washington University School of Medicine, St. Louis, MO, USA
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15
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Lindsey C, Dornan GJ, McKelvey K. Integration of collaborative care model ameliorates population level COVID-19 Pandemic-related depressive symptoms among orthopaedic clinic patient population in US major metropolitan area. CURRENT ORTHOPAEDIC PRACTICE 2023. [DOI: 10.1097/bco.0000000000001204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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16
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Fu E, Carroll AJ, Rosenthal LJ, Rado J, Burnett-Zeigler I, Jordan N, Carlo AD, Ekwonu A, Kust A, Brown CH, Csernansky JG, Smith JD. Implementation Barriers and Experiences of Eligible Patients Who Failed to Enroll in Collaborative Care for Depression and Anxiety. J Gen Intern Med 2023; 38:366-374. [PMID: 35931910 PMCID: PMC9362538 DOI: 10.1007/s11606-022-07750-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 07/20/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Effective and efficient implementation of the Collaborative Care Model (CoCM) for depression and anxiety is imperative for program success. Studies examining barriers to implementation often omit patient perspectives. OBJECTIVES To explore experiences and attitudes of eligible patients referred to CoCM who declined participation or were unable to be reached, and identify implementation barriers to inform strategies. DESIGN Convergent mixed-methods study with a survey and interview. PARTICIPANTS Primary care patients at an academic medical center who were referred to a CoCM program for anxiety and depression by their primary care clinician (PCC) but declined participation or were unable to be reached by the behavioral health care manager to initiate care (n = 80). Interviews were conducted with 45 survey respondents. MAIN MEASURES Survey of patients' referral experiences and behavioral health preferences as they related to failing to enroll in the program. Interview questions were developed using the Consolidated Framework for Implementation Research version 2.0 (CFIR 2.0) to identify implementation barriers to enrollment. KEY RESULTS Survey results found that patients were uncertain about insurance coverage, did not understand the program, and felt services were not necessary. Referred patients who declined participation were concerned about how their mental health information would be used and preferred treatment without medication. Men agreed more that they did not need services. Qualitative results exhibited a variety of implementation determinants (n = 23) across the five CFIR 2.0 domains. Barriers included mental health stigma, perceiving behavioral health as outside of primary care practice guidelines, short or infrequent primary care appointments, prioritizing physical health over mental health, receiving inaccurate program information, low motivation to engage, and a less established relationship with their PCC. CONCLUSIONS Multiple barriers to enrollment led to failing to link patients to care, which can inform implementation strategies to address the patient-reported experiences and concerns.
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Affiliation(s)
- Emily Fu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Allison J Carroll
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lisa J Rosenthal
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Northwestern Medicine, Chicago, IL, USA
| | - Jeffrey Rado
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Northwestern Medicine, Chicago, IL, USA
| | - Inger Burnett-Zeigler
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
| | - Andrew D Carlo
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Adaora Ekwonu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Ariella Kust
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John G Csernansky
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Justin D Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA.
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17
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Moise N, Paniagua-Avila A, Barbecho JM, Blanco L, Dauber-Decker K, Simantiris S, McElhiney M, Serafini M, Straussman D, Patel SR, Ye S, Duran AT. A theory-informed, rapid cycle approach to identifying and adapting strategies to promote sustainability: optimizing depression treatment in primary care clinics seeking to sustain collaborative care (The Transform DepCare Study). Implement Sci Commun 2023; 4:10. [PMID: 36698220 PMCID: PMC9875183 DOI: 10.1186/s43058-022-00383-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 12/04/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Few real-world examples exist of how best to select and adapt implementation strategies that promote sustainability. We used a collaborative care (CC) use case to describe a novel, theory-informed, stakeholder engaged process for operationalizing strategies for sustainability using a behavioral lens. METHODS Informed by the Dynamic Sustainability Framework, we applied the Behaviour Change Wheel to our prior mixed methods to identify key sustainability behaviors and determinants of sustainability before specifying corresponding intervention functions, behavior change techniques, and implementation strategies that would be acceptable, equitable and promote key tenets of sustainability (i.e., continued improvement, education). Drawing on user-centered design principles, we enlisted 22 national and local stakeholders to operationalize and adapt (e.g., content, functionality, workflow) a multi-level, multi-component implementation strategy to maximally target behavioral and contextual determinants of sustainability. RESULTS After reviewing the long-term impact of early implementation strategies (i.e., external technical support, quality monitoring, and reimbursement), we identified ongoing care manager CC delivery, provider treatment optimization, and patient enrollment as key sustainability behaviors. The most acceptable, equitable, and feasible intervention functions that would facilitate ongoing improvement included environmental restructuring, education, training, modeling, persuasion, and enablement. We determined that a waiting room delivered shared decision-making and psychoeducation patient tool (DepCare), the results of which are delivered to providers, as well as ongoing problem-solving meetings/local technical assistance with care managers would be the most acceptable and equitable multi-level strategy in diverse settings seeking to sustain CC programs. Key adaptations in response to dynamic contextual factors included expanding the DepCare tool to incorporate anxiety/suicide screening, triage support, multi-modal delivery, and patient activation (vs. shared decision making) (patient); pairing summary reports with decisional support and yearly onboarding/motivational educational videos (provider); incorporating behavioral health providers into problem-solving meetings and shifting from billing support to quality improvement and triage (system). CONCLUSION We provide a roadmap for designing behavioral theory-informed, implementation strategies that promote sustainability and employing user-centered design principles to adapt strategies to changing mental health landscapes.
