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Hu X, Jiang H, Liu P, Li Z, Zhang R. Continued stepped care model improves early-stage self-report quality of life and knee function after total knee arthroplasty. Technol Health Care 2024:THC240780. [PMID: 39031415 DOI: 10.3233/thc-240780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
BACKGROUND The Stepped Care Model (SCM) is an evidence-based treatment approach that tailors treatment intensity based on patients' health status, aiming to achieve the most positive treatment outcomes with the least intensive and cost-effective interventions. Currently, the effectiveness of the Stepped Care Model in postoperative rehabilitation for TKA (Total Knee Arthroplasty) patients has not been reported. OBJECTIVE The present study aimed to investigate whether the stepped care model could improve early-stage self-report quality of life and knee function after total knee arthroplasty via a prospective randomized controlled design. METHODS It was a mono-center, parallel-group, open-label, prospective randomized controlled study. Patients who aging from 60-75 years old as well as underwent unilateral primary total knee arthroplasty due to end-stage knee osteoarthritis between 2020.06 to 2022.02 were enrolled. Participants were randomized and arranged into two groups in a 1:1 allocation. The control group was given traditional rehabilitation guidance, while the stepped care model group was given continued stepped care. Hospital for special surgery knee score, daily living ability (ADL), knee flexion range, and adverse events at 1, 3, and 6 months after total knee arthroplasty were recorded. RESULTS 88 patients proceeded to the final analysis. There was no significant difference of age, gender, length of stay, BMI, and educational level between the two groups at the baseline. After specific stepped care model interventions, patients showed significant improvements in HHS in 1 month (85.00 (82.25, 86.00) vs. 80.00 (75.00, 83.00), p< 0.001), 3 months (88.00 (86.00, 92.00) vs. 83.00 (76.75, 85.00), p< 0.001), and 6 months (93.00 (90.25, 98.00) vs. 88.00 (84.25, 91.75), p< 0.001) when compared with the control group. Similar results were also found in both daily living ability and knee flexion angle measurements. No adverse event was observed during the follow-up. CONCLUSION The present study found that the stepped care model intervention significantly improved early-stage knee function and self-reported life quality after total knee arthroplasty due to knee osteoarthritis. Female patients and those less than 70 years old benefit more from the stepped care model intervention after total knee arthroplasty.
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Scodari BT, Chacko S, Matsumura R, Jacobson NC. Using machine learning to forecast symptom changes among subclinical depression patients receiving stepped care or usual care. J Affect Disord 2023; 340:213-220. [PMID: 37541599 PMCID: PMC10548339 DOI: 10.1016/j.jad.2023.08.004] [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: 08/05/2022] [Revised: 03/08/2023] [Accepted: 08/01/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Subclinical depression (SD) is a mental health disorder characterized by minor depressive symptoms. Most SD patients are treated in the primary practice, but many respond poorly to treatment at the expense of provider resources. Stepped care approaches are appealing for tiering SD care to efficiently allocate scarce resources while jointly optimizing patient outcomes. However, stepped care can be time inefficient, as some persons may respond poorly and be forced to suffer with their symptoms for prolonged periods. Machine learning can offer insight into optimal treatment paths and inform clinical recommendations for incident patients. METHODS As part of the Step-Dep trial, participants with SD were randomized to receive stepped care (N=96) or usual care (N=140). Machine learning was used to predict changes in depressive symptoms every three months over a year for each treatment group. RESULTS Tree-based models were effective in predicting PHQ-9 changes among patients who received stepped care (r=0.35-0.46, MAE=0.14-0.17) and usual care (r=0.34-0.49, MAE=0.15-0.18). Patients who received stepped care were more likely to reduce PHQ-9 scores if they had high PHQ-9 but low HADS-A scores at baseline, a low number of chronic illnesses, and an internal locus of control. LIMITATIONS Models may suffer from potential overfitting due to sample size limitations. CONCLUSION Our findings demonstrate the promise of machine learning for predicting changes in depressive symptoms for SD patients receiving different treatments. Trained models can intake incident patient information and predict outcomes to inform personalized care.
