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Hassan S, Liu S, Johnson LCM, Patel SA, Emmert-Fees KMF, Suvada K, Tandon N, Sridhar GR, Aravind S, Poongothai S, Anjana RM, Mohan V, Chwastiak L, Ali MK. Association of collaborative care intervention features with depression and metabolic outcomes in the INDEPENDENT study: A mixed methods study. Prim Care Diabetes 2024; 18:319-326. [PMID: 38360505 PMCID: PMC11127790 DOI: 10.1016/j.pcd.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/17/2024]
Abstract
AIMS The INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT) trial tested a collaborative care model including electronic clinical decision support (CDS) for treating diabetes and depression in India. We aimed to assess which features of this clinically and cost-effective intervention were associated with improvements in diabetes and depression measures. METHODS Post-hoc analysis of the INDEPENDENT trial data (189 intervention participants) was conducted to determine each intervention feature's effect: 1. Collaborative case reviews between expert psychiatrists and the care team; 2. Patient care-coordinator contacts; and 3. Clinicians' CDS prompt modifications. Primary outcome was baseline-to-12-months improvements in diabetes control, blood pressure, cholesterol, and depression. Implementer interviews revealed barriers and facilitators of intervention success. Joint displays integrated mixed methods' results. RESULTS High baseline HbA1c≥ 74.9 mmol/mol (9%) was associated with 5.72 fewer care-coordinator contacts than those with better baseline HbA1c (76.8 mmol/mol, 9.18%, p < 0.001). Prompt modification proportions varied from 38.3% (diabetes) to 1.3% (LDL). Interviews found that providers' and participants' visit frequencies were preference dependent. Qualitative data elucidated patient-level factors that influenced number of clinical contacts and prompt modifications explaining their lack of association with clinical outcomes. CONCLUSION Our mixed methods approach underlines the importance of the complementarity of different intervention features. Qualitative findings further illuminate reasons for variations in fidelity from the core model.
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Affiliation(s)
- Saria Hassan
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, GA, USA; Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Star Liu
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA; Department of Biomedical Informatics and Data Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leslie C M Johnson
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, GA, USA
| | - Shivani A Patel
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, GA, USA
| | - Karl M F Emmert-Fees
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA; Public Health and Prevention, Technical University of Munich, Munich, Germany
| | - Kara Suvada
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences New Delhi, India
| | | | - Sosale Aravind
- Diabetes Care and Research Center, Diacon Hospital, Bengaluru, India
| | - Subramani Poongothai
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Mohammed K Ali
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, GA, USA
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Carlo AD, McNutt C, Talebi H. Extending the Clinical Impact of Behavioral Health Prescribing Clinicians Using the Collaborative Care Model (CoCM). J Gen Intern Med 2024; 39:1525-1527. [PMID: 38316699 PMCID: PMC11169101 DOI: 10.1007/s11606-024-08649-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Andrew D Carlo
- Meadows Mental Health Policy Institute, Dallas, TX, USA.
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Clare McNutt
- Meadows Mental Health Policy Institute, Dallas, TX, USA
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
- The George Washington University, Washington, DC, USA
| | - Hani Talebi
- Meadows Mental Health Policy Institute, Dallas, TX, USA
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
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Huang H, Huynh B, Nidey N, Huang H. Meaningful Engagement in Depression and Anxiety Collaborative Care: Associations With Systematic Case Review. J Acad Consult Liaison Psychiatry 2024; 65:254-260. [PMID: 38309684 DOI: 10.1016/j.jaclp.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/16/2024] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Collaborative care (CC) is an evidence-based model of care for treating behavioral health conditions in primary care settings. The CC team consists of a primary care provider, behavioral health care manager (CM), and a consultant psychiatrist who collaborate to create treatment plans. To date, there is limited data on factors associated with meaningful engagement in CC programs. OBJECTIVE To identify the proportion of patients who were meaningfully engaged and to investigate the factors associated with meaningful engagement in a CC program. METHODS Data was collected from a CC program implemented across 27 adult primary care clinics in a Midwestern, U.S. academic medical system. Logistic regression (n = 5218) was used to estimate the odds of receiving meaningful engagement. RESULTS Data was collected from 6437 individuals with 68% being female and a mean age of 45 years old (standard deviation 17.6). Overall, 57% of patients were meaningfully engaged; however, this proportion differed based on demographic and clinical factors. Among modifiable clinical factors, systematic case reviews between the CM and psychiatrist (odds ratio: 10.2, 95% confidence interval: 8.6-12.1) and warm handoffs (odds ratio: 1.3, 95% confidence interval: 1.1-1.5) were associated with a higher likelihood of receiving meaningful engagement. CONCLUSIONS The presence of systematic case reviews between the behavioral health CM and the consultant psychiatrist was highly associated with meaningful engagement. When implementing such programs, high fidelity to the core principles including regularly scheduled systematic case reviews should be pursued.