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Affiliation(s)
- Nathalie Moise
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | - Alejandra Paniagua-Avila
- grid.21729.3f0000000419368729Mailman School of Public Health, Columbia University, New York, NY USA
| | - Jennifer Mizhquiri Barbecho
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | - Luis Blanco
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | | | - Samantha Simantiris
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | - Martin McElhiney
- grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY USA
| | - Maria Serafini
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | - Darlene Straussman
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | - Sapana R. Patel
- grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY USA ,grid.21729.3f0000000419368729Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Siqin Ye
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | - Andrea T. Duran
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
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18
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Pourat N, Padilla-Frausto DI, Chen X, Lim D, Osterweil D, Batra RA. The Impact of a Primary Care Telepsychiatry Program on Outcomes of Managed Care Older Adults. J Am Med Dir Assoc 2023; 24:119-124.e4. [PMID: 36356654 DOI: 10.1016/j.jamda.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The goal of this study was to assess the outcomes of a primary-based telepsychiatry intervention program for older managed care enrollees with depression/anxiety and with limited access to in-person psychiatric care. DESIGN A pre-post design was used to examine service use (n = 218) and severity of depression (n = 204). Enrollment, claims, and depression and anxiety score data were obtained from the medical group. The implementation process and self-reported outcomes were examined. SETTING AND PARTICIPANTS The program was funded by the Senior Care Action Network (SCAN) group and implemented by a large medical group serving older adults who were identified as needing outpatient psychiatric care, including those with psychiatric hospitalizations, depression/anxiety disorders, comorbid substance use disorders, or other multiple comorbidities. METHODS Poisson regressions were used to examine changes in predicted rates of outpatient services, emergency department visits, and hospitalizations up to 24 months prior and 24 months following the first telepsychiatry visit. Changes in predicted severity of depression up to 2 quarters prior and 3 quarters following the first telepsychiatry visit were examined. RESULTS The number of outpatient services declined significantly by 0.24 per patient per 6-month time frame following the first telepsychiatry visit. The number of emergency department visits and hospitalizations also declined after the first visit (0.07 and 0.03 per patient per 6-month time frame, respectively). Depression severity scores also declined in the quarters following the first visit (1.52). The medical group reported improvements in both wait time for appointments and no-show rates with the integration of telepsychiatry in primary care. CONCLUSIONS AND IMPLICATIONS The telepsychiatry program lowered service use, depression severity, and increased better access to psychiatry care. The findings highlight the potential benefits of sustaining and expanding the telepsychiatry program by SCAN and other plans facing a limited supply of psychiatrists.
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Affiliation(s)
- Nadereh Pourat
- University of California Los Angeles, Center for Health Policy Research, Los Angeles, CA, USA; Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.