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Affiliation(s)
- Bruno T Scodari
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Sarah Chacko
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Rina Matsumura
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Nicholas C Jacobson
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Computer Science, Dartmouth College, Hanover, NH, USA
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Vriesman M, Dhuga J, LaLonde L, Orkopoulou E, Lucy C, Teeple T, Good J, Maragakis A. Clinical Psychologists as T-Shaped Professionals. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:996-1008. [PMID: 36459685 DOI: 10.1177/17456916221135615] [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: 09/02/2023]
Abstract
The modern world is becoming increasingly integrated, and disciplines are frequently collaborating with each other. Following this trend, clinical psychologists are also often working within multidisciplinary teams and in settings outside of traditional mental health. To be competent and effective in these contexts, clinical psychologists could benefit from skills outside of psychology. The current psychology training model provides depth of training in psychology but could be improved by providing the breadth of training required of modern clinical psychologists working in these contexts. Other disciplines, such as engineering, business, and social work, have improved their breadth of training through the adoption of the T-shaped model. This model of training allows individuals to simultaneously acquire the depth of knowledge required for their discipline and the breadth required to work effectively in multidisciplinary contexts. This article discusses areas in which clinical psychologists could benefit from broad training and recommendations to implement the T-shaped model.
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Affiliation(s)
| | | | - Leah LaLonde
- Psychology Department, Eastern Michigan University
| | | | | | - Tatum Teeple
- Psychology Department, Eastern Michigan University
| | - Jessica Good
- Psychology Department, Eastern Michigan University
| | - Alexandros Maragakis
- Psychology Department, Eastern Michigan University
- Deree, The American College of Greece, School of Graduate and Professional Studies
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Cole R, Kynn M, Carberry A, Jones R, Parekh S, Whitehead E, Taylor J, Merollini K. Examining service utilisation and impact among consumers of a national mental health stepped care programme in Australia: a protocol using linked administrative data. BMJ Open 2023; 13:e072404. [PMID: 37419645 PMCID: PMC10335474 DOI: 10.1136/bmjopen-2023-072404] [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: 02/01/2023] [Accepted: 06/16/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Mental well-being is a global public health priority with increasing mental health conditions having substantial burden on individuals, health systems and society. 'Stepped care', where services are provided at an intensity to meet the changing needs of the consumer, is the chosen approach to mental health service delivery in primary healthcare in Australia for its efficiencies and patient outcomes; yet limited evidence exists on how the programme is being rolled out and its impact in practice. This protocol outlines a data linkage project to characterise and quantify healthcare service utilisation and impacts among a cohort of consumers of a national mental health stepped care programme in one region of Australia. METHODS AND ANALYSIS Data linkage will be used to establish a retrospective cohort of consumers of mental health stepped care services between 1 July 2020 and 31 December 2021 in one primary healthcare region in Australia (n=approx. 12 710). These data will be linked with records from other healthcare service data sets (eg, hospitalisations, emergency department presentations, community-based state government-delivered mental healthcare, hospital costs). Four areas for analysis will include: (1) characterising the nature of mental health stepped care service use; (2) describing the cohort's sociodemographic and health characteristics; (3) quantifying broader service utilisation and associated economic costs; and (4) assessing the impact of mental health stepped care service utilisation on health and service outcomes. ETHICS AND DISSEMINATION Approval from the Darling Downs Health Human Research Ethics Committee (HREA/2020/QTDD/65518) has been granted. All data will be non-identifiable, and research findings will be disseminated through peer-reviewed journals, conference presentations and industry meetings.