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Affiliation(s)
- Heather Huang
- Department of Psychiatry, University of Wisconsin Hospitals and Clinics, Madison, WI.
| | - Brandon Huynh
- Department of Psychiatry, University of Wisconsin Hospitals and Clinics, Madison, WI
| | - Nichole Nidey
- College of Public Health, University of Iowa, Iowa City, IA
| | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA
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Whitfield J, Owens S, Bhat A, Felker B, Jewell T, Chwastiak L. Successful ingredients of effective Collaborative Care programs in low- and middle-income countries: A rapid review. Glob Ment Health (Camb) 2023; 10:e11. [PMID: 37854388 PMCID: PMC10579696 DOI: 10.1017/gmh.2022.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/01/2022] [Accepted: 11/22/2022] [Indexed: 03/19/2023] Open
Abstract
Integrating mental health care in primary healthcare settings is a compelling strategy to address the mental health treatment gap in low- and middle-income countries (LMICs). Collaborative Care is the integrated care model with the most evidence supporting its effectiveness, but most research has been conducted in high-income countries. Efforts to implement this complex multi-component model at scale in LMICs will be enhanced by understanding the model components that have been effective in LMIC settings. Following Cochrane Rapid Reviews Methods Group recommendations, we conducted a rapid review to identify studies of the effectiveness of Collaborative Care for priority adult mental disorders of mhGAP (mood and anxiety disorders, psychosis, substance use disorders and epilepsy) in outpatient medical settings in LMICs. Article screening and data extraction were performed using Covidence software. Data extraction by two authors utilized a checklist of key components of effective interventions. Information was aggregated to examine how frequently the components were applied. Our search yielded 25 articles describing 20 Collaborative Care models that treated depression, anxiety, schizophrenia, alcohol use disorder or epilepsy in nine different LMICs. Fourteen of these models demonstrated statistically significantly improved clinical outcomes compared to comparison groups. Successful models shared key structural and process-of-care elements: a multi-disciplinary care team with structured communication; standardized protocols for evidence-based treatments; systematic identification of mental disorders, and a stepped-care approach to treatment intensification. There was substantial heterogeneity across studies with respect to the specifics of model components, and clear evidence of the importance of tailoring the model to the local context. This review provides evidence that Collaborative Care is effective across a range of mental disorders in LMICs. More work is needed to demonstrate population-level and longer-term outcomes, and to identify strategies that will support successful and sustained implementation in routine clinical settings.
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Affiliation(s)
- Jessica Whitfield
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
| | - Shanise Owens
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Bradford Felker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Teresa Jewell
- University of Washington Health Sciences Library, University of Washington, Seattle, WA, USA
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA
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Dombrowski JC, Halliday S, Tsui JI, Rao D, Sherr K, Ramchandani MS, Emerson R, Fleming M, Wood T, Chwastiak L. Adaptation of the collaborative care model to integrate behavioral health care into a low-barrier HIV clinic. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231167105. [PMID: 37790178 PMCID: PMC10123894 DOI: 10.1177/26334895231167105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background The collaborative care management (CoCM) model is an evidence-based intervention for integrating behavioral health care into nonpsychiatric settings. CoCM has been extensively studied in primary care clinics, but implementation in nonconventional clinics, such as those tailored to provide care for high-need, complex patients, has not been well described. Method We adapted CoCM for a low-barrier HIV clinic that provides walk-in medical care for a patient population with high levels of mental illness, substance use, and housing instability. The Exploration, Preparation, Implementation, and Sustainment model guided implementation activities and support through the phases of implementing CoCM. The Framework for Reporting Adaptations and Modifications to Evidence-Based Interventions guided our documentation of adaptations to process-of-care elements and structural elements of CoCM. We used a multicomponent strategy to implement the adapted CoCM model. In this article, we describe our experience through the first 6 months of implementation. Results The key contextual factors necessitating adaptation of the CoCM model were the clinic team structure, lack of scheduled appointments, high complexity of the patient population, and time constraints with competing priorities for patient care, all of which required substantial flexibility in the model. The process-of-care elements were adapted to improve the fit of the intervention with the context, but the core structural elements of CoCM were maintained. Conclusions The CoCM model can be adapted for a setting that requires more flexibility than the usual primary care clinic while maintaining the core elements of the intervention.