| | | | - Xiao Chen
- University of California Los Angeles, Center for Health Policy Research, Los Angeles, CA, USA
| | - Dominic Lim
- Senior Care Action Network (SCAN) Health Group, Long Beach, CA, USA
| | - Dan Osterweil
- Senior Care Action Network (SCAN) Health Group, Long Beach, CA, USA; Division of Geriatric Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Romilla A Batra
- Senior Care Action Network (SCAN) Health Group, Long Beach, CA, USA
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Eghaneyan BH, Killian MO, Sanchez K. The Integration of Behavioral Health and Primary Care for Hispanic/Latino Patients with Depression and Comorbid PTSD. J Behav Health Serv Res 2023; 50:95-107. [PMID: 36352161 PMCID: PMC9646280 DOI: 10.1007/s11414-022-09824-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
Comorbid PTSD and depression are notably high within primary care settings serving low-income and/or immigrant Hispanic/Latino populations. There is limited research examining how comorbid PTSD impacts the response to depression treatment for patients within these settings. The purpose of this study was to examine PTSD-depression comorbidity and its association with treatment outcomes among Hispanic/Latino patients enrolled in an integrated behavioral health intervention for depression. Participants were Hispanic/Latino adult primary care patients who met the criteria for depression and were not currently in treatment. Depression and anxiety severity were assessed at baseline and the 6 and 12 month follow-ups. Outcomes were compared between participants who met the criteria for a PTSD diagnosis and those that did not. Depression and anxiety scores significantly decreased through the 1-year intervention period regardless of PTSD diagnosis. More research is needed to understand what elements of culturally adapted, linguistically concordant treatment benefit diverse patients the most.
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Affiliation(s)
- Brittany H. Eghaneyan
- Department of Social Work, California State University, Fullerton, 800 N. State College Blvd, Fullerton, CA 92831 USA
| | - Michael O. Killian
- College of Social Work, Florida State University, 296 Champions Way, Tallahassee, FL 32306 USA
| | - Katherine Sanchez
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Box 19129, Arlington, TX 76019 USA
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Yang KG, Flores MW, Carson NJ, Cook BL. Racial and Ethnic Disparities in Childhood ADHD Treatment Access and Utilization: Results From a National Study. Psychiatr Serv 2022; 73:1338-1345. [PMID: 35959536 PMCID: PMC11212017 DOI: 10.1176/appi.ps.202100578] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined racial-ethnic disparities in access to and utilization of treatment for attention-deficit hyperactivity disorder (ADHD) and other psychiatric diagnoses among children with ADHD. METHODS Nationally representative, cross-sectional data from the Household Component of the Medical Expenditure Panel Survey 2011-2019 were used to examine racial-ethnic disparities in access to and utilization of treatment by children ages 5-17 with ADHD (N=5,838). Logistic regression models were estimated for access outcomes, and generalized linear models were estimated for utilization outcomes. Multivariable regression models adjusted for race-ethnicity, age, sex, and treatment need in accordance with the Institute of Medicine definition of health care disparities. RESULTS In adjusted analyses, compared with White children with ADHD, Black, Hispanic, and Asian children with ADHD had significantly lower rates of any past-year treatment visit for ADHD or for other psychiatric diagnoses. They also had lower rates of having accessed ADHD medication. Compared with White children, Black and Asian children with ADHD used fewer ADHD medications, and Black and Hispanic children with ADHD had lower overall mental health treatment expenditures. CONCLUSIONS Disparities in ADHD treatment among children from racial-ethnic minority populations may be driven primarily by disparities in access rather than in utilization. Once treatment had been accessed, disparities in utilization were largely accounted for by differences in socioeconomic status. These findings suggest that interventions targeting access to treatment among children from racial-ethnic minority populations may help close existing care gaps.
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Affiliation(s)
- Kelly Guanhua Yang
- Prime Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York City (Yang); Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Boston (Flores, Carson, Cook); Department of Psychiatry, Harvard Medical School, Boston (Flores, Cook)
| | - Michael William Flores
- Prime Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York City (Yang); Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Boston (Flores, Carson, Cook); Department of Psychiatry, Harvard Medical School, Boston (Flores, Cook)
| | - Nicholas J Carson
- Prime Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York City (Yang); Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Boston (Flores, Carson, Cook); Department of Psychiatry, Harvard Medical School, Boston (Flores, Cook)
| | - Benjamin Lê Cook
- Prime Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York City (Yang); Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Boston (Flores, Carson, Cook); Department of Psychiatry, Harvard Medical School, Boston (Flores, Cook)
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21
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Toward Population Health: Using a Learning Behavioral Health System and Measurement-Based Care to Improve Access, Care, Outcomes, and Disparities. Community Ment Health J 2022; 58:1428-1436. [PMID: 35352203 PMCID: PMC8964387 DOI: 10.1007/s10597-022-00957-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 03/01/2022] [Indexed: 01/27/2023]
Abstract
Achieving population behavioral health is urgently needed. The mental health system struggles with enormous challenges of providing access to mental health services, improving quality and equitability of care, and ensuring good health outcomes across subpopulations. Little data exists about increasing access within highly constrained resources, staging/sequencing treatment along care pathways, or personalizing treatments. The conceptual model of the learning healthcare system offers a potential paradigm shift for addressing these challenges. In this article we present an overview of how the three constructs of population health, learning health systems, and measurement-based care are inter-related, and we provide an example of how one academic, community-based, safety net health system is approaching integrating these paradigms into its service delivery system. Implementation outcomes will be described in a subsequent publication. We close by discussing how ultimately, to meaningfully improve population behavioral health, a learning healthcare system could expand into a learning health community in order to target critical points of prevention and intervention.