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Affiliation(s)
- Rachel Cole
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Sunshine Coast Health Network, Maroochydore, Queensland, Australia
| | - Mary Kynn
- School of Electrical Engineering, Computing and Mathematical Sciences, Curtin University, Perth, Western Australia, Australia
| | - Angela Carberry
- Sunshine Coast Health Network, Maroochydore, Queensland, Australia
| | - Rhian Jones
- Sunshine Coast Health Network, Maroochydore, Queensland, Australia
| | | | - Emma Whitehead
- Sunshine Coast Health Network, Maroochydore, Queensland, Australia
| | - Jane Taylor
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Katharina Merollini
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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Kolaas K, Berman AH, Hedman-Lagerlöf E, Zakrevska A, Epstein M, Hammarberg SAW, Axelsson E. Feasibility of a video-delivered mental health course for primary care patients: a single-group prospective cohort study. BMC PRIMARY CARE 2023; 24:28. [PMID: 36690940 PMCID: PMC9869530 DOI: 10.1186/s12875-023-01989-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/18/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND In many health care systems, primary care is tasked with offering psychological treatment for common mental disorders. Resources are often limited, which complicates widespread dissemination of traditional psychological treatments. Stepped care models where the less resource-intensive interventions are delivered first, can be employed, but often do not eliminate the need for a thorough diagnostic assessment, which can be time-consuming, has the potential to bottleneck patient intake, and can add to waiting times. Novel low-threshold formats are needed to improve access to mental health care in the primary care setting. METHODS This was a single-group prospective cohort study (N = 91). We assessed the feasibility of a video-delivered course as a first-line intervention for patients seeking help for mental health problems at a primary care center. The course had a transdiagnostic approach, suitable for both depression and anxiety disorders, and was based on cognitive behavioral techniques. Patients in need of psychosocial assessment, which usually entailed a four- to six-week wait, were referred by physicians or triage nurses. Study participants could start within a week, without the need for conventional diagnostic assessment, and were informed that they would be offered assessment after the course if needed. Key feasibility outcomes included participant satisfaction, attendance rates, the proportion of participants in need of additional clinical intervention after the course, and the rate of clinically significant improvement in anxiety and depression symptoms. RESULTS Participants scored a mean of 21.8 (SD = 4.0, 9-32, n = 86) on the Client Satisfaction Questionnaire-8; just below our target of 22. The mean attendance rate was 5.0/6 lectures (SD = 1.6, range: 0-6, n = 91). Forty-six percent (37/81) reported experiencing no need of further clinical intervention after the course. The rate of clinically significant improvement was 59% (27/46) for anxiety and 48% (22/46) for depression. No serious adverse event was reported. CONCLUSIONS Delivering a low-threshold online video-delivered mental health course in primary care appears to be feasible. Adjustments to further improve patient satisfaction are warranted, such as offering the choice of participating online or face-to-face. TRIAL REGISTRATION (ClinicalTrials.gov NCT04522713) August 21, 2020.
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Affiliation(s)
- Karoline Kolaas
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden.
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden.
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden.
| | - Anne H Berman
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Gustavsberg Primary Health Care Clinic, Region Stockholm, Stockholm, Sweden
| | - Anastasiya Zakrevska
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
| | - Majken Epstein
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Af Winklerfelt Hammarberg
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Erland Axelsson
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Hungerford C, Hills S, Richards C, Robinson T, Hills D. Facilitating Mindfulness-Based Interventions for Anxiety in Older People: History, Effectiveness, and Future Possibilities. Issues Ment Health Nurs 2022; 43:1014-1021. [PMID: 36053887 DOI: 10.1080/01612840.2022.2116510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The origins of mindfulness go back some 25 centuries to Eastern teachings, including Buddhism and Hinduism. Mindfulness-based interventions gained credence in Western mental health settings in the late 1970s through the work of medical researcher Kabat-Zinn, whose interest in Eastern meditation led him to develop a program for stress reduction. Since then, mindfulness-based interventions have been utilized for various populations, including older people with anxiety. Group mindfulness-based interventions have demonstrated benefits for older people with anxiety living in residential aged care and the community. In primary care settings, innovative delivery models for group mindfulness-based interventions could be facilitated by nurses to support older people with anxiety to age in place with dignity. The benefits of mindfulness-based interventions suggest the value of integrating ancient Eastern techniques with modern Western strategies to achieve better health outcomes for older people with mental health concerns.
