1
|
Saulnier KG, Panaite V, Ganoczy D, Kim HM, Zivin K, Hofer T, Piette JD, Pfeiffer PN. Depression symptom outcomes and re-engagement among VA patients who discontinue care while symptomatic. Gen Hosp Psychiatry 2023; 85:87-94. [PMID: 37862961 DOI: 10.1016/j.genhosppsych.2023.10.008] [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: 03/02/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Evaluate outcomes of Veterans who discontinued treatment with at least moderate ongoing depressive symptoms. METHOD Veterans with elevated depression symptoms from 29 Department of Veterans Affairs facilities completed baseline surveys and follow-up assessments for one year. Analyses examined rates and predictors of treatment discontinuation, treatment re-engagement, and subsequent symptoms among patients who remained out of care. RESULTS A total of 242 (17.8%; n = 1359) participants discontinued treatment while symptomatic, with Black participants, participants with less severe depression, and participants receiving only psychotherapy (versus combined psychotherapy and antidepressant medications) discontinuing at higher rates. Among all participants who discontinued treatment (n = 445), 45.8% re-engaged within the following six months with participants receiving combined treatment re-engaging at higher rates. Of participants who discontinued while symptomatic within the first 6 months of the study and did not return to care (n = 112), 68.8% remained symptomatic at 12 months. Lower baseline treatment expectancy and greater depression symptom severity were associated with remaining symptomatic while untreated. CONCLUSIONS Black race, lower symptom severity, and treatment modality may help identify patients at higher risk for discontinuing care while symptomatic, whereas patients with lower treatment expectations may be at greater risk for remaining out of care despite continuing symptoms.
Collapse
Affiliation(s)
- K G Saulnier
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA; VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan Medical School, Ann Arbor, MI, USA.
| | - V Panaite
- James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - D Ganoczy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - H M Kim
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan Consulting for Statistics, Computing, and Analytics Research, Ann Arbor, MI, USA
| | - K Zivin
- University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - T Hofer
- University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - J D Piette
- University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - P N Pfeiffer
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| |
Collapse
|
2
|
Eliacin J, Burgess D, Rollins AL, Patterson S, Damush T, Bair MJ, Salyers MP, Spoont M, Chinman M, Slaven JE, Matthias MS. Outcomes of a peer-led navigation program, PARTNER-MH, for racially minoritized Veterans receiving mental health services: a pilot randomized controlled trial to assess feasibility and acceptability. Transl Behav Med 2023; 13:710-721. [PMID: 37130337 DOI: 10.1093/tbm/ibad027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
This pilot study explored the feasibility and acceptability of PARTNER-MH, which aimed to engage racially diverse Veterans in mental health services, facilitate their active participation in care, and improve their communication with providers. Fifty participants were randomized to the intervention or a waitlist control group. For primary outcomes, we assessed the feasibility of the study design and PARTNER-MH's feasibility and acceptability. For secondary outcomes, we explored preliminary effects on patient engagement, patient activation, shared decision-making, and health-related outcomes. The study had a recruitment rate of 68%, enrollment rate of 91%, and a follow-up retention rate of 72%. For intervention feasibility and acceptability, fidelity scores were satisfactory and improved over time, session attendance was modest with 33% of participants completing ≥6 sessions, and 89% of participants were satisfied with the intervention. For secondary outcomes, patients in the intervention arm showed significant improvement on self-reported mental health and depression, compared with those in the control group at both 6- and 9-month follow-ups. However, there were no significant differences between study arms on the other measures. Pilot results provide support for future testing of PARTNER-MH in a larger trial, although modifications are needed to increase session attendance and follow-up retention rate. CLINICAL TRIAL INFORMATION The study was preregistered at Clinical Trials.gov. The study Trial registration number is ClinicalTrials.gov NCT04515771.