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Affiliation(s)
- Julia C. Dombrowski
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
| | - Scott Halliday
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Judith I. Tsui
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Kenneth Sherr
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Industrial & Systems Engineering, University of Washington, Seattle, WA, USA
| | - Meena S. Ramchandani
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
| | - Ramona Emerson
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Mark Fleming
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
| | - Teagan Wood
- Department of Social Work, Harborview Medical Center, Seattle, WA, USA
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Rosenfeld LC, Wang P, Holland J, Ruble M, Parsons T, Huang H. Care Management of Comorbid Medical and Psychiatric Illness: A Conceptual Framework for Improving Equity of Care. Popul Health Manag 2022; 25:148-156. [PMID: 35442788 PMCID: PMC9058884 DOI: 10.1089/pop.2021.0366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Psychiatric and medical comorbidities are common among adults in the United States. Due to the complex interplay between medical and psychiatric illness, comorbidities result in substantial disparities in morbidity, mortality, and health care costs. There is, thus, both an ethical and fiscal imperative to develop care management programs to address the needs of individuals with comorbid conditions. Although there is substantial evidence supporting the use of care management for improving health outcomes for patients with chronic diseases, the majority of interventions described in the literature are condition-specific. Given the prevalence of comorbidities, the authors of this article reviewed the literature and drew on their clinical expertise to guide the development of future multimorbidity care management programs. Their review yielded one study of multimorbidity care management and two studies of multimorbidity collaborative care. The authors supplemented their findings by describing three key pillars of effective care management, as well as specific interventions to offer patients based on their psychiatric diagnoses and illness severity. The authors proposed short-, medium-, and long-term indicators to measure and track the impact of care management programs on disparities in care. Future studies are needed to identify which elements of existing multimorbidity collaborative care models are active ingredients, as well as which of the suggested supplemental interventions offer the greatest value.
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Affiliation(s)
- Lisa C Rosenfeld
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Philip Wang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Howland M, Chang D, Ratzliff A, Palm-Cruz K. C-L Case Conference: Chronic Psychosis Managed in Collaborative Care. J Acad Consult Liaison Psychiatry 2021; 63:189-197. [PMID: 34902599 DOI: 10.1016/j.jaclp.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Molly Howland
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA.
| | - Denise Chang
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
| | - Anna Ratzliff
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
| | - Katherine Palm-Cruz
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
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Bowen DJ, Heald A, LePoire E, Jones A, Gadbois D, Russo J, Carruthers J. Population-based implementation of behavioral health detection and treatment into primary care: early data from New York state. BMC Health Serv Res 2021; 21:922. [PMID: 34488741 PMCID: PMC8420002 DOI: 10.1186/s12913-021-06892-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background The Collaborative Care Model is a well-established, evidence-based approach to treating depression and other common behavioral health conditions in primary care settings. Despite a robust evidence base, real world implementation of Collaborative Care has been limited and very slow. The goal of this analysis is to better describe and understand the progression of implementation in the largest state-led Collaborative Care program in the nation—the New York State Collaborative Care Medicaid Program. Data are presented using the RE-AIM model, examining the proportion of clinics in each of the model’s five steps from 2014 to 2019. Methods We used the RE-AIM model to shape our data presentation, focusing on the proportion of clinics moving into each of the five steps of this model over the years of implementation. Data sources included: a New York State Office of Mental Health clinic tracking database, billing applications, quarterly reports, and Medicaid claims. Results A total of 84% of clinics with which OMH had an initial contact [n = 611clinics (377 FQHCs and 234 non-FQHCs)] received some form of training and technical assistance. Of those, 51% went on to complete a billing application, 41% reported quarterly data at least once, and 20% were able to successfully bill Medicaid. Of clinics that reported data prior to the first quarter of 2019, 79% (n = 130) maintained Collaborative Care for 1 year or more. The receipt of any training and technical assistance was significantly associated with our implementation indices: (completed billing application, data reporting, billing Medicaid, and maintaining Collaborative Care). The average percent of patient improvement for depression and anxiety across 155 clinics that had at least one quarter of data was 44.81%. Training and technical assistance source (Office of Mental Health, another source, or both) and intensity (high/low) were significantly related to implementation indices and were observed in FQHC versus non-FQHC samples. Conclusions Offering Collaborative Care training and technical assistance, particularly high intensity training and technical assistance, increases the likelihood of implementation. Other state-wide organizations might consider the provision of training and technical assistance when assisting clinics to implement Collaborative Care.