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Affiliation(s)
- Catherine Hungerford
- Faculty of Health, Federation University Australia, Ballarat, Victoria, Australia.,Central Queensland University, Sydney, New South Wales, Australia
| | - Sharon Hills
- Faculty of Health, Federation University Australia, Ballarat, Victoria, Australia
| | - Catelyn Richards
- Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Tracy Robinson
- Faculty of Science, Charles Sturt University, Orange, New South Wales, Australia
| | - Danny Hills
- Faculty of Health, Federation University Australia, Ballarat, Victoria, Australia.,Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
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Plys E, Beam R, Boxer RS, Portz JD. Behavioral Health Services with Short-Stay Residents in Skilled Nursing Facilities: A Qualitative Study of Clinicians and Administrators. Clin Gerontol 2022; 45:1189-1200. [PMID: 34128773 PMCID: PMC8671564 DOI: 10.1080/07317115.2021.1937425] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The perspectives of professionals involved in behavioral health (BH) services with short-stay residents in skilled nursing facilities (SNFs) are rarely captured in the literature. This study examines the real-world experiences of BH clinicians and administrators in post-acute/subacute care units in SNFs. METHODS This qualitative study used semi-structured interviews with 18 clinicians (e.g., psychologists and social workers) and five administrators (e.g., directors of social services or BH company executives) involved in BH services with short-stay SNF residents. Interviews were recorded, transcribed, and analyzed by two independent coders using conventional thematic content analysis. RESULTS Three themes emerged from the data: (1) BH needs are high among short-stay residents and families during post-acute care transitions; (2) BH services offer multiple unique opportunities to enhance post-acute/subacute care in SNFs; and (3) barriers to providing optimal BH care exist at multiple levels and require action from BH clinicians and stakeholders. CONCLUSIONS Variability in clinician roles and barriers to optimized care suggest the need for future research targeting best practices and implementation strategies for BH services with short-stay SNF residents. CLINICAL IMPLICATIONS Results identified multiple ways in which BH services may enhance resident, family, and staff outcomes, as well as the milieu in SNFs.
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Affiliation(s)
- Evan Plys
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus
- Division of General Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Campus
| | | | | | - Jennifer D. Portz
- Division of General Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Campus
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Pike K, Moller CI, Bryant C, Farrow M, Dao DP, Ellis KA. Examination of the Feasibility, Acceptability, and Efficacy of the Online Personalised Training in Memory Strategies for Everyday (OPTIMiSE) Program for Older Adults: Results from a Single-Arm Pre-Post Trial (Preprint). J Med Internet Res 2022; 25:e41712. [PMID: 37079356 PMCID: PMC10160943 DOI: 10.2196/41712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 02/14/2023] [Accepted: 02/27/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Memory strategy training for older adults helps maintain and improve cognitive health but is traditionally offered face-to-face, which is resource intensive, limits accessibility, and is challenging during a pandemic. Web-based interventions, such as the Online Personalised Training in Memory Strategies for Everyday (OPTIMiSE) program, may overcome such barriers. OBJECTIVE We report on OPTIMiSE's feasibility, acceptability, and efficacy. METHODS Australians aged ≥60 years reporting subjective cognitive decline participated in this single-arm pre-post web-based intervention. OPTIMiSE is a 6-module web-based program offered over 8-weeks with a 3-month booster. It has a problem-solving approach to memory issues, focusing on psychoeducation about memory and aging, knowledge and practice of compensatory memory strategies, and personalized content related to individual priorities. We examined the feasibility (recruitment, attrition, and data collection), acceptability (recommendation to others, suggestions for improvement, and withdrawal reasons), and efficacy (change in goal satisfaction, strategy knowledge and use, self-reported memory, memory satisfaction and knowledge, and mood; thematic content analysis of the most significant change; and the application of knowledge and strategies in daily life) of OPTIMiSE. RESULTS OPTIMiSE was feasible, demonstrated by strong interest (633 individuals screened), a satisfactory level of attrition (158/312, 50.6%), and minimal missing data from those completing the intervention. It was acceptable, with 97.4% (150/154) of participants agreeing they would recommend OPTIMiSE, the main suggestion for improvement being more time to complete modules, and withdrawal reasons similar to those in in-person interventions. OPTIMiSE was also efficacious, with linear mixed-effects analyses revealing improvements, of moderate to large effect sizes, across all primary outcomes (all P<.001): memory goal satisfaction (Cohen d after course=1.24; Cohen d at 3-month booster=1.64), strategy knowledge (Cohen d after course=0.67; Cohen d at 3-month booster=0.72) and use (Cohen d after course=0.79; Cohen d at 3-month booster=0.90), self-reported memory (Cohen d after course=0.80; Cohen d at 3-month booster=0.83), memory satisfaction (Cohen d after course=1.25; Cohen d at 3-month booster=1.29) and knowledge (Cohen d after course=0.96; Cohen d at 3-month booster=0.26), and mood (Cohen d after course=-0.35; nonsignificant Cohen d at booster). Furthermore, the most significant changes reported by participants (strategy use, improvements in daily life, reduced concern about memory, confidence and self-efficacy, and sharing and shame busting with others) reflected the course objectives and were consistent with themes arising from previous in-person interventions. At the 3-month booster, many participants reported continued implementation of knowledge and strategies in their daily lives. CONCLUSIONS This feasible, acceptable, and efficacious web-based program has the potential to enable access to evidence-based memory interventions for older adults worldwide. Notably, the changes in knowledge, beliefs, and strategy use continued beyond the initial program. This is particularly important for supporting the growing number of older adults living with cognitive concerns. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12620000979954; https://tinyurl.com/34cdantv. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.3233/ADR-200251.
