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Gofton C, Bondezi K, Kotze B, McKee K, Yesudoss A, McCaughan G, George J. Micro-elimination of chronic hepatitis C virus in mental health settings: A prospective multicentre pragmatic trial. Drug Alcohol Rev 2024; 43:1247-1255. [PMID: 38773898 DOI: 10.1111/dar.13854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 05/24/2024]
Abstract
INTRODUCTION Hepatitis C virus (HCV) prevalence is high in the mental health population. We sought to evaluate testing and treatment uptake for HCV following the implementation of a universal nurse led study in inpatient and outpatient mental health populations. METHODS From January 2018 to December 2020, we screened mental health inpatients (n = 322) and community mental health patients (n = 615) for HCV with either specialist hepatology nurses or mental health nurses (mental health nurse). RESULTS 75.5% (464/615) of community patients and 100% (322/322) of inpatients consented to screening, with an HCV antibody-positive prevalence of 12.7% (59/464) in community patients and 19.6% (63/322) in inpatients. RNA detectable prevalence was 4.0% (22/464) and 7.5% (24/322), respectively. Community patients who were screened by specialist hepatology nurses were more likely to consent to screening (94.4% vs. 45.7%, p < 0.001) but had lower proportion of HCV antibody (10.5% vs. 20.3%, p < 0.001) and RNA detectable (4.0% vs. 7.5%, p = 0.018) when compared to mental health nurse screening. Engagement with treatment was 27.0% of community mental health patients and 45.8% of mental health inpatients undergoing treatment. All patients undergoing treatment and underwent sustained viral response (SVR) testing achieved SVR. DISCUSSION AND CONCLUSIONS Universal screening of HCV using a nurse-led model has high rates of success in mental health patients with high proportions undergoing screening, with no reduction in the rates of SVR achieved with DAA therapy compared to the general population. Further work is needed to bridge the gap between identification of HCV and treatment among mental health patients.
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Affiliation(s)
- Cameron Gofton
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
- Department of Gastroenterology and Hepatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Department of Gastroenterology and Hepatology, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
| | - Kindness Bondezi
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
| | - Beth Kotze
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Kristen McKee
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
| | - Antoni Yesudoss
- Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Geoff McCaughan
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney Local Health District, Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
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Janich NK, Vazquez-Arreola E. Patient Service Utilization Among Individuals with Co-occurring Disorders: A Comparison of Two Models of Care Coordination. Community Ment Health J 2022; 58:1168-1178. [PMID: 35040009 DOI: 10.1007/s10597-021-00927-1] [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: 06/08/2021] [Accepted: 11/27/2021] [Indexed: 11/03/2022]
Abstract
Healthcare systems have increasingly adopted integrated care models with demonstrated effectiveness. However, few studies examine integrated care for individuals with co-morbid mental illness and medical conditions. This quasi-experimental study compared service use for two integrated care models for patients with co-occurring conditions. We used hierarchical negative binomial and logistic regressions with random effects to test the relationship between integration and service use. Patients treated at co-located agencies had significantly higher odds of inpatient hospitalization compared to those in fully integrated settings. Additionally, some comorbidities had significantly different levels of service use. Patients at co-located agencies had more outpatient and emergency visits, but was not statistically significant. Our findings provide evidence that the model of care may impact service use for patients experiencing co-occurring conditions, however, variations in service use for specific co-morbid conditions highlight the need to examine the specific needs and characteristics of this population.
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Affiliation(s)
- Nicole K Janich
- Center for Applied Behavioral Health Policy, 618 N. Central Ave. Suite 100, Phoenix, AZ, 85004, USA.
| | - Elsa Vazquez-Arreola
- National Institute of Diabetes and Digestive and Kidney Diseases, 1550 E. Indian School Road, Phoenix, AZ, 85014, USA
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Liu XL, Wang T, Tan JY, Stewart S, Chan RJ, Eliseeva S, Polotan MJ, Zhao I. Sustainability of healthcare professionals' adherence to clinical practice guidelines in primary care. BMC PRIMARY CARE 2022; 23:36. [PMID: 35232391 PMCID: PMC8889781 DOI: 10.1186/s12875-022-01641-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Sustainability of adherence to clinical practice guidelines (CPGs) represents an important indicator of the successful implementation in the primary care setting. AIM To explore the sustainability of primary care providers' adherence to CPGs after receiving planned guideline implementation strategies, activities, or programmes. METHODS Cochrane Central Register of Controlled Trials (CENTRAL); Cumulative Index to Nursing and Allied Health Literature (CINAHL); EMBase; Joanna Briggs Institute; Journals@Ovid; Medline; PsycoINFO; PubMed, and Web of Science were searched from January 2000 through May 2021 to identify relevant studies. Studies evaluating the sustainability of primary care providers' (PCPs') adherence to CPGs in primary care after any planned guideline implementation strategies, activities, or programmes were included. Two reviewers extracted data from the included studies and assessed methodological quality independently. Narrative synthesis of the findings was conducted. RESULTS Eleven studies were included. These studies evaluated the sustainability of adherence to CPGs related to drug prescribing, disease management, cancer screening, and hand hygiene in primary care. Educational outreach visits, teaching sessions, reminders, audit and feedback, and printed materials were utilized in the included studies as guideline implementation strategies. None of the included studies utilized purpose-designed measurements to evaluate the extent of sustainability. Three studies showed positive sustainability results, three studies showed mixed sustainability results, and four studies reported no significant changes in the sustainability of adherence to CPGs. Overall, it was difficult to quantify the extent to which CPG-based healthcare behaviours were fully sustained based on the variety of results reported in the included studies. CONCLUSION Current guideline implementation strategies may potentially improve the sustainability of PCPs' adherence to CPGs. However, the literature reveals a limited body of evidence for any given guideline implementation strategy. Further research, including the development of a validated purpose-designed sustainability tool, is required to address this important clinical issue. TRIAL REGISTRATION The study protocol has been registered at PROSPERO (No. CRD42021259748 ).
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Affiliation(s)
- Xian-Liang Liu
- College of Nursing and Midwifery, Charles Darwin University, 410 Ann Street, Brisbane, QLD, 4000, Australia
| | - Tao Wang
- College of Nursing and Midwifery, Charles Darwin University, 410 Ann Street, Brisbane, QLD, 4000, Australia
| | - Jing-Yu Tan
- College of Nursing and Midwifery, Charles Darwin University, 410 Ann Street, Brisbane, QLD, 4000, Australia
| | - Simon Stewart
- Torrens University Australia, Wakefield Campus, Adelaide, SA, 5000, Australia
- University of Glasgow, Glasgow, Scotland, UK
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia
| | - Sabina Eliseeva
- College of Nursing and Midwifery, Charles Darwin University, 410 Ann Street, Brisbane, QLD, 4000, Australia
- Thornlands General Practice, 51 Island Outlook Ave Thornlands, Redland, QLD, 4164, Australia
| | - Mary Janice Polotan
- College of Nursing and Midwifery, Charles Darwin University, 410 Ann Street, Brisbane, QLD, 4000, Australia
- Thornlands General Practice, 51 Island Outlook Ave Thornlands, Redland, QLD, 4164, Australia
| | - Isabella Zhao
- College of Nursing and Midwifery, Charles Darwin University, 410 Ann Street, Brisbane, QLD, 4000, Australia.