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Affiliation(s)
- Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, 1959 NE Pacific Street A204, Seattle, WA, 98195, USA.
| | - Ashley Heald
- AIMS Center, University of Washington, Seattle, WA, USA
| | - Erin LePoire
- AIMS Center, University of Washington, Seattle, WA, USA
| | - Amy Jones
- New York State, Office of Mental Health, Albany, NY, USA
| | | | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center University of Washington, Seattle, WA, USA
| | - Jay Carruthers
- Bureau of Psychiatric Services, NYS Office of Mental Health, New York, USA
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Howland M, Tennant M, Bowen DJ, Bauer AM, Fortney JC, Pyne JM, Shore J, Cerimele JM. Psychiatrist and Psychologist Experiences with Telehealth and Remote Collaborative Care in Primary Care: A Qualitative Study. J Rural Health 2021; 37:780-787. [PMID: 33022079 PMCID: PMC8518862 DOI: 10.1111/jrh.12523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Availability of mental health services is limited in the rural United States. Two promising models to reach patients with limited access to care are telehealth referral and collaborative care. The objective of this study was to assess telepsychiatrist- and telepsychologist-level facilitators and barriers to satisfaction with and implementation of these 2 telehealth models in rural settings. METHODS Focus groups were held in 2019 using a semistructured interview guide. Participants were off-site telepsychiatrists (N = 10) and telepsychologists (N = 4) for primary care clinics across 3 states (Washington, Michigan, and Arkansas) involved in a recent pragmatic comparative effectiveness trial. Qualitative analysis occurred inductively by 2 independent coders. FINDINGS Participants were satisfied with the models partly owing to good patient rapport and expanding access to care. Teamwork was highlighted as a facilitator in collaborative care and was often related to work with care managers. However, participants described communication with primary care providers as a challenge, especially in the telehealth referral arm. Barriers centered on variability of logistical processes (eg, symptom monitoring, scheduling, electronic medical record processes, and credentialing) among sites. Staff turnover, variable clinic investment, and inadequacy of training were possible explanations for these barriers. CONCLUSIONS Participants described high motivation to provide team-based, remote care for patients, though they experienced operational challenges. Centralized credentialing, scheduling, and record keeping are possible solutions. These findings are important because consulting psychiatrists and psychologists may play a leadership role in the dissemination of these models.
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Affiliation(s)
- Molly Howland
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashington
| | - McKenna Tennant
- Department of Public Health GeneticsUniversity of Washington School of Public HealthSeattleWashington
| | - Deborah J. Bowen
- Department of Bioethics and HumanitiesUniversity of WashingtonSeattleWashington
| | - Amy M. Bauer
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashington
| | - John C. Fortney
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashington
- Department of Veterans Affairs, HSR&D Center of Innovation for Veteran‐Centered and Value‐Driven CareVA Puget Sound Health Care SystemSeattleWashington
- Department of Health ServicesUniversity of Washington School of Public HealthSeattleWashington
| | - Jeffrey M. Pyne
- Department of Psychiatry and Behavioral Sciences, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansas
| | - Jay Shore
- Helen and Arthur E. Johnson Depression Center, Anschutz Medical Campus, Departments of Psychiatry and Family MedicineUniversity of Colorado School of MedicineAuroraColorado
- Centers for American Indian and Alaska Native Health, Colorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraColorado
| | - Joseph M. Cerimele
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashington
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Raney L, Williams M, Gibson P, Salter T. Consultative Approaches to Leveraging the Psychiatric Workforce for Larger Populations in Need of Psychiatric Expertise. Psychiatr Serv 2020; 71:1084-1087. [PMID: 32517641 DOI: 10.1176/appi.ps.202000052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Efforts are underway to leverage the expertise of the limited psychiatric workforce by utilizing psychiatrists as consultants to primary care providers (PCPs). These approaches have demonstrated the potential to increase access to care by having PCPs manage patients with common, less complex behavioral health conditions earlier and more effectively, thereby reducing demand for specialty psychiatric evaluation. Multiple approaches to indirect psychiatric consultation have been developed with varying levels of evidence and success. These ongoing efforts will require modifications in workforce training to prepare psychiatrists and PCPs for this new role and in reimbursement approaches that cover the cost of the psychiatric consultants' work.