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Affiliation(s)
- Kerryn Pike
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- John Richards Centre for Rural Ageing Research, La Trobe University, Wodonga, Australia
- School of Applied Psychology, Griffith Centre for Mental Health & Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Carl I Moller
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Maree Farrow
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Duy P Dao
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Kathryn A Ellis
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
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Stroke Caregiver Depression: Qualitative Comparison of Treatment Responders and Nonresponders at 1 Year. J Cardiovasc Nurs 2022; 37:581-588. [PMID: 34369913 PMCID: PMC8818052 DOI: 10.1097/jcn.0000000000000852] [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: 01/03/2023]
Abstract
BACKGROUND Mixed-method studies can shed light on the mechanisms through which interventions effectively reduce caregiver depression. OBJECTIVE The objective of this qualitative study was to understand factors contributing to reduced depressive symptoms in stroke caregiver treatment responders compared with nonresponders. METHODS A mixed-methods explanatory sequential design was used to assess cognitive behavioral coping use and helpfulness in reducing depression among experimental study treatment responders and nonresponders. Using purposive sampling at 1-year of caregiving, we selected responders who were not depressed or demonstrated reduction to probable depression and nonresponders whose scores indicated worsened or new depression. Participants responded to semistructured interviews on life changes and the use and helpfulness of intervention coping strategies. Thematic analysis identified codes and themes. RESULTS Twelve of 25 participants were responders. We identified 2 overarching outcome themes: "It was about me, changing to make life better" (responders) and "Lamenting our changed lives" (nonresponders). Five subthemes related to coping were identified. Whereas responders coped actively and were less dependent on the counseling relationship, nonresponders were passive in coping and more dependent on the initial counseling relationship. Anger or previous psychologic treatment was found in more than a quarter of nonresponders and in no responders. Negative life change was found in 9 of 13 nonresponders compared with 1 responder. CONCLUSION Findings support the helpfulness of cognitive behavioral coping. For many caregivers, engagement interviews and a more intense, longer intervention, such as stepped care and anger management, are indicated to mitigate treatment resistance and depressive symptoms, respectively.
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Anwar MR, Rowe BH, Metge C, Star ND, Aboud Z, Kreindler SA. Realist analysis of streaming interventions in emergency departments. BMJ LEADER 2021. [DOI: 10.1136/leader-2020-000369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSeveral of the many emergency department (ED) interventions intended to address the complex problem of (over)crowding are based on the principle of streaming: directing different groups of patients to different processes of care. Although the theoretical basis of streaming is robust, evidence on the effectiveness of these interventions remains inconclusive.MethodsThis qualitative research, grounded in the population-capacity-process model, sought to determine how, why and under what conditions streaming interventions may be effective. Data came from a broader study exploring patient flow strategies across Western Canada through in-depth interviews with managers at all levels. We undertook realist analysis of interview data from the 98 participants who discussed relevant interventions (fast-track/minor treatment areas, rapid assessment zones, diverse short-stay units), focusing on their explanations of initiatives’ perceived outcomes.ResultsEssential features of streaming interventions included separation of designated populations (population), provision of dedicated space and resources (capacity) and rapid cycle time (process). These features supported key mechanisms of impact: patients wait only for services they need; patient variability is reduced; lag time between steps is eliminated; and provider attitude change promotes prompt discharge. Conversely, reported failures usually involved neglect of one of these dimensions during intervention design and/or implementation. Participants also identified important contextual barriers to success, notably lack of outflow sites and demand outstripping capacity. Nonetheless, failure was more commonly attributed to intervention flaws than to context factors.ConclusionsWhile streaming interventions have the potential to reduce crowding, a theory-based intervention relies on its implementers’ adherence to the theory. Streaming interventions cannot be expected to yield the desired results if operationalised in a manner incongruent with the theory on which they are supposedly based.