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22
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Staab EM, Wan W, Campbell A, Gedeon S, Schaefer C, Quinn MT, Laiteerapong N. Elements of Integrated Behavioral Health Associated with Primary Care Provider Confidence in Managing Depression at Community Health Centers. J Gen Intern Med 2022; 37:2931-2940. [PMID: 34981360 PMCID: PMC9485335 DOI: 10.1007/s11606-021-07294-3] [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] [Received: 04/05/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Depression is most often treated by primary care providers (PCPs), but low self-efficacy in caring for depression may impede adequate management. We aimed to identify which elements of integrated behavioral health (BH) were associated with greater confidence among PCPs in identifying and managing depression. DESIGN Mailed cross-sectional surveys in 2016. PARTICIPANTS BH leaders and PCPs caring for adult patients at community health centers (CHCs) in 10 midwestern states. MAIN MEASURES Survey items asked about depression screening, systems to support care, availability and integration of BH, and PCP attitudes and experiences. PCPs rated their confidence in diagnosing, assessing severity, providing counseling, and prescribing medication for depression on a 5-point scale. An overall confidence score was calculated (range 4 (low) to 20 (high)). Multilevel linear mixed models were used to identify factors associated with confidence. KEY RESULTS Response rates were 60% (N=77/128) and 52% (N=538/1039) for BH leaders and PCPs, respectively. Mean overall confidence score was 15.25±2.36. Confidence was higher among PCPs who were satisfied with the accuracy of depression screening (0.38, p=0.01), worked at CHCs with depression tracking systems (0.48, p=0.045), had access to patients' BH treatment plans (1.59, p=0.002), and cared for more patients with depression (0.29, p=0.003). PCPs who reported their CHC had a sufficient number of psychiatrists were more confident diagnosing depression (0.20, p=0.02) and assessing severity (0.24, p=0.03). Confidence in prescribing was lower at CHCs with more patients living below poverty (-0.66, p<0.001). Confidence in diagnosing was lower at CHCs with more Black/African American patients (-0.20, p=0.03). CONCLUSIONS PCPs who had access to BH treatment plans, a system for tracking patients with depression, screening protocols, and a sufficient number of psychiatrists were more confident identifying and managing depression. Efforts are needed to address disparities and support PCPs caring for vulnerable patients with depression.
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Affiliation(s)
| | - Wen Wan
- University of Chicago, Chicago, IL, USA
| | | | - Stacey Gedeon
- Mid-Michigan Community Health Services, Houghton Lake, MI, USA
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23
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Remmert JE, Guzman G, Mavandadi S, Oslin D. Racial Disparities in Prescription of Antidepressants Among U.S. Veterans Referred to Behavioral Health Care. Psychiatr Serv 2022; 73:984-990. [PMID: 35414191 DOI: 10.1176/appi.ps.202100237] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Antidepressants are often prescribed in primary care to treat veterans who have depression. An evaluation of current racial disparities in integrated primary care is warranted. This study examined the association between race and prescription of antidepressants among veterans in primary care. METHODS Veterans in primary care (Black, N=4,120; White, N=4,372) who were referred from primary care to a collaborative care program completed an assessment of demographic characteristics and clinical symptoms, including of current antidepressant prescription before the referral, verified by chart review. Patient data were collected from January 1, 2015, to December 22, 2020. Logistic regression analyses were conducted to examine the relationships between patient race and both depression symptoms and antidepressant prescription. Analyses were also stratified by severity of depression symptoms to understand the results in the context of clinical guidelines. RESULTS White patients were almost two times (odds ratio=1.96, 95% confidence interval [CI]=1.75–2.19, p<0.001) more likely than Black patients to receive an antidepressant prescription, after the analysis was controlled for depression symptoms, demographic characteristics, and other clinical symptoms. Among patients with severe depression, for whom prescription of antidepressants is clinically indicated, White patients were 1.87 times more likely than Black patients to receive an antidepressant prescription (95% CI=1.40–2.50, p<0.001). CONCLUSIONS The findings reveal racial disparities in antidepressant prescription for veterans in primary care. Regular clinical review of antidepressant prescription is recommended to identify disparities in individual clinics. Future research should aim to identify drivers of racial disparities and provide recommendations for health care systems, providers, and patients.