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Affiliation(s)
- Lori Raney
- Principal Health Management Associates, Denver (Raney); Mayo Clinic, Rochester, Minnesota (Williams, Salter); Alleviant Health Systems, Little Rock, Arkansas (Gibson). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Mark Williams
- Principal Health Management Associates, Denver (Raney); Mayo Clinic, Rochester, Minnesota (Williams, Salter); Alleviant Health Systems, Little Rock, Arkansas (Gibson). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Patty Gibson
- Principal Health Management Associates, Denver (Raney); Mayo Clinic, Rochester, Minnesota (Williams, Salter); Alleviant Health Systems, Little Rock, Arkansas (Gibson). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Tom Salter
- Principal Health Management Associates, Denver (Raney); Mayo Clinic, Rochester, Minnesota (Williams, Salter); Alleviant Health Systems, Little Rock, Arkansas (Gibson). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
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Suh J, Williams S, Fann JR, Fogarty J, Bauer AM, Hsieh G. Parallel Journeys of Patients with Cancer and Depression: Challenges and Opportunities for Technology-Enabled Collaborative Care. ACTA ACUST UNITED AC 2020; 4. [PMID: 32656502 DOI: 10.1145/3392843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Depression is common but under-treated in patients with cancer, despite being a major modifiable contributor to morbidity and early mortality. Integrating psychosocial care into cancer services through the team-based Collaborative Care Management (CoCM) model has been proven to be effective in improving patient outcomes in cancer centers. However, there is currently a gap in understanding the challenges that patients and their care team encounter in managing co-morbid cancer and depression in integrated psycho-oncology care settings. Our formative study examines the challenges and needs of CoCM in cancer settings with perspectives from patients, care managers, oncologists, psychiatrists, and administrators, with a focus on technology opportunities to support CoCM. We find that: (1) patients with co-morbid cancer and depression struggle to navigate between their cancer and psychosocial care journeys, and (2) conceptualizing co-morbidities as separate and independent care journeys is insufficient for characterizing this complex care context. We then propose the parallel journeys framework as a conceptual design framework for characterizing challenges that patients and their care team encounter when cancer and psychosocial care journeys interact. We use the challenges discovered through the lens of this framework to highlight and prioritize technology design opportunities for supporting whole-person care for patients with co-morbid cancer and depression.
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Affiliation(s)
- Jina Suh
- University of Washington, USA and Microsoft Research, USA
| | | | - Jesse R Fann
- University of Washington, USA and Seattle Cancer Care Alliance, USA
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Bhat A, Bennett IM, Bauer AM, Beidas RS, Eriksen W, Barg FK, Gold R, Unützer J. Longitudinal Remote Coaching for Implementation of Perinatal Collaborative Care: A Mixed-Methods Analysis. Psychiatr Serv 2020; 71:518-521. [PMID: 31996114 PMCID: PMC7196015 DOI: 10.1176/appi.ps.201900341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The collaborative care model (CoCM) is a multicomponent, team-based integrated behavioral health framework. Its effectiveness in the treatment of perinatal depression is established, but implementation has been limited. The authors used longitudinal remote coaching (LRC) as a novel implementation strategy to support systematic case review in a multistate cluster-randomized trial of CoCM for perinatal depression. They describe LRC for perinatal CoCM in three clinics and use of a mixed-methods analysis of data from LRC feedback forms and interviews with participants. LRC is a scalable implementation strategy with potential to support complex models of integrated behavioral health, such as perinatal CoCM.