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Wadoo O, Ouanes S, Ahmed MAS, Saeid ISA, AlAbdulla SA, AlAbdulla M. Improving referrals from primary care to secondary mental health services through an educational intervention: experience from Qatar. BJPsych Int 2021; 18:70-74. [PMID: 34382952 PMCID: PMC8314983 DOI: 10.1192/bji.2021.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 11/23/2022] Open
Abstract
Primary care is geared to manage patients with mild to moderate presentations of common mental disorders and to refer patients with more severe mental disorders to specialist mental health services. With growing demand for specialty care, the quality of the referral is increasingly important to ensure efficient patient flow across the primary/secondary care interface and appropriate use of secondary services. We report on an initiative in a Qatari mental health clinic to improve the quality of referrals from primary care to specialist mental health services through an educational intervention for family physicians. We highlight the problem, the intervention and the outcome of our initiative, which was the first of its kind in the region. The number of inappropriate referrals fell by 93%, and the number of referrals with inadequate clinical information declined from 15 (January 2019) to 1 (September 2019). Feedback was very positive; respondents reported feeling supported, with better understanding of care pathways, the scope of primary care and mental health services.
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Affiliation(s)
- Ovais Wadoo
- Senior Consultant, Department of Psychiatry, Hamad Medical Corporation, Qatar.
| | - Sami Ouanes
- Clinical Fellow, Department of Psychiatry, Hamad Medical Corporation, Qatar
| | | | | | - Samya Ahmad AlAbdulla
- Senior Consultant and Executive Director of Operations, Family Medicine, Primary Health Care Corporation, Qatar
| | - Majid AlAbdulla
- Senior Consultant and Chairman, Department of Psychiatry, Hamad Medical Corporation, Qatar
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Ransing R, Kukreti P, Mahadevaiah M, Raghuveer P, Karkal R, Rana S, Yadav R, Choudhary V, Patil I, Sonkar S, Deshpande SN. COVID-19 Pandemic and Stepped Care Model for Perinatal Depression in Rural India: Lessons Learned and the Way Forward. Indian J Psychol Med 2021; 43:246-251. [PMID: 34345101 PMCID: PMC8287401 DOI: 10.1177/02537176211005017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Ramdas Ransing
- Dept. of Psychiatry, BKL Walawalkar
Rural Medical College, Sawarde, Ratnagiri, Maharashtra, India
| | - Prerna Kukreti
- Dept. of Psychiatry, Lady Hardinge
Medical College, New Delhi, Delhi, India
| | - Mahesh Mahadevaiah
- Dept. of Psychiatry, Dharwad Institute
of Mental Health and Neurosciences (DIMHANS), Dharwad, Karnataka, India
| | - Pracheth Raghuveer
- Dept. of Community Medicine, Yenepoya
Medical College, Mangalore, Karnataka, India
| | - Ravichandra Karkal
- Dept. of Psychiatry, Yenepoya Medical
College, Mangalore, Karnataka, India
| | - Sumit Rana
- Dept. of Psychiatry, Lady Hardinge
Medical College, New Delhi, Delhi, India
| | - Reena Yadav
- Dept. of Obs and Gyne, Lady Hardinge
Medical College, New Delhi, Delhi, India
| | - Vinod Choudhary
- Dept. of Pediatrics, BKL Walawalkar
Rural Medical College, Sawarde, Ratnagiri, Maharashtra, India
| | - Ishwar Patil
- Dept. of Psychiatry, BKL Walawalkar
Rural Medical College, Sawarde, Ratnagiri, Maharashtra, India
| | - Suruchi Sonkar
- Dept. of Psychiatry, Dharwad Institute
of Mental Health and Neurosciences (DIMHANS), Dharwad, Karnataka, India
| | - Smita N. Deshpande
- Dept. of Psychiatry, De-Addiction
Services and Resource Center for Tobacco Control, Centre of Excellence in Mental
Health, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia
Hospital, New Delhi, Delhi, India