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Affiliation(s)
- Jocelyn E Remmert
- Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center (MIRECC) (Remmert, Mavandadi, Oslin) and Psychology Department (Guzman), Corporal Michael J. Crescenz Department of Veterans Affairs (VA) Medical Center, Philadelphia; Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey (Guzman); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Mavandadi, Oslin)
| | - Gabriella Guzman
- Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center (MIRECC) (Remmert, Mavandadi, Oslin) and Psychology Department (Guzman), Corporal Michael J. Crescenz Department of Veterans Affairs (VA) Medical Center, Philadelphia; Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey (Guzman); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Mavandadi, Oslin)
| | - Shahrzad Mavandadi
- Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center (MIRECC) (Remmert, Mavandadi, Oslin) and Psychology Department (Guzman), Corporal Michael J. Crescenz Department of Veterans Affairs (VA) Medical Center, Philadelphia; Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey (Guzman); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Mavandadi, Oslin)
| | - Dave Oslin
- Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center (MIRECC) (Remmert, Mavandadi, Oslin) and Psychology Department (Guzman), Corporal Michael J. Crescenz Department of Veterans Affairs (VA) Medical Center, Philadelphia; Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey (Guzman); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Mavandadi, Oslin)
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Garcia ME, Hinton L, Neuhaus J, Feldman M, Livaudais-Toman J, Karliner LS. Equitability of Depression Screening After Implementation of General Adult Screening in Primary Care. JAMA Netw Open 2022; 5:e2227658. [PMID: 35980633 PMCID: PMC9389351 DOI: 10.1001/jamanetworkopen.2022.27658] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
IMPORTANCE Depression is a debilitating and costly medical condition that is often undertreated. Men, racial and ethnic minority individuals, older adults, and those with language barriers are at increased risk for undertreatment of depression. Disparities in screening may contribute to undertreatment. OBJECTIVE To examine depression screening rates among populations at risk for undertreatment of depression during and after rollout of general screening. DESIGN, SETTING, AND PARTICIPANTS This cohort study from September 1, 2017, to December 31, 2019, of electronic health record data from 52 944 adult patients at 6 University of California, San Francisco, primary care facilities assessed depression screening rates after implementation of a general screening policy. Patients were excluded if they had a baseline diagnosis of depression, bipolar disorder, schizophrenia, schizoaffective disorder, or dementia. EXPOSURES Screening year, including rollout (September 1, 2017, to December 31, 2017) and each subsequent calendar year (January 1 to December 31, 2018, and January 1 to December 31, 2019). MAIN OUTCOMES AND MEASURES Rates of depression screening performed by medical assistants using the Patient Health Questionnaire-2. Data collected included age, sex, race and ethnicity, and language preference (English vs non-English); to compare English and non-English language preference groups and also assess depression screening by race and ethnicity within the English-speaking group, a single language-race-ethnicity variable with non-English language preference and English language preference categories was created. In multivariable analyses, the likelihood of being screened was evaluated using annual logistic regression models for 2018 and 2019, examining sex, age, language-race-ethnicity, and comorbidities, with adjustment for primary care site. RESULTS There were 52 944 unique, eligible patients with 1 or more visits in one of the 6 primary care practices during the entire study period (59% female; mean [SD] age, 48.9 [17.6] years; 178 [0.3%] American Indian/Alaska Native, 13 241 [25.0%] English-speaking Asian, 3588 [6.8%] English-speaking Black/African American, 4744 [9.0%] English-speaking Latino/Latina/Latinx, 760 [1.4%] Pacific Islander, 22 689 [42.9%] English-speaking White, 4857 [9.0%] English-speaking other [including individuals who indicated race and ethnicity as other and individuals for whom race and ethnicity data were missing or unknown], and 2887 [5.5%] with language barriers [non-English language preference]). Depression screening increased from 40.5% at rollout (2017) to 88.8% (2019). In 2018, the likelihood of being screened decreased with increasing age (adusted odds ratio [aOR], 0.89 [95% CI, 0.82-0.98] for ages 45-54 and aOR, 0.75 [95% CI, 0.65-0.85] for ages 75 and older compared with ages 18-30); and, except for Spanish-speaking patients, patients with limited English proficiency were less likely to be screened for depression than English-speaking White patients (Chinese language preference: aOR, 0.59 [95% CI, 0.51-0.67]; other non-English language preference: aOR, 0.55 [95% CI, 0.47-0.64]). By 2019, depression screening had increased dramatically for all at-risk groups, and for most, disparities had disappeared; the odds of screening were only still significantly lower for men compared with women (aOR, 0.87 [95% CI, 0.81 to 0.93]). CONCLUSIONS AND RELEVANCE In this cohort study in a large academic health system, full implementation of depression screening was associated with a substantial increase in screening rates among groups at risk for undertreatment of depression. In addition, depression screening disparities narrowed over time for most groups, suggesting that routine depression screening in primary care may reduce screening disparities and improve recognition and appropriate treatment of depression for all patients.