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Affiliation(s)
- Amritha Bhat
- Department of Psychiatry and Behavioral Sciences (Bhat, Bennett, Bauer, Unützer) and Department of Family Medicine (Bennett), University of Washington, Seattle; Department of Psychiatry (Beidas), Department of Medical Ethics and Health Policy (Beidas), and Department of Family Medicine and Community Health (Eriksen, Barg), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Gold). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Ian M Bennett
- Department of Psychiatry and Behavioral Sciences (Bhat, Bennett, Bauer, Unützer) and Department of Family Medicine (Bennett), University of Washington, Seattle; Department of Psychiatry (Beidas), Department of Medical Ethics and Health Policy (Beidas), and Department of Family Medicine and Community Health (Eriksen, Barg), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Gold). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Amy M Bauer
- Department of Psychiatry and Behavioral Sciences (Bhat, Bennett, Bauer, Unützer) and Department of Family Medicine (Bennett), University of Washington, Seattle; Department of Psychiatry (Beidas), Department of Medical Ethics and Health Policy (Beidas), and Department of Family Medicine and Community Health (Eriksen, Barg), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Gold). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Rinad S Beidas
- Department of Psychiatry and Behavioral Sciences (Bhat, Bennett, Bauer, Unützer) and Department of Family Medicine (Bennett), University of Washington, Seattle; Department of Psychiatry (Beidas), Department of Medical Ethics and Health Policy (Beidas), and Department of Family Medicine and Community Health (Eriksen, Barg), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Gold). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Whitney Eriksen
- Department of Psychiatry and Behavioral Sciences (Bhat, Bennett, Bauer, Unützer) and Department of Family Medicine (Bennett), University of Washington, Seattle; Department of Psychiatry (Beidas), Department of Medical Ethics and Health Policy (Beidas), and Department of Family Medicine and Community Health (Eriksen, Barg), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Gold). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Frances K Barg
- Department of Psychiatry and Behavioral Sciences (Bhat, Bennett, Bauer, Unützer) and Department of Family Medicine (Bennett), University of Washington, Seattle; Department of Psychiatry (Beidas), Department of Medical Ethics and Health Policy (Beidas), and Department of Family Medicine and Community Health (Eriksen, Barg), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Gold). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Rachel Gold
- Department of Psychiatry and Behavioral Sciences (Bhat, Bennett, Bauer, Unützer) and Department of Family Medicine (Bennett), University of Washington, Seattle; Department of Psychiatry (Beidas), Department of Medical Ethics and Health Policy (Beidas), and Department of Family Medicine and Community Health (Eriksen, Barg), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Gold). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences (Bhat, Bennett, Bauer, Unützer) and Department of Family Medicine (Bennett), University of Washington, Seattle; Department of Psychiatry (Beidas), Department of Medical Ethics and Health Policy (Beidas), and Department of Family Medicine and Community Health (Eriksen, Barg), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Gold). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
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Hu J, Wu T, Damodaran S, Tabb KM, Bauer A, Huang H. The Effectiveness of Collaborative Care on Depression Outcomes for Racial/Ethnic Minority Populations in Primary Care: A Systematic Review. PSYCHOSOMATICS 2020; 61:632-644. [PMID: 32381258 DOI: 10.1016/j.psym.2020.03.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Racial/ethnic minorities experience a greater burden of mental health problems than white adults in the United States. The collaborative care model is increasingly being adopted to improve access to services and to promote diagnosis and treatment of psychiatric diseases. OBJECTIVE This systematic review seeks to summarize what is known about collaborative care on depression outcomes for racial/ethnic minorities in the United States. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. Collaborative care studies were included if they comprised adults from at least one racial/ethnic minority group, were located in primary care clinics in the United States, and had depression outcome measures. Core principles described by the University of Washington Advancing Integrated Mental Health Solutions Center were used to define the components of collaborative care. RESULTS Of 398 titles screened, 169 full-length articles were assessed for eligibility, and 19 studies were included in our review (10 randomized controlled trials, 9 observational). Results show there is potential that collaborative care, with or without cultural/linguistic tailoring, is effective in improving depression for racial/ethnic minorities, including those from low socioeconomic backgrounds. CONCLUSIONS Collaborative care