- Cancer & Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia.
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Ee C, Lake J, Firth J, Hargraves F, de Manincor M, Meade T, Marx W, Sarris J. An integrative collaborative care model for people with mental illness and physical comorbidities. Int J Ment Health Syst 2020; 14:83. [PMID: 33292354 PMCID: PMC7659089 DOI: 10.1186/s13033-020-00410-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/28/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Many individuals with mental health problems have comorbid physical conditions, or may present with substance/alcohol misuse or abuse issues. This results in complex treatment challenges that may not be adequately addressed by a model of care that is solely delivered by an individual clinician using a sole intervention. Mainstream pharmacotherapeutic treatment of mental health problems often have limited effectiveness in completely resolving symptoms, and may cause adverse side effects. Adjunctive treatment approaches, including nutraceuticals, lifestyle and behaviour change interventions, are widely used to assist with treatment of mental health problems. However, whilst these can be generally safer with fewer side effects, they have varying levels of evidentiary support. These circumstances warrant reframing the current treatment approach towards a more evidence-based integrative model which may better address the real-world challenges of psychiatric disorders and comorbid physical conditions. In essence, this means developing an integrative model of care which embodies an evidence-informed, personalized stepwise approach using both conventional pharmacological treatments alongside novel adjunctive treatments (where applicable) via the application of a collaborative care approach. DISCUSSION In order to inform this position, a brief review of findings on common patterns of comorbidity in mental illness is presented, followed by identification of limitations of conventional treatments, and potential applications of integrative medicine interventions. Advantages and challenges of integrative mental health care, collaborative models of care, review of research highlights of select integrative approaches, and comment on potential cost advantages are then discussed. We propose that a collaborative care model incorporating evidence-based integrative medicine interventions may more adequately address mental health problems with comorbid medical conditions. Robust research is now required of such a model, potentially within an integrative clinical practice.
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Affiliation(s)
- C. Ee
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
| | - J. Lake
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
| | - J. Firth
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
| | - F. Hargraves
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
| | - M. de Manincor
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
| | - T. Meade
- School of Psychology and Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - W. Marx
- IMPACT, Food & Mood Centre, Deakin University, Barwon Health, Geelong, Australia
| | - J. Sarris
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
- Professorial Unit, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
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Wagner TH, Dopp AR, Gold HT. Estimating Downstream Budget Impacts in Implementation Research. Med Decis Making 2020; 40:968-977. [PMID: 32951506 DOI: 10.1177/0272989x20954387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health care decision makers often request information showing how a new treatment or intervention will affect their budget (i.e., a budget impact analysis; BIA). In this article, we present key topics for considering how to measure downstream health care costs, a key component of the BIA, when implementing an evidence-based program designed to reduce a quality gap. Tracking health care utilization can be done with administrative or self-reported data, but estimating costs for these utilization data raises 2 issues that are often overlooked in implementation science. The first issue has to do with applicability: are the cost estimates applicable to the health care system that is implementing the quality improvement program? We often use national cost estimates or average payments, without considering whether these cost estimates are appropriate. Second, we need to determine the decision maker's time horizon to identify the costs that vary in that time horizon. If the BIA takes a short-term time horizon, then we should focus on costs that vary in the short run and exclude costs that are fixed over this time. BIA is an increasingly popular tool for health care decision makers interested in understanding the financial effect of implementing an evidence-based program. Without careful consideration of some key conceptual issues, we run the risk of misleading decision makers when presenting results from implementation studies.
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Affiliation(s)
- Todd H Wagner
- Health Economics Resource Center, US Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, CA, USA.,Department of Surgery, Stanford University, Stanford, CA
| | | | - Heather T Gold
- Departments of Population Health and Orthopedic Surgery, New York University (NYU) Langone Health, NY, USA
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Richardson A, Richard L, Gunter K, Cunningham R, Hamer H, Lockett H, Wyeth E, Stokes T, Burke M, Green M, Cox A, Derrett S. A systematic scoping review of interventions to integrate physical and mental healthcare for people with serious mental illness and substance use disorders. J Psychiatr Res 2020; 128:52-67. [PMID: 32521251 DOI: 10.1016/j.jpsychires.2020.05.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 02/07/2023]
Abstract
Integrated care approaches have been recommended to remove barriers to healthcare and improve the physical health outcomes of people living with serious mental illness (SMI) and/or substance use disorders (SUDs). The aim of this systematic scoping review was to describe empirical investigations of interventions designed to integrate physical, mental, and addiction healthcare for this population. An iterative and systematic search of five electronic databases (Medline (Ovid), PsycINFO, CINAHL, Embase (Ovid) and Scopus) was conducted to identify peer-reviewed articles published between January 2000 and April 2019. Two reviewers independently screened publications in two successive stages of title and abstract screening, followed by full-text screening of eligible publications. Data from each included publication were extracted independently by two reviewers using a standardised spreadsheet. A total of 28 eligible publications were identified, representing 25 unique studies. Over half of the included studies investigated the use of case managers to provide self-management skills or to coordinate mental and physical healthcare (n = 14). Other interventions examined the co-location of services (n = 9) and the implementation of screening and referral pathways to specialist treatment (n = 2). Less than half of the included studies described a framework, theory or model that was underpinning the intervention tested. While some aspects of integrated care have been identified and addressed by interventions, other key dimensions have not been considered, such as shared decision-making. Identification of a comprehensive model of integrated care is recommended to inform the development and evaluation of future interventions for people with SMI/SUDs.
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Affiliation(s)
- Amy Richardson
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Lauralie Richard
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Kathryn Gunter
- Chicago Center for Diabetes Translation Research, The University of Chicago Department of Medicine, Chicago, IL, 60637, USA.
| | - Ruth Cunningham
- Department of Public Health, University of Otago, Wellington, PO Box 7343, Wellington, 6242, New Zealand.
| | - Helen Hamer
- Helen Hamer & Associates Ltd, Auckland, New Zealand.
| | - Helen Lockett
- Department of Public Health, University of Otago, Wellington, PO Box 7343, Wellington, 6242, New Zealand.
| | - Emma Wyeth
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Martin Burke
- Addictions, Supportive Accommodation, Reintegration and Palliative Care Services, Salvation Army, PO Box 6015, Wellington, 6141, New Zealand.
| | - Mel Green
- South Community Mental Health Team, Southern District Health Board, Private Bag 1921, Dunedin, 9054, New Zealand.
| | - Adell Cox
- Southern District Health Board, New Zealand.