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Affiliation(s)
- Maria E. Garcia
- Center for Aging in Diverse Communities, University of California, San Francisco, San Francisco
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco
- Implementation Science Training Program, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis
| | - John Neuhaus
- Implementation Science Training Program, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Mitchell Feldman
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco
| | | | - Leah S. Karliner
- Center for Aging in Diverse Communities, University of California, San Francisco, San Francisco
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco
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25
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Rosenfeld LC, Wang P, Holland J, Ruble M, Parsons T, Huang H. Care Management of Comorbid Medical and Psychiatric Illness: A Conceptual Framework for Improving Equity of Care. Popul Health Manag 2022; 25:148-156. [PMID: 35442788 PMCID: PMC9058884 DOI: 10.1089/pop.2021.0366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Psychiatric and medical comorbidities are common among adults in the United States. Due to the complex interplay between medical and psychiatric illness, comorbidities result in substantial disparities in morbidity, mortality, and health care costs. There is, thus, both an ethical and fiscal imperative to develop care management programs to address the needs of individuals with comorbid conditions. Although there is substantial evidence supporting the use of care management for improving health outcomes for patients with chronic diseases, the majority of interventions described in the literature are condition-specific. Given the prevalence of comorbidities, the authors of this article reviewed the literature and drew on their clinical expertise to guide the development of future multimorbidity care management programs. Their review yielded one study of multimorbidity care management and two studies of multimorbidity collaborative care. The authors supplemented their findings by describing three key pillars of effective care management, as well as specific interventions to offer patients based on their psychiatric diagnoses and illness severity. The authors proposed short-, medium-, and long-term indicators to measure and track the impact of care management programs on disparities in care. Future studies are needed to identify which elements of existing multimorbidity collaborative care models are active ingredients, as well as which of the suggested supplemental interventions offer the greatest value.
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Affiliation(s)
- Lisa C Rosenfeld
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Philip Wang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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26
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Rafla-Yuan E, Moore S, Carvente-Martinez H, Yang P, Balasuriya L, Jackson K, McMickens C, Robles-Ramamurthy B. Striving for Equity in Community Mental Health: Opportunities and Challenges for Integrating Care for BIPOC Youth. Child Adolesc Psychiatr Clin N Am 2022; 31:295-312. [PMID: 35361366 DOI: 10.1016/j.chc.2021.11.007] [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] [Indexed: 12/12/2022]
Abstract
Supporting the mental health of youth who identify as Black, Indigenous, or Persons of Color (BIPOC) continues to be a challenge for clinicians and policymakers alike. Children and adolescents are a vulnerable population, and for BIPOC youth, these vulnerabilities are magnified by the effects of structural, interpersonal, and internalized racism. Integration of psychiatric care into other medical settings has emerged as an evidence-based method to improve access to psychiatric care, but to bridge the gap experienced by BIPOC youth, care must extend beyond medical settings to other child-focused sectors, including local governments, education, child welfare, juvenile legal systems, and beyond. Intentional policy decisions are needed to incentivize and support these systems, which typically rely on coordination and collaboration between clinicians and other stakeholders. Clinicians must be trauma-informed and strive for structural competency to successfully navigate and advocate for collaborative systems that benefit BIPOC youth.