Collapse
Affiliation(s)
- Johanne Eliacin
- Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Diana Burgess
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Angela L Rollins
- Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Scott Patterson
- Department of Psychiatry, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Teresa Damush
- Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew J Bair
- Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Michele Spoont
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Matthew Chinman
- Center for Health Equity Research and Promotion, Pittsburg VA, Pittsburg, PA, USA
- RAND, Pittsburgh, PA, USA
| | - James E Slaven
- Deparmtent of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marianne S Matthias
- Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
3
|
Leung T, Burgess DJ, Rollins AL, Patterson S, Damush T, Bair MJ, Salyers MP, Spoont M, Slaven JE, O'Connor C, Walker K, Zou DS, Austin E, Akins J, Miller J, Chinman M, Matthias MS. Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH), a Peer-Led Patient Navigation Intervention for Racially and Ethnically Minoritized Veterans in Veterans Health Administration Mental Health Services: Protocol for a Mixed Methods Randomized Controlled Feasibility Study. JMIR Res Protoc 2022; 11:e37712. [PMID: 36066967 PMCID: PMC9490546 DOI: 10.2196/37712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Mental health care disparities are persistent and have increased in recent years. Compared with their White counterparts, members of racially and ethnically minoritized groups have less access to mental health care. Minoritized groups also have lower engagement in mental health treatment and are more likely to experience ineffective patient-provider communication, which contribute to negative mental health care experiences and poor mental health outcomes. Interventions that embrace recovery-oriented practices to support patient engagement and empower patients to participate in their mental health care and treatment decisions may help reduce mental health care disparities. Designed to achieve this goal, the Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH) is a peer-led patient navigation intervention that aims to engage minoritized patients in mental health treatment, support them to play a greater role in their care, and facilitate their participation in shared treatment decision-making. OBJECTIVE The primary aim of this study is to assess the feasibility and acceptability of PARTNER-MH delivered to patients over 6 months. The second aim is to evaluate the preliminary effects of PARTNER-MH on patient activation, patient engagement, and shared decision-making. The third aim is to examine patient-perceived barriers to and facilitators of engagement in PARTNER-MH as well as contextual factors that may inhibit or promote the integration, sustainability, and scalability of PARTNER-MH using the Consolidated Framework for Implementation Research. METHODS This pilot study evaluates the feasibility and acceptability of PARTNER-MH in a Veterans Health Administration (VHA) mental health setting using a mixed methods, randomized controlled trial study design. PARTNER-MH is tested under real-world conditions using certified VHA peer specialists (peers) selected through usual VHA hiring practices and assigned to the mental health service line. Peers provide PARTNER-MH and usual peer support services. The study compares the impact of PARTNER-MH versus a wait-list control group on patient activation, patient engagement, and shared decision-making as well as other patient-level outcomes. PARTNER-MH also examines organizational factors that could impact its future implementation in VHA settings. RESULTS Participants (N=50) were Veterans who were mostly male (n=31, 62%) and self-identified as non-Hispanic (n=44, 88%) and Black (n=35, 70%) with a median age of 45 to 54 years. Most had at least some college education, and 32% (16/50) had completed ≥4 years of college. Randomization produced comparable groups in terms of characteristics and outcome measures at baseline, except for sex. CONCLUSIONS Rather than simply documenting health disparities among vulnerable populations, PARTNER-MH offers opportunities to evaluate a tailored, culturally sensitive, system-based intervention to improve patient engagement and patient-provider communication in mental health care for racially and ethnically minoritized individuals. TRIAL REGISTRATION ClinicalTrials.gov NCT04515771; https://clinicaltrials.gov/ct2/show/NCT04515771. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/37712.
Collapse
Affiliation(s)
| | - Diana J Burgess
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, United States.,Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Angela L Rollins
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States.,Regenstrief Institute, Indianapolis, IN, United States.,Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Scott Patterson
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Teresa Damush
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States.,Regenstrief Institute, Indianapolis, IN, United States.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Matthew J Bair
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States.,Regenstrief Institute, Indianapolis, IN, United States.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Michele Spoont
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, United States.,Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - James E Slaven
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Caitlin O'Connor
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Kiara Walker
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Denise S Zou
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Emily Austin
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States
| | - John Akins
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, United States
| | - James Miller
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Matthew Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care, Pittsburgh, PA, United States.,RAND Corporation Pittsburgh Office, Pittsburgh, PA, United States
| | - Marianne S Matthias
- Center for Health Information and Communication, Health Services Research & Development, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States.,Regenstrief Institute, Indianapolis, IN, United States.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| |
Collapse
|
4
|
Eliacin J, Matthias MS, Burgess DJ, Patterson S, Damush T, Pratt-Chapman M, McGovern M, Chinman M, Talib T, O'Connor C, Rollins A. Pre-implementation Evaluation of PARTNER-MH: A Mental Healthcare Disparity Intervention for Minority Veterans in the VHA. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:46-60. [PMID: 32399857 DOI: 10.1007/s10488-020-01048-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
To design PARTNER-MH, a peer-led, patient navigation program for implementation in Veterans Health Administration (VHA) mental health care settings, we conducted a pre-implementation evaluation during intervention development to assess stakeholders' views of the intervention and to explore implementation factors critical to its future adoption. This is a convergent mixed-methods study that involved qualitative semi-structured interviews and survey data. Data collection was guided by the Consolidated Framework for Implementation Research (CFIR). We interviewed and administered the surveys to 23 peers and 10 supervisors from 12 midwestern VHA facilities. We used deductive and inductive approaches to analyze the qualitative data. We also conducted descriptive analysis and Fisher Exact Test to compare peers and supervisors' survey responses. We triangulated findings to refine the intervention. Overall, participants viewed PARTNER-MH favorably. However, they saw the intervention's focus on minority Veterans and social determinants of health framework as potential barriers, believing this could negatively affect the packaging of the intervention, complicate its delivery process, and impact its adoption. They also viewed clinic structures, available resources, and learning climate as potential barriers. Peers and supervisors' selections and discussions of CFIR items were similar. Our findings informed PARTNER-MH development and helped identify factors that could impact its implementation. This project is responsive to the increasing recognition of the need to incorporate implementation science in healthcare disparities research. Understanding the resistance to the intervention's focus on minority Veterans and the potential barriers presented by contextual factors positions us to adjust the intervention prior to testing, in an effort to maximize implementation success.