| | - Sarah Derrett
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
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Fehily CMC, Bartlem KM, Wiggers JH, Wye PM, Clancy RV, Castle DJ, Wilson A, Rissel CE, Wutzke S, Hodder RK, Colyvas K, Murphy F, Bowman JA. Effectiveness of embedding a specialist preventive care clinician in a community mental health service in increasing preventive care provision: A randomised controlled trial. Aust N Z J Psychiatry 2020; 54:620-632. [PMID: 32403938 PMCID: PMC7285986 DOI: 10.1177/0004867420914741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Clinical practice guidelines recommend that community mental health services provide preventive care for clients' chronic disease risk behaviours; however, such care is often not routinely provided. This study aimed to assess the effectiveness of offering clients an additional consultation with a specialist clinician embedded within a community mental health service, in increasing client-reported receipt of, and satisfaction with, preventive care. METHOD A randomised controlled trial was undertaken in one Australian community mental health service. Participants (N = 811) were randomised to receive usual care (preventive care in routine consultations; n = 405) or usual care plus the offer of an additional consultation with a specialist preventive care clinician (n = 406). Blinded interviewers assessed at baseline and 1-month follow-up the client-reported receipt of preventive care (assessment, advice and referral) for four key risk behaviours individually (smoking, poor nutrition, alcohol overconsumption and physical inactivity) and all applicable risks combined, acceptance of referrals and satisfaction with preventive care received. RESULTS Analyses indicated significantly greater increases in 12 of the 18 preventive care delivery outcomes in the intervention compared to the usual care condition from baseline to follow-up, including assessment for all risks combined (risk ratio = 4.00; 95% confidence interval = [1.57, 10.22]), advice for all applicable risks combined (risk ratio = 2.40; 95% confidence interval = [1.89, 6.47]) and offer of referral to applicable telephone services combined (risk ratio = 20.13; 95% confidence interval = [2.56, 158.04]). For each component of care, there was a significant intervention effect for at least one of the individual risk behaviours. Participants reported high levels of satisfaction with preventive care received, ranging from 77% (assessment) to 87% (referral), with no significant differences between conditions. CONCLUSION The intervention had a significant effect on the provision of the majority of recommended elements of preventive care. Further research is needed to maximise its impact, including identifying strategies to increase client uptake.
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Affiliation(s)
- Caitlin MC Fehily
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Kate M Bartlem
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - John H Wiggers
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Paula M Wye
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Richard V Clancy
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Mental Health, Hunter New England Local Health District, NSW Health, New Lambton, NSW, Australia
- School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - David J Castle
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
- St Vincent’s Health, Fitzroy, VIC, Australia
| | - Andrew Wilson
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Menzies Centre for Health Policy, The University of Sydney, Sydney, NSW, Australia
| | - Chris E Rissel
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- NSW Office of Preventive Health, Liverpool, NSW, Australia
| | - Sonia Wutzke
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rebecca K Hodder
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Kim Colyvas
- School of Mathematical and Physical Sciences, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
| | - Fionna Murphy
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jenny A Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Braithwaite J, Ludlow K, Testa L, Herkes J, Augustsson H, Lamprell G, McPherson E, Zurynski Y. Built to last? The sustainability of healthcare system improvements, programmes and interventions: a systematic integrative review. BMJ Open 2020; 10:e036453. [PMID: 32487579 PMCID: PMC7265014 DOI: 10.1136/bmjopen-2019-036453] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The sustainability of healthcare delivery systems is challenged by ageing populations, complex systems, increasing rates of chronic disease, increasing costs associated with new medical technologies and growing expectations by healthcare consumers. Healthcare programmes, innovations and interventions are increasingly implemented at the front lines of care to increase effectiveness and efficiency; however, little is known about how sustainability is conceptualised and measured in programme evaluations. OBJECTIVES We aimed to describe theoretical frameworks, definitions and measures of sustainability, as applied in published evaluations of healthcare improvement programmes and interventions. DESIGN Systematic integrative review. METHODS We searched six academic databases, CINAHL, Embase, Ovid MEDLINE, Emerald Management, Scopus and Web of Science, for peer-reviewed English journal articles (July 2011-March 2018). Articles were included if they assessed programme sustainability or sustained outcomes of a programme at the healthcare system level. Six reviewers conducted the abstract and full-text review. Data were extracted on study characteristics, definitions, terminology, theoretical frameworks, methods and tools. Hawker's Quality Assessment Tool was applied to included studies. RESULTS Of the 92 included studies, 75.0% were classified as high quality. Twenty-seven (29.3%) studies provided 32 different definitions of sustainability. Terms used interchangeably for sustainability included continuation, maintenance, follow-up or long term. Eighty studies (87.0%) clearly reported the timepoints at which sustainability was evaluated: 43.0% at 1-2 years and 11.3% at <12 months. Eighteen studies (19.6%) used a theoretical framework to conceptualise or assess programme sustainability, including frameworks that were not specifically designed to assess sustainability. CONCLUSIONS The body of literature is limited by the use of inconsistent definitions and measures of programme sustainability. Evaluations of service improvement programmes and interventions seldom used theoretical frameworks. Embedding implementation science and healthcare service researchers into the healthcare system is a promising strategy to improve the rigour of programme sustainability evaluations.
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Affiliation(s)
- Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kristiana Ludlow
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Luke Testa
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jessica Herkes
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hanna Augustsson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gina Lamprell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Elise McPherson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Fehily C, Ling R, Searles A, Bartlem K, Wiggers J, Hodder R, Wilson A, Colyvas K, Bowman J. An economic evaluation of a specialist preventive care clinician in a community mental health service: a randomised controlled trial. BMC Health Serv Res 2020; 20:405. [PMID: 32393307 PMCID: PMC7212584 DOI: 10.1186/s12913-020-05204-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/12/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Clinical practice guidelines and policies direct community mental health services to provide preventive care to address chronic disease risks, however, such care is infrequently provided in routine consultations. An alternative model of care is to appoint a clinician to the dedicated role of offering and providing preventive care in an additional consultation: the 'specialist clinician' model. Economic evaluations of models of care are needed to determine the cost of adhering to guidelines and policies, and to inform pragmatic service delivery decisions. This study is an economic evaluation of the specialist clinician model; designed to achieve policy concordant preventive care delivery. METHODS A retrospective analysis of the incremental costs, cost-effectiveness, and budget impact of a 'specialist preventive care clinician' (an occupational therapist) was conducted in a randomised controlled trial, where participants were randomised to receive usual care; or usual care plus the offer of an additional preventive care consultation with the specialist clinician. The study outcome was client acceptance of referrals to two free telephone-based chronic disease prevention services. This is a key care delivery outcome mandated by the local health district policy of the service. The base case analysis assumed the mental health service cost perspective. A budget impact analysis determined the annual budget required to implement the model of care for all clients of the community mental health service over 5 years. RESULTS There was a significantly greater increase from baseline to follow-up in the proportion of intervention participants accepting referrals to both telephone services, compared to usual care. The incremental cost-effectiveness ratio was $347 per additional acceptance of a referral (CI: $263-$494). The annual budget required to implement the model of care for all prospective clients was projected to be $711,446 over 5-years; resulting in 2616 accepted referrals. CONCLUSIONS The evaluation provides key information regarding the costs for the mental health service to adhere to policy targets, indicating the model of care involved a low per client cost whilst increasing key preventive care delivery outcomes. Additional modelling is required to further explore its economic benefits. TRIAL REGISTRATION ACTRN12616001519448. Registered 3 November 2016, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371709.
