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Hoeft TJ, Hall JD, Solberg LI, Takamine LH, Danna MN, Fortney JC, Shushan S, Cohen DJ. Clinician Experiences With Telepsychiatry Collaborative Care for Posttraumatic Stress Disorder and Bipolar Disorder. Psychiatr Serv 2022:appips202100595. [PMID: 36444528 DOI: 10.1176/appi.ps.202100595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) and bipolar disorder are common in primary care. Evidence supports collaborative care in primary care settings to treat depression and anxiety, and recent studies have evaluated its effectiveness in treating complex conditions such as PTSD and bipolar disorder. This study aimed to examine how primary care clinicians experience collaborative care for patients with these more complex psychiatric disorders. METHODS The authors conducted semistructured interviews with 22 primary care clinicians participating in a pragmatic trial that included telepsychiatry collaborative care (TCC) to treat patients with PTSD or bipolar disorder in rural or underserved areas. Analysis utilized a constant comparative method to identify recurring themes. RESULTS Clinicians reported that TCC improved their confidence in managing medications for patients with PTSD or bipolar disorder and supported their ongoing learning and skill development. Clinicians also reported improvements in patient engagement in care. Care managers were crucial to realizing these benefits by fostering communication within the clinical team while engaging patients through regular outreach. Clinicians valued TCC because it included and supported them in improving the care of patients' mental health conditions, which opened opportunities for clinicians to enhance care and address co-occurring general medical conditions. Overall, benefits of the TCC model outweighed its minimal burdens. CONCLUSIONS Clinicians found that TCC supported their care of patients with PTSD or bipolar disorder. This approach has the potential to extend the reach of specialty mental health care and to support primary care clinicians treating patients with these more complex psychiatric disorders.
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Affiliation(s)
- Theresa J Hoeft
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - Jennifer D Hall
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - Leif I Solberg
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - Linda H Takamine
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - Maria N Danna
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - Stephanie Shushan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
| | - Deborah J Cohen
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Hoeft, Fortney); Department of Family Medicine, Oregon Health & Science University, Portland (Hall, Danna, Cohen); HealthPartners Institute, Bloomington, Minnesota (Solberg); Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor (Takamine); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle (Fortney); Community Health Plan of Washington, Seattle (Shushan)
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Rogers R, Hartigan SE, Sanders CE. Identifying Mental Disorders in Primary Care: Diagnostic Accuracy of the Connected Mind Fast Check (CMFC) Electronic Screen. J Clin Psychol Med Settings 2021; 28:882-896. [PMID: 34609692 PMCID: PMC8491449 DOI: 10.1007/s10880-021-09820-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/27/2022]
Abstract
Primary care physicians (PCPs) often daily address diagnoses and treatment of mental disorders in their practices. The current study examined the Connected Mind Fast Check (CMFC), a two-tiered electronic screen, assessing six common mental disorders. The eight-item Initial Screen assesses possible symptoms, whereas SAM modules establish provisional diagnoses and areas of clinical concern. With 234 patients from five independent PCP offices, diagnostic accuracy was tested with the SCID-5-RV as the external criterion. Concerningly, many patients were unaware of their current mental disorders and comorbidities. The CMFC Initial Screen evidenced strong sensitivity, identifying with very few missing diagnoses. About two-thirds of provisional SAM diagnoses were confirmed with high specificities. Bipolar Disorder posed the most challenges at both tiers. Importantly, the suicide screen identified all patients with suicide plans and three-fourths with ideation. In general, the CMFC effectively identified provisional diagnoses, impairment, and potential suicidality.
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Affiliation(s)
- Richard Rogers
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, 311280, USA.
| | - Sara E Hartigan
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, 311280, USA
| | - Courtney E Sanders
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, 311280, USA
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Ralat SI, Barrios RI. THE MANAGEMENT OF CARDIOVASCULAR DISEASE RISK FACTORS IN BIPOLAR DISORDER PATIENTS IN PRIMARY HEALTHCARE SETTINGS. REVISTA PUERTORRIQUENA DE PSICOLOGIA 2020; 31:62-78. [PMID: 34221244 PMCID: PMC8249201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Accumulating evidence supports the association between cardiovascular disease (CVD) risk factors and bipolar disorder (BD). CVD is the leading cause of morbidity and mortality in patients with bipolar disorder. However, there is a need to study the management of the risk factors in the primary healthcare context. This narrative review aims to appraise the different approaches of care that have been used in the management of these patients to address CVD risk factors in primary care. We reviewed articles from PubMed, Science Direct and other studies cited in the articles found. The keywords used for this review included "bipolar," "bipolar disorder," "cardiovascular" or "metabolic syndrome," "screening," "primary care," and "integrative" or "integrated care model" or "collaborative care model." This review includes studies published over a period of 48 months (January 2016 through December 2019). We identified 128 articles, removing two duplicates. From them, 115 articles are excluded based on the inclusion/exclusion criteria leaving eleven relevant articles. Upon full-text review, six studies were excluded. The final studies included are five. We used the study-quality assessment tools from the National Heart, Lung, and Blood Institute to assess the quality of the articles found. CVD risk factors in patients with BD and forms of other severe mental illness (SMI) are often underdetected. Primary healthcare providers need to identify these risk factors in the management of these patients to determine and recommend appropriate strategies.
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Affiliation(s)
- Sandra I. Ralat
- Department of Psychiatry, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Rossana I. Barrios
- Conrado F. Asenjo Library, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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