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Translating evidence-based psychological interventions for older adults with depression and anxiety into public and private mental health settings using a stepped care framework: Study protocol. Contemp Clin Trials 2021; 104:106360. [PMID: 33766760 DOI: 10.1016/j.cct.2021.106360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND With expected increases in the number of older adults worldwide, the delivery of stepped psychological care for depression and anxiety in older populations may improve both treatment and allocative efficiency for individual patients and the health system. DESIGN A multisite pragmatic randomised controlled trial evaluating the clinical and cost-effectiveness of a stepped care model of care for treating depression and anxiety among older adults compared to treatment as usual (TAU) will be conducted. Eligible participants (n = 666) with clinically interfering anxiety and/or depression symptoms will be recruited from and treated within six Australian mental health services. The intervention group will complete a low intensity cognitive behavioural therapy (CBT) program: Internet-delivered or using a work-at-home book with brief therapist calls (STEP 1). Following STEP 1 a higher intensity face-to-face CBT (STEP 2) will then be offered if needed. Intention-to-treat analyses will be used to examine changes in primary outcomes (e.g. clinician-rated symptom severity changes) and secondary outcomes (e.g. self-reported symptoms severity, health related quality of life and service utilisation costs). An economic evaluation will be conducted using a cost-utility analysis to derive the incremental cost-effectiveness ratio for the stepped care intervention. DISCUSSION This study will demonstrate the relative clinical and economic benefits of stepped care model of psychological care for older adults experiencing anxiety and/or depression compared to TAU. The evaluation of the intervention within existing mental health services means that results will have significant implications for the translation of evidence-based interventions in older adult services across urban and rural settings. TRAIL REGISTRATION Prospectively registered on anzctr.org.au (ACTRN12619000219189) and isrctn.com (ISRCTN37503850).
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Osma J, Peris-Baquero O, Suso-Ribera C, Sauer-Zavala S, Barlow DH. Predicting and Moderating the Response to the Unified Protocol: Do Baseline Personality and Affective Profiles Matter? COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10208-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fiorillo RG, Oliveira DVD, Graça Á, Fonseca HS, Guilherme FR, Fiorese L, Nascimento JRAD, Pina FLC, Mayhew J, Nascimento MAD. Changes in the daily routine and life perceptions of older adults due to the coronavirus disease 2019 (covid-19) pandemic. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.5327/z2447-212320212000115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: This study aimed to analyze changes in the daily routine and life perceptions of older adults due to the coronavirus disease 2019 pandemic. METHODS: This is a cross-sectional study conducted with 338 older adults (93 men and 238 women) residing in southern Brazil. An online questionnaire consisting of 20 questions was created using the Google Forms platform and was distributed to older adults (> 60 years of age) during the isolation period caused by the coronavirus disease pandemic. Data analysis was conducted through Student's-t and χ2 tests. RESULTS: Our results showed a significant association between social isolation and sex (p < 0.01), revealing that women experienced higher levels of social isolation than men. We observed that 82.21% of the older adults participating in this study reported changes in their social routines during the pandemic. CONCLUSIONS: During this period of extended social isolation, women reported more negative effects than men.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jerry Mayhew
- Truman State University, United States of America
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Spelten ER, Burmeister OK. Growing old gracefully in rural and remote Australia? Aust J Rural Health 2019; 27:272-274. [PMID: 31429135 DOI: 10.1111/ajr.12555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Evelien R Spelten
- Department of Public Health, La Trobe Rural Health School, La Trobe University, Melbourne, Victoria, Australia
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