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Affiliation(s)
- Caitlin Fehily
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia.
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia.
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia.
| | - Rod Ling
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Kate Bartlem
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Population Health, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - John Wiggers
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Population Health, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Rebecca Hodder
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Population Health, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Andrew Wilson
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
| | - Kim Colyvas
- School of Mathematical and Physical Sciences, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, Australia
| | - Jenny Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
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10
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Furness T, Wallace E, McElhinney J, McKenna B, Cuzzillo C, Foster K. Colocating an accredited practising dietitian to an adult community mental health service: An exploratory study. Int J Ment Health Nurs 2018; 27:1709-1718. [PMID: 29704288 DOI: 10.1111/inm.12470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2018] [Indexed: 11/30/2022]
Abstract
For people with severe mental illness, accredited practising dietitians may assist with a nutrition care plan that considers the medical, psychiatric, psychological, social, spiritual, and pharmacological aspects of their care. However, consumers' access to care has been limited by difficulties attending appointments and suboptimal interface between nutritional and mental health services. Therefore, the objectives of this exploratory study were to describe access to, and key stakeholder perspectives of, the accredited practising dietitian role colocated in a community mental health service. A total of 16 key stakeholders participated in one-to-one interviews. Two main themes with subthemes were derived from analysis of interviews: (i) 'building empowerment and collaboration' and included the subthemes, (a) nutrition awareness and education and (b) healthy lifestyle changes, and (ii) 'overcoming challenges to optimal nutrition and effective health care'. In addition, improved access to the role was demonstrated with 124 (79%) consumers attending at least one appointment with an accredited practising dietitian. A total of 15 (12%) consumers attended more than 10 appointments during their outpatient admission to the community mental health service. Colocating an accredited practising dietitian was perceived to build empowerment and collaboration, and overcome challenges to optimal nutrition and effective health care for consumers, carers, and clinicians. The colocation of a dietitian can empower consumers' to make health-informed decisions and support their willingness to engage with physical healthcare provision when it is prioritized alongside mental healthcare provision.
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Affiliation(s)
- Trentham Furness
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
| | - Elizabeth Wallace
- NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
| | - Jo McElhinney
- NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
| | - Brian McKenna
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.,Centre for Forensic Behavioural Science, Swinburne University of Technology, Hawthorne, Victoria, Australia
| | - Celeste Cuzzillo
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
| | - Kim Foster
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia.,NorthWestern Mental Health, Melbourne Health, Parkville, Victoria, Australia
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11
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Jones A, Hannigan B, Coffey M, Simpson A. Traditions of research in community mental health care planning and care coordination: A systematic meta-narrative review of the literature. PLoS One 2018; 13:e0198427. [PMID: 29933365 PMCID: PMC6014652 DOI: 10.1371/journal.pone.0198427] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 05/20/2018] [Indexed: 11/19/2022] Open
Abstract
CONTEXT In response to political and social factors over the last sixty years mental health systems internationally have endeavoured to transfer the delivery of care from hospitals into community settings. As a result, there has been increased emphasis on the need for better quality care planning and care coordination between hospital services, community services and patients and their informal carers. The aim of this systematic review of international research is to explore which interventions have proved more or less effective in promoting personalized, recovery oriented care planning and coordination for community mental health service users. METHODS A systematic meta-narrative review of research from 1990 to the present was undertaken. From an initial return of 3940 papers a total of 50 research articles fulfilled the inclusion criteria, including research from the UK, Australia and the USA. FINDINGS Three research traditions are identified consisting of (a) research that evaluates the effects of government policies on the organization, management and delivery of services; (b) evaluations of attempts to improve organizational and service delivery efficiency; (c) service-users and carers experiences of community mental health care coordination and planning and their involvement in research. The review found no seminal papers in terms of high citation rates, or papers that were consistently cited over time. The traditions of research in this topic area have formed reactively in response to frequent and often unpredictable policy changes, rather than proactively as a result of intrinsic academic or intellectual activity. This may explain the absence of seminal literature within the subject field. As a result, the research tradition within this specific area of mental health service delivery has a relatively short history, with no one dominant researcher or researchers, tradition or seminal studies amongst or across the three traditions identified. CONCLUSIONS The research findings reviewed suggests a gap has existed internationally over several decades between policy aspirations and service level interventions aimed at improving personalised care planning and coordination and the realities of everyday practices and experiences of service users and carers. Substantial barriers to involvement are created through poor information exchange and insufficient opportunities for care negotiation.
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Affiliation(s)
- Aled Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
- * E-mail:
| | - Ben Hannigan
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Michael Coffey
- Department of Public Health Policy and Social Sciences, Swansea University, Swansea, United Kingdom
| | - Alan Simpson
- Centre for Mental Health Research, School of Health Sciences, City University London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
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12
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Lake J, Turner MS. Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care. Perm J 2018; 21:17-024. [PMID: 28898197 DOI: 10.7812/tpp/17-024] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Current treatments and the dominant model of mental health care do not adequately address the complex challenges of mental illness, which accounts for roughly one-third of adult disability globally. These circumstances call for radical change in the paradigm and practices of mental health care, including improving standards of clinician training, developing new research methods, and re-envisioning current models of mental health care delivery. Because of its dominant position in the US health care marketplace and its commitment to research and innovation, Kaiser Permanente (KP) is strategically positioned to make important contributions that will shape the future of mental health care nationally and globally.This article reviews challenges facing mental health care and proposes an agenda for developing a collaborative care model in primary care settings that incorporates conventional biomedical therapies and complementary and alternative medicine approaches. By moving beyond treatment delivery via telephone and secure video and providing earlier interventions through primary care clinics, KP is shifting the paradigm of mental health care to a collaborative care model focusing on prevention. Recommendations are to expand current practices to include integrative treatment strategies incorporating evidence-based biomedical and complementary and alternative medicine modalities that can be provided to patients using a collaborative care model. Recommendations also are made for an internal research program aimed at investigating the efficacy and cost-effectiveness of promising complementary and alternative medicine and integrative treatments addressing the complex needs of patients with severe psychiatric disorders, many of whom respond poorly to treatments available in KP mental health clinics.