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Affiliation(s)
- Eric Rafla-Yuan
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, #0851, San Diego, CA 92093, USA.
| | - Shavon Moore
- Department of Psychiatry, UC San Diego Health Psychiatry - La Jolla, 8950 Villa La Jolla Drive, Suite C101, MC 9057, La Jolla, CA 92037, USA
| | | | - Phillip Yang
- Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7985, San Antonio, TX 78229, USA
| | - Lilanthi Balasuriya
- Yale University School of Medicine, 333 Cedar Street, SHM IE-66, PO Box 208088, New Haven, CT 06510-8088, USA
| | - Kamilah Jackson
- PerformCare, 300 Horizon Drive Suit 306, Trenton, NJ 08691, USA
| | - Courtney McMickens
- North Carolina, Eleanor Health, 610 Pembroke Road, Greensboro, NC 27408-7608, USA
| | - Barbara Robles-Ramamurthy
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7792, San Antonio, TX 78229, USA
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27
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Lim CT, Rosenfeld LC, Nissen NJ, Wang PS, Patel NC, Powers BW, Huang H. Remote care management for older adult populations with elevated prevalence of depression or anxiety and comorbid chronic medical illness: A systematic review. J Acad Consult Liaison Psychiatry 2022; 63:198-212. [PMID: 35189427 DOI: 10.1016/j.jaclp.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 01/28/2022] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Comorbidity of psychiatric and medical illnesses among older adult populations is highly prevalent and associated with adverse outcomes. Care management is a common form of outpatient support for both psychiatric and medical conditions in which assessment, care planning, and care coordination are provided. Although care management is often remote and delivered by telephone, the evidence supporting this model of care is uncertain. OBJECTIVE To perform a systematic review of the literature on remote care management programs for older adult populations with elevated prevalence of depression or anxiety and comorbid chronic medical illness. METHODS A systematic review was performed in accordance with PRISMA guidelines. A multi-database search was performed. Articles were included for review if they studied fully remote care management for older adult populations with elevated prevalence of depression or anxiety and chronic medical illness or poor physical health. A narrative synthesis was performed. RESULTS A total of 6 articles representing 6 unique studies met inclusion criteria. The 6 studies included 4 randomized controlled trials, 1 case-matched retrospective cohort study, and 1 pre-post analysis. Two studies focused on specific medical conditions. All interventions were entirely telephonic. Five of 6 studies involved an intervention that was 3 to 6 months in duration. Across the 6 studies, care management demonstrated mixed results in terms of impact on psychiatric outcomes and limited impact on medical outcomes. No studies demonstrated a statistically significant impact on health care utilization or cost. CONCLUSION Among older adult populations with elevated prevalence of depression or anxiety and comorbid chronic medical illness, remote care management may have favorable impact on psychiatric symptoms, but impact on physical health and health care utilization is uncertain. Future research should focus on identifying effective models and elements of remote care management for this population, with a particular focus on optimizing medical outcomes.
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Affiliation(s)
- Christopher T Lim
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Humana Inc., Louisville, KY, USA.
| | - Lisa C Rosenfeld
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Humana Inc., Louisville, KY, USA
| | - Nicholas J Nissen
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Humana Inc., Louisville, KY, USA
| | - Philip S Wang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Humana Inc., Louisville, KY, USA
| | - Nick C Patel
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Humana Inc., Louisville, KY, USA
| | - Brian W Powers
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Humana Inc., Louisville, KY, USA
| | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Humana Inc., Louisville, KY, USA
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Cheville A, Basford JR. A View of the Development of Patient Reported Outcomes Measures, their Clinical Integration, Electronification, and Potential Impact on Rehabilitation Service Delivery. Arch Phys Med Rehabil 2021; 103:S24-S33. [PMID: 34896403 DOI: 10.1016/j.apmr.2021.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022]
Abstract
Recognition of the importance of a patient's perception of their status and experience has become central to medical care and its evaluation. This recognition has led to a growing reliance on the use of patient reported outcome measures (PROMs). Nevertheless, while awareness of PROMs and acceptance of their utility has increased markedly, few of us have a good insight into their development; their utility relative to clinician-rated and performance measures such as the FIM and 6-Minute Walk Test or how their "electronification" and incorporation into electronic health records (EHRs) may improve the individualization, value, and quality of medical care. In all, the goal of this commentary is to provide some insight into historical factors and technology developments that we believe have shaped modern clinical PROMs as they relate to medicine in general and to rehabilitation in particular. In addition, we speculate that while the growth of PROM use may have been triggered by an increased emphasis on the centrality of the patient in their care, future uptake will be shaped by their embedding in EHRs and use to improve clinical decision support though their integration with other sources of clinical and sociodemographic data.