Collapse
Affiliation(s)
- Johanne Eliacin
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA.
- Psychology Department, ACT Center of Indiana, IUPUI, Indianapolis, USA.
- Regenstrief Institute, Inc, Indianapolis, IN, USA.
| | - Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
- Department of Communication Studies, IUPUI, Indianapolis, USA
| | - Diana J Burgess
- Center for Chronic Disease Outcomes Research (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Scott Patterson
- Department of Psychiatry, Richard L. Roudebush VAMC, Indianapolis, IN, USA
| | - Teresa Damush
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
- General Internal Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Mandi Pratt-Chapman
- Institute for Patient-Centered Initiatives & Health Equity, George Washington University Cancer Center, Washington, DC, USA
| | - Mark McGovern
- Psychiatry & Behavioral Sciences; Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew Chinman
- Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | | | - Caitlin O'Connor
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA
| | - Angela Rollins
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA
- Psychology Department, ACT Center of Indiana, IUPUI, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
| |
Collapse
|
5
|
Wheeler S, MacKay J, Moody L, D'Souza J, Gilbert J. Engaging Patient and Family Advisors in Health-Care System Planning: Experiences and Recommendations. J Patient Exp 2019; 7:331-337. [PMID: 32821792 PMCID: PMC7410124 DOI: 10.1177/2374373519840343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Patient and family advisors (PFAs) contributed to the development of the Ontario Cancer Plan IV (OCP IV), a 4-year strategic plan for Ontario, Canada's cancer system produced by Cancer Care Ontario. Objective To understand the barriers and facilitators PFAs experience when they are engaged in health-care system planning and provide recommendations for future engagement. Method Patient and family advisors who had an ongoing involvement in the development of the OCP IV were invited to take part in an interview. Qualitative data were analyzed for emergent themes and recommendations were generated. Results Key emergent themes highlighted necessary elements for effective engagement of PFAs. These included rapport (feeling valued, included as an equal and having supportive interpersonal relationships), communication (clarity and transparency, shared language and understanding, feeling heard, and effective teleconferencing), and leadership (from PFAs and staff). Recommendations for optimizing PFA engagement in health-care system planning were generated. Conclusion Patient and family advisors can be effectively engaged in system-level strategic planning by building reciprocal rapport, effective communication, and strong leadership. Notably, developing "systems literacy" in PFAs is key to ensuring the voices of patients and their families are heard and reflected in health-care system plans.
Collapse
Affiliation(s)
- Sarah Wheeler
- Enhanced Program Evaluation Unit, Planning and Regional Programs, Cancer Care Ontario, Ontario, Canada
| | - Jenna MacKay
- Enhanced Program Evaluation Unit, Planning and Regional Programs, Cancer Care Ontario, Ontario, Canada
| | - Lesley Moody
- Person-Centred Care, Clinical Programs and Quality Initiatives, Cancer Care Ontario, Ontario, Canada
| | - Junell D'Souza
- System and Infrastructure Planning, Planning and Regional Programs, Cancer Care Ontario, Ontario, Canada
| | - Julie Gilbert
- Enhanced Program Evaluation Unit, Planning and Regional Programs, Cancer Care Ontario, Ontario, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| |
Collapse
|
6
|
|
7
|
Eliacin J, Coffing JM, Matthias MS, Burgess DJ, Bair MJ, Rollins AL. The Relationship Between Race, Patient Activation, and Working Alliance: Implications for Patient Engagement in Mental Health Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 45:186-192. [DOI: 10.1007/s10488-016-0779-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|