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Affiliation(s)
- James Lake
- Staff Psychiatrist at the Oakland Medical Center in CA at the time this article was written, and is a founding member and former Chair of the American Psychiatric Association Caucus on Complementary and Alternative Medicine. He is the author of four books on integrative mental health care.
| | - Mason Spain Turner
- Director of Outpatient Mental Health and Addiction Medicine for Regional Mental Health Services for The Permanente Medical Group, the Chief of the Department of Psychiatry at the San Francisco Medical Center, and an Assistant Clinical Professor at the Univesity of California, San Francisco.
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13
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Connor KL, Breslau J, Finnerty MT, Leckman-Westin E, Pritam R, Yu H. Integrating physical health: What were the costs to behavioral health care clinics? Gen Hosp Psychiatry 2018; 51:41-45. [PMID: 29316449 PMCID: PMC5869100 DOI: 10.1016/j.genhosppsych.2017.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To inform providers and policy-makers about the potential costs of providing physical health care in mental health clinics. METHODS Cost data were collected through interviews with 22 behavioral health clinics participating in New York State Office of Mental Health's health monitoring and health physicals programs. The interview data was combined with financial reporting data provided to the state to identify per interaction costs for two levels of physical health services: health monitoring and health monitoring plus health physicals. RESULTS This study gives detailed information on the costs of clinics' health integration programs, including per interaction costs related to direct service, charting and administration, and total care coordination. Average direct costs per client interaction were 3 times higher for health physicals than for health monitoring. CONCLUSIONS Costs of integrating physical care services are not trivial to mental health clinics, and may pose a barrier to widespread adoption. Provision of limited health monitoring services is less expensive for clinics, but generates proportionally large non-clinical costs than health physicals. The relative health impact of this more limited approach is an important area for future study. Also, shifting reimbursement to include health care coordination time may improve program sustainability.
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Affiliation(s)
- Kathryn L. Connor
- RAND Corporation, 4570 Fifth Avenue, Suite Pittsburgh, PA, 15213 USA
| | - Joshua Breslau
- RAND Corporation, 4570 Fifth Avenue, Suite Pittsburgh, PA 15213, USA.
| | - Molly T. Finnerty
- New York State Office of Mental Health, Capital District Psychiatric Center, 75 New Scotland Avenue, Albany, NY 12208, USA
| | - Emily Leckman-Westin
- New York State Office of Mental Health, Capital District Psychiatric Center, 75 New Scotland Avenue, Albany, NY 12208, USA.
| | - Riti Pritam
- New York State Office of Mental Health, Capital District Psychiatric Center, 75 New Scotland Avenue, Albany, NY 12208, USA.
| | - Hao Yu
- RAND Corporation, 4570 Fifth Avenue, Suite Pittsburgh, PA 15213, USA.
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14
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Moukaddam N, Udoetuk S, Tucci V, Shah AA. Exclusionary Criteria for Inpatient Hospitalization: Quality Safeguards or Unnecessary Roadblocks? Psychiatr Ann 2018. [DOI: 10.3928/00485713-20171205-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Mangurian C, Niu GC, Schillinger D, Newcomer JW, Dilley J, Handley MA. Utilization of the Behavior Change Wheel framework to develop a model to improve cardiometabolic screening for people with severe mental illness. Implement Sci 2017; 12:134. [PMID: 29137666 PMCID: PMC5686815 DOI: 10.1186/s13012-017-0663-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 11/01/2017] [Indexed: 12/21/2022] Open
Abstract
Background Individuals with severe mental illness (e.g., schizophrenia, bipolar disorder) die 10–25 years earlier than the general population, primarily from premature cardiovascular disease (CVD). Contributing factors are complex, but include systemic-related factors of poorly integrated primary care and mental health services. Although evidence-based models exist for integrating mental health care into primary care settings, the evidence base for integrating medical care into specialty mental health settings is limited. Such models are referred to as “reverse” integration. In this paper, we describe the application of an implementation science framework in designing a model to improve CVD outcomes for individuals with severe mental illness (SMI) who receive services in a community mental health setting. Methods Using principles from the theory of planned behavior, focus groups were conducted to understand stakeholder perspectives of barriers to CVD risk factor screening and treatment identify potential target behaviors. We then applied results to the overarching Behavior Change Wheel framework, a systematic and theory-driven approach that incorporates the COM-B model (capability, opportunity, motivation, and behavior), to build an intervention to improve CVD risk factor screening and treatment for people with SMI. Results Following a stepped approach from the Behavior Change Wheel framework, a model to deliver primary preventive care for people that use community mental health settings as their de facto health home was developed. The CRANIUM (cardiometabolic risk assessment and treatment through a novel integration model for underserved populations with mental illness) model focuses on engaging community psychiatrists to expand their scope of practice to become responsible for CVD risk, with significant clinical decision support. Conclusion The CRANIUM model was designed by integrating behavioral change theory and implementation theory. CRANIUM is feasible to implement, is highly acceptable to, and targets provider behavior change, and is replicable and efficient for helping to integrate primary preventive care services in community mental health settings. CRANIUM can be scaled up to increase CVD preventive care delivery and ultimately improve health outcomes among people with SMI served within a public mental health care system.
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Affiliation(s)
- Christina Mangurian
- Department of Psychiatry, Weill Institute for Neurosciences, UCSF at Zuckerberg San Francisco General (ZSFG), 1001 Potrero Avenue, 7M8, San Francisco, CA, 94110, USA. .,UCSF Center for Vulnerable Populations at ZSFG, San Francisco, CA, USA.
| | - Grace C Niu
- Department of Psychiatry, Weill Institute for Neurosciences, UCSF at Zuckerberg San Francisco General (ZSFG), 1001 Potrero Avenue, 7M8, San Francisco, CA, 94110, USA
| | - Dean Schillinger
- UCSF Center for Vulnerable Populations at ZSFG, San Francisco, CA, USA.,UCSF Department of Medicine, Division of General Internal Medicine at ZSFG, 1001 Potrero Avenue, 1320A, San Francisco, CA, 94110, USA
| | - John W Newcomer
- Department of Clinical Biomedical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71 Rm 241, Boca Raton, FL, 33431, USA
| | - James Dilley
- Department of Psychiatry, Weill Institute for Neurosciences, UCSF at Zuckerberg San Francisco General (ZSFG), 1001 Potrero Avenue, 7M8, San Francisco, CA, 94110, USA
| | - Margaret A Handley
- UCSF Center for Vulnerable Populations at ZSFG, San Francisco, CA, USA.,UCSF Department of Medicine, Division of General Internal Medicine at ZSFG, 1001 Potrero Avenue, 1320A, San Francisco, CA, 94110, USA.,UCSF Department of Epidemiology and Biostatistics, 550 16th Street, San Francisco, CA, 64158, USA
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16
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Tucci VT, Moukaddam N, Alam A, Rachal J. Emergency Department Medical Clearance of Patients with Psychiatric or Behavioral Emergencies, Part 1. Psychiatr Clin North Am 2017; 40:411-423. [PMID: 28800798 DOI: 10.1016/j.psc.2017.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients presenting to the emergency department with mental illness or behavioral complaints merit workup for underlying physical conditions that can trigger, mimic, or worsen psychiatric symptoms. However, interdisciplinary consensus on medical clearance is lacking, leading to wide variations in quality of care and, quite often, poor medical care. Psychiatry and emergency medicine specialty guidelines support a tailored, customized approach. This article summarizes best-practice approaches to the medical clearance of patients with psychiatric illness, tips on history taking, system reviews, clinical or physical examination, and common pitfalls in the medical clearance process.