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Affiliation(s)
- Andrea Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Jeffrey R Basford
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN.
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29
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Behavioral Health Services use Among Racial and Ethnic Groups: Results from the California Health Interview Survey (CHIS). J Immigr Minor Health 2021; 24:118-124. [PMID: 34333722 DOI: 10.1007/s10903-021-01250-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
Access and utilization of behavioral health services is a public health issue, yet disparities among racial/ethnic groups persist, resulting in fewer access points and lower utilization. Using pooled 2015 and 2016 California Health Interview Survey (N = 42,089) data of diverse adults, this study examines provider access points for behavioral health services use. Latinx (OR = 0.55, 95% CI, 0.38-0.80), Asian (OR = 0.32, 95% CI, 0.17-0.59), and first generation (OR = 0.56, 95% CI, .38-.83) individuals, reported lower odds of accessing specialty care behavioral health services, compared to no services. First generation adults reported lower odds accessing a primary care physician (OR = 0.66, 95% CI, 0.44-0.98), compared to none. Results advance knowledge of behavioral health services access points among racial, ethnic and immigrant groups, following passage of the California Mental Health Services Act. Findings suggest primary care may be an important entry point for behavioral health service use engagement among underserved populations.
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Abstract
Accumulating evidence documenting the high percentage of patients who first discuss mental health needs with their primary care physician has accelerated the integration of physical and mental health care to a national priority. Several models have been developed describing how health care settings can integrate physical and mental health care and how training programs might better prepare clinicians to work in integrated behavioral health care settings. This article explores models of integrated behavioral health, highlights contributions of social work and psychology, and describes the training and experiences of social workers and psychologists working in integrated behavioral health.
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Affiliation(s)
- Mark S Barajas
- Department of Psychology, Saint Mary's College of California, 1928 St Mary's Road, Moraga, CA 94575, USA.
| | - Derrick Bines
- Department of Counseling, San Francisco State University, 1600 Holloway Avenue, Burk Hall, Room 524, San Francisco, CA 94132, USA
| | - Jason Straussman
- Tang Counseling Center, University of California, 2222 Bancroft Way, Berkeley, CA 94720, USA
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Tobin JN, Cassells A, Weiss E, Lin TJ, Holder T, Carrozzi G, Barsanti F, Morales A, Maling A, Espejo M, Ascher A, Gilbert E, Casiano L, O-Hara-Cicero E, Weed J, Dietrich A. Integrating Cancer Screening and Mental Health Services in Primary Care: Protocol and Baseline Results of a Patient-Centered Outcomes Intervention Study. J Health Care Poor Underserved 2021; 32:1907-1934. [PMID: 34803050 PMCID: PMC10999254 DOI: 10.1353/hpu.2021.0173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Low-income and minority women are significantly more likely to be diagnosed with preventable, late-stage cancers and suffer from depression than the general population. Intervention studies aiming to reduce depression to increase cancer screening among underserved minority women are sparse. METHODS This patient-centered outcomes trial compared Collaborative Care Intervention plus Cancer Prevention Care Management (CCI+PCM) versus PCM alone. Participants from six Federally Qualified Health Centers (FQHCs) were interviewed at baseline, 6-and 12-month follow-up to monitor adherence to screening guidelines, depressive symptoms, quality of life, barriers to screening, and other psychosocial and health-related variables. RESULTS Participants included 757 English-or Spanish-speaking women (ages 50-64) who screened positive for depression on the Patient Health Questionnaire (PHQ)-9 and were not up-to-date for breast, cervical, and/or colorectal cancer screening. CONCLUSIONS Study methodology and baseline participant characteristics are reported to contribute to the literature on evidence-based interventions for cancer screening among underserved, depressed women.
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Robinson DM, Taylor AD, Zein M, Behbahani KS, Khandai AC. A Call to Action: A New Era Calls for Incorporating Social Justice Into Consultation-Liaison Psychiatry. J Acad Consult Liaison Psychiatry 2020; 62:157-158. [PMID: 33097226 PMCID: PMC7502224 DOI: 10.1016/j.psym.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Diana M Robinson
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX.
| | | | - Mira Zein
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | | | - Abhisek C Khandai
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
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