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Affiliation(s)
- Veronica Theresa Tucci
- Merit Health Wesley, Department of Emergency Medicine, 5001 Hardy Street, Hattiesburg, MS 39402, USA.
| | - Nidal Moukaddam
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1502 Taub Loop, NPC Building 2nd Floor, Houston, TX 77030, USA
| | - Al Alam
- Weill Cornell Medical College, NewYork-Presbyterian/Westchester, 21 Bloomingdale Road, White Plains, NY 10605, USA; Stony Brook University, Stony Brook, NY, USA
| | - James Rachal
- Carolinas Health Care System, Behavioral Health, 501 Billingsley Road, Charlotte, NC 28211, USA
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17
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Williams MD, Ratzliff AH. Developing the Business Case and Supporting Practice Change for Collaborative Care. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2017; 15:294-297. [PMID: 31975861 PMCID: PMC6519547 DOI: 10.1176/appi.focus.20170009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Mark D Williams
- Dr. Williams is with the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota. Dr. Ratzliff is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Anna H Ratzliff
- Dr. Williams is with the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota. Dr. Ratzliff is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
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18
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Delaney KR, Naegle MA, Valentine NM, Antai-Otong D, Groh CJ, Brennaman L. The Effective Use of Psychiatric Mental Health Nurses in Integrated Care: Policy Implications for Increasing Quality and Access to Care. J Behav Health Serv Res 2017; 45:300-309. [DOI: 10.1007/s11414-017-9555-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Al-Huseini S, Al-Madhani A, Al-Shehhi A, Al-Sinawi H. Physical Examinations of Psychiatric Patients who Presented at the Emergency Department of a Tertiary-Care Hospital in Oman. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2016; 4:206-211. [PMID: 30787731 PMCID: PMC6298336 DOI: 10.4103/1658-631x.188248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: The objective of this study was to examine the completeness of physical assessment of patients presenting with psychiatric problems to the Emergency Department (ED). Methods: This was to observational study based on a retrospective review of the medical records of patients who attended the ED of Sultan Qaboos University Hospital and referred to the on-duty psychiatrist for assessment over a 12 months period. All patients aged 16 years and above, who presented to the ED with a psychiatric complaint were included in the study. A data collection sheet was designed to gather each patient's demographic data such as age and gender, past psychiatric history, nature of the presenting complaints, thoroughness of physical assessment, medications prescribed by the ED doctor prior to psychiatric assessment, and whether the patient was discharged, admitted to a psychiatry or medical ward. Results: A total of 202 patients met the inclusion criteria. The mean age of the patients was 34.2 years. Females represented 56% of the sample. The majority of the study group (60.4%) were patients with a documented past psychiatric history. Physical examination was conducted in the ED for 61.4% of the patients, while vital signs were recorded for 68.8% of them. Approximately, 31% of the patients required injectable psychotropic medications as tranquillizers in the ED. Patients with an isolated psychiatric complaint coupled with a documented past psychiatric history were more likely to be referred to the on-call psychiatrist without a physical examination by the ED doctors. Conclusion: In our institution, not all patients with psychiatric presentations had a complete physical examination by the ED doctors.
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Affiliation(s)
- Salim Al-Huseini
- Department of Behaviour Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Abdullah Al-Madhani
- Department of Behaviour Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Afaf Al-Shehhi
- Department of Behaviour Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Hamed Al-Sinawi
- Department of Behaviour Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
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20
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Serious Mental Illness and Risk for Hospitalizations and Rehospitalizations for Ambulatory Care-sensitive Conditions in Denmark: A Nationwide Population-based Cohort Study. Med Care 2016; 54:90-7. [PMID: 26492210 DOI: 10.1097/mlr.0000000000000448] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Hospitalizations for ambulatory care-sensitive conditions (ACSCs) and early rehospitalizations increase health care costs. OBJECTIVES To determine if individuals with serious mental illnesses (SMIs) (eg, schizophrenia or bipolar disorder) are at increased risk for hospitalizations for ACSCs, and rehospitalization for the same or another ACSC, within 30 days. RESEARCH DESIGN Population-based cohort study. PARTICIPANTS A total of 5.9 million Danish persons aged 18 years and older between January 1, 1999 and December 31, 2013. MEASURES The Danish Psychiatric Central Register provided information on SMI diagnoses and the Danish National Patient Register on hospitalizations for ACSCs and 30-day rehospitalizations. RESULTS SMI was associated with increased risk for having any ACSC-related hospitalization after adjusting for demographics, socioeconomic factors, comorbidities, and prior primary care utilization [incidence rate ratio (IRR): 1.41; 95% confidence interval (95% CI), 1.37-1.45]. Among individual ACSCs, SMI was associated with increased risk for hospitalizations for angina (IRR: 1.14, 95% CI, 1.04-1.25), chronic obstructive pulmonary disease/asthma exacerbation (IRR: 1.87; 95% CI, 1.74-2.00), congestive heart failure exacerbation (IRR: 1.25; 95% CI, 1.16-1.35), and diabetes (IRR: 1.43; 95% CI, 1.31-1.57), appendiceal perforation (IRR: 1.49; 95% CI, 1.30-1.71), pneumonia (IRR: 1.72; 95% CI, 1.66-1.79), and urinary tract infection (IRR: 1.70; 95% CI, 1.62-1.78). SMI was also associated with increased risk for rehospitalization within 30 days for the same (IRR: 1.28; 95% CI, 1.18-1.40) or for another ACSC (IRR: 1.62; 95% CI, 1.49-1.76). CONCLUSION Persons with SMI are at increased risk for hospitalizations for ACSCs, and after discharge, are at increased risk for rehospitalizations for ACSCs within 30 days.
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21
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Sowers W, Arbuckle M, Shoyinka S. Recommendations for Primary Care Provided by Psychiatrists. Community Ment Health J 2016; 52:379-86. [PMID: 26803759 DOI: 10.1007/s10597-015-9983-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
Abstract
Recent studies have shown that people with severe mental illness have a dramatically lower life expectancy than the general population. Psychiatrists have not traditionally been very attentive to or involved with physical health issues and there has been growing emphasis on integrated care for physical and mental health and access to primary care for all members of the population. This paper examines the role of psychiatrists in the provision of primary care to the patients they treat. Some recommendations are offered for their involvement in the provision of primary care at three levels of complexity: Level 1--Universal Basic Psychiatric Primary Care; Level 2--Enhanced Psychiatric Primary Care; and Level 3--Fully Integrated Primary Care and Psychiatric Management. Some of the obstacles to the provision of primary care by psychiatrists are considered along with some suggestions for overcoming them.
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Affiliation(s)
- Wesley Sowers
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara St, Webster Hall, Pittsburgh, PA, 15213, USA.
| | - Melissa Arbuckle
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, Box 103, New York, NY, 10032, USA
| | - Sosunmolu Shoyinka
- Sunflower State Health Plan Columbia, University of Missouri Medical Center, 4507 Maxwell Lane, Columbia, MO, 65203-6565, USA
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22
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Tucci V, Siever K, Matorin A, Moukaddam N. Down the Rabbit Hole: Emergency Department Medical Clearance of Patients with Psychiatric or Behavioral Emergencies. Emerg Med Clin North Am 2015; 33:721-37. [PMID: 26493519 DOI: 10.1016/j.emc.2015.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Patients presenting with behavior or psychiatric complaints may have an underlying medical disorder causing or worsening their symptoms. Misdiagnosing a medical illness as psychiatric can lead to increased morbidity and mortality. A thorough history and physical examination, including mental status, are important to identify these causes and guide further testing. Laboratory and ancillary testing should be guided by what is indicated based on clinical assessment. Certain patient populations and signs and symptoms have a higher association with organic causes of behavioral complaints. Many medical problems can present with or exacerbate psychiatric symptoms, and a thorough medical assessment is imperative.
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Affiliation(s)
- Veronica Tucci
- Section of Emergency Medicine, Baylor College of Medicine, 1504 Taub Loop, Houston, TX 77030, USA.
| | - Kaylin Siever
- Section of Emergency Medicine, Baylor College of Medicine, 1504 Taub Loop, Houston, TX 77030, USA
| | - Anu Matorin
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1502 Taub Loop, NPC Building 2nd Floor, Houston, TX 77030, USA
| | - Nidal Moukaddam
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1502 Taub Loop, NPC Building 2nd Floor, Houston, TX 77030, USA
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23
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Happell B, Platania-Phung C, Scott D, Stanton R. Predictors of Nurse Support for the Introduction of the Cardiometabolic Health Nurse in the Australian Mental Health Sector. Perspect Psychiatr Care 2015; 51:162-70. [PMID: 24957751 DOI: 10.1111/ppc.12077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/22/2014] [Accepted: 05/29/2014] [Indexed: 11/28/2022] Open
Abstract
PURPOSE A cardiometabolic specialist nursing role could potentially improve physical health of people with serious mental illness. DESIGN AND METHODS A national survey of Australian nurses working in mental health settings investigated predictors of support for the role. FINDINGS Predictors included belief in physical healthcare neglect, interest in training; higher perceived value of improving physical health care. PRACTICE IMPLICATIONS The findings suggest that nurses see the cardiometabolic health nurse role as a promising initiative for closing gaps in cardiometabolic health care and skilling other nurses in mental health. However, as the majority of variance in cardiometabolic health nurse support was unexplained, more research is urgently needed on factors that explain differences in cardiometabolic health nurse endorsement.
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Affiliation(s)
- Brenda Happell
- Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
| | - Chris Platania-Phung
- Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
| | - David Scott
- Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
| | - Robert Stanton
- Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
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Proctor E, Luke D, Calhoun A, McMillen C, Brownson R, McCrary S, Padek M. Sustainability of evidence-based healthcare: research agenda, methodological advances, and infrastructure support. Implement Sci 2015; 10:88. [PMID: 26062907 PMCID: PMC4494699 DOI: 10.1186/s13012-015-0274-5] [Citation(s) in RCA: 215] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 05/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about how well or under what conditions health innovations are sustained and their gains maintained once they are put into practice. Implementation science typically focuses on uptake by early adopters of one healthcare innovation at a time. The later-stage challenges of scaling up and sustaining evidence-supported interventions receive too little attention. This project identifies the challenges associated with sustainability research and generates recommendations for accelerating and strengthening this work. METHODS A multi-method, multi-stage approach, was used: (1) identifying and recruiting experts in sustainability as participants, (2) conducting research on sustainability using concept mapping, (3) action planning during an intensive working conference of sustainability experts to expand the concept mapping quantitative results, and (4) consolidating results into a set of recommendations for research, methodological advances, and infrastructure building to advance understanding of sustainability. Participants comprised researchers, funders, and leaders in health, mental health, and public health with shared interest in the sustainability of evidence-based health care. RESULTS Prompted to identify important issues for sustainability research, participants generated 91 distinct statements, for which a concept mapping process produced 11 conceptually distinct clusters. During the conference, participants built upon the concept mapping clusters to generate recommendations for sustainability research. The recommendations fell into three domains: (1) pursue high priority research questions as a unified agenda on sustainability; (2) advance methods for sustainability research; (3) advance infrastructure to support sustainability research. CONCLUSIONS Implementation science needs to pursue later-stage translation research questions required for population impact. Priorities include conceptual consistency and operational clarity for measuring sustainability, developing evidence about the value of sustaining interventions over time, identifying correlates of sustainability along with strategies for sustaining evidence-supported interventions, advancing the theoretical base and research designs for sustainability research, and advancing the workforce capacity, research culture, and funding mechanisms for this important work.
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Affiliation(s)
- Enola Proctor
- George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, USA.
| | - Douglas Luke
- George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, USA.
| | | | - Curtis McMillen
- School of Social Service Administration, The University of Chicago, 969 E. 60th Street, Chicago, IL, USA.
| | - Ross Brownson
- George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, USA.
| | - Stacey McCrary
- George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, USA.
| | - Margaret Padek
- George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, USA.
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McConnell KJ, Chang AM, Cohen DJ, Wallace N, Chernew ME, Kautz G, McCarty D, McFarland B, Wright B, Smith J. Oregon's Medicaid Transformation: An Innovative Approach To Holding A Health System Accountable For Spending Growth. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2014; 2:163-167. [PMID: 25540719 DOI: 10.1016/j.hjdsi.2013.11.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In 2012, Oregon initiated a significant transformation of its Medicaid program, catalyzed in part through an innovative arrangement with the Centers for Medicare and Medicaid Services (CMS), which provided an upfront investment of $1.9 billion to the state. In exchange, Oregon agreed to reduce the rate of Medicaid spending by 2 percentage points without degrading quality. A failure to meet these targets triggers penalties on the order of hundreds of millions of dollars from CMS. We describe the novel arrangement with CMS and how the CCO structure compares to Accountable Care Organizations (ACOs) and managed care organizations (MCOs).
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Affiliation(s)
- K John McConnell
- Center for Health Systems Effectiveness, Department of Emergency Medicine, Oregon Health & Science University
| | - Anna Marie Chang
- Department of Emergency Medicine, Oregon Health & Science University
| | - Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University
| | - Neal Wallace
- Hatfield School of Government, Portland State University
| | | | - Glenn Kautz
- Center for Health Systems Effectiveness, Oregon Health & Science University
| | - Dennis McCarty
- Department of Public Health and Preventive Medicine, Oregon Health & Science University
| | | | - Bill Wright
- Providence Center for Outcomes Research and Education
| | - Jeanene Smith
- Office of Health Policy and Research, Oregon Health Authority
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Viron M, Zioto K, Schweitzer J, Levine G. Behavioral Health Homes: an opportunity to address healthcare inequities in people with serious mental illness. Asian J Psychiatr 2014; 10:10-6. [PMID: 25042945 DOI: 10.1016/j.ajp.2014.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 02/14/2014] [Accepted: 03/05/2014] [Indexed: 11/28/2022]
Abstract
People with serious mental illness (SMI) face striking reductions in lifespan versus the general population, in part due to the inadequacy of healthcare systems in meeting the substantial physical health needs of this group. Integrated care, the strategic combination and coordination of behavioral health and primary care services, has been proposed as a potential healthcare service delivery solution to address these care gaps. Inspired by the primary care Patient-Centered Medical Home concept, Behavioral Health Homes bring primary care services into the community mental health center in various ways. In this paper the authors review the literature describing Behavioral Health Home interventions and highlight an integration project that provides co-located and coordinated primary care and wellness services in a community mental health center. Such approaches hold great promise for improving the health and healthcare of people with SMI.
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Affiliation(s)
- Mark Viron
- Massachusetts Mental Health Center, Boston, MA, USA; Beth Israel Deaconess Medical Center, Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Kathryn Zioto
- Harvard Medical School, Boston, MA, USA; Harvard Longwood Psychiatry Residency Training Program, Boston, MA, USA
| | - Jason Schweitzer
- Harvard Medical School, Boston, MA, USA; Harvard Longwood Psychiatry Residency Training Program, Boston, MA, USA
| | - Gail Levine
- Massachusetts Mental Health Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA
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Shigayeva A, Coker RJ. Communicable disease control programmes and health systems: an analytical approach to sustainability. Health Policy Plan 2014; 30:368-85. [PMID: 24561988 DOI: 10.1093/heapol/czu005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
There is renewed concern over the sustainability of disease control programmes, and re-emergence of policy recommendations to integrate programmes with general health systems. However, the conceptualization of this issue has remarkably received little critical attention. Additionally, the study of programmatic sustainability presents methodological challenges. In this article, we propose a conceptual framework to support analyses of sustainability of communicable disease programmes. Through this work, we also aim to clarify a link between notions of integration and sustainability. As a part of development of the conceptual framework, we conducted a systematic literature review of peer-reviewed literature on concepts, definitions, analytical approaches and empirical studies on sustainability in health systems. Identified conceptual proposals for analysis of sustainability in health systems lack an explicit conceptualization of what a health system is. Drawing upon theoretical concepts originating in sustainability sciences and our review here, we conceptualize a communicable disease programme as a component of a health system which is viewed as a complex adaptive system. We propose five programmatic characteristics that may explain a potential for sustainability: leadership, capacity, interactions (notions of integration), flexibility/adaptability and performance. Though integration of elements of a programme with other system components is important, its role in sustainability is context specific and difficult to predict. The proposed framework might serve as a basis for further empirical evaluations in understanding complex interplay between programmes and broader health systems in the development of sustainable responses to communicable diseases.
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Affiliation(s)
- Altynay Shigayeva
- Communicable Diseases Policy Research Group, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard J Coker
- Communicable Diseases Policy Research Group, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Dow AW, Bohannon A, Garland S, Mazmanian PE, Retchin SM. The effects of expanding primary care access for the uninsured: implications for the health care workforce under health reform. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:1855-1861. [PMID: 24128619 DOI: 10.1097/acm.0000000000000032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The Patient Protection and Affordable Care Act seeks to improve health equity in the United States by expanding Medicaid coverage for adults who are uninsured and/or socioeconomically disadvantaged; however, when millions more become eligible for Medicaid in 2014, the health care workforce and care delivery systems will be inadequate to meet the care needs of the U.S. population. To provide high-quality care efficiently to the expanded population of insured individuals, the health care workforce and care delivery structures will need to be tailored to meet the needs of specific groups within the population.To help create a foundation for understanding the use patterns of the newly insured and to recommend possible approaches to care delivery and workforce development, the authors describe the 13-year-old experience of the Virginia Coordinated Care program (VCC). The VCC, developed by Virginia Commonwealth University Health System in Richmond, Virginia, is a health-system-sponsored care coordination program that provides primary and specialty care services to patients who are indigent. The authors have categorized VCC patients from fiscal year 2011 by medical complexity. Then, on the basis of the resulting utilization data for each category over the next fiscal year, the authors describe the medical needs and health behaviors of the four different patient groups. Finally, the authors discuss possible approaches for providing primary, preventive, and specialty care to improve the health of the population while controlling costs and how adoption of the approaches might be shaped by care delivery systems and educational institutions.
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Affiliation(s)
- Alan W Dow
- Dr. Dow is assistant vice president of health sciences for interprofessional education and collaborative care, assistant dean of medical education, and associate professor of medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia. Dr. Bohannon is associate professor of medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia. Ms. Garland is vice president of health policy and community relations, Virginia Commonwealth University Health System, Richmond, Virginia. Dr. Mazmanian is associate dean for assessment and evaluation studies, School of Medicine, and director of evaluation, Virginia Commonwealth University Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia. Dr. Retchin is senior vice president of health sciences, Virginia Commonwealth University, and chief executive officer, Virginia Commonwealth University Health System, Richmond, Virginia
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Kilbourne AM, Goodrich DE, O’Donnell AN, Miller CJ. Integrating bipolar disorder management in primary care. Curr Psychiatry Rep 2012; 14:687-95. [PMID: 23001382 PMCID: PMC3492519 DOI: 10.1007/s11920-012-0325-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There is growing realization that persons with bipolar disorder may exclusively be seen in primary (general medical) care settings, notably because of limited access to mental health care and stigma in seeking mental health treatment. At least two clinical practice guidelines for bipolar disorder recommend collaborative chronic care models (CCMs) to help integrate mental health care to better manage this illness. CCMs, which include provider guideline support, self-management support, care management, and measurement-based care, are well-established in primary care settings, and may help primary care practitioners manage bipolar disorder. However, further research is required to adapt CCMs to support complexities in diagnosing persons with bipolar disorder, and integrate decision-making processes regarding medication safety and tolerability in primary care. Additional implementation studies are also needed to adapt CCMs for persons with bipolar disorder in primary care, especially those seen in smaller practices with limited infrastructure and access to mental health care.
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Affiliation(s)
- Amy M. Kilbourne
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - David E. Goodrich
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | | | - Christopher J. Miller
- Center for Organization, Leadership, & Management Research, VA Boston Healthcare System, Boston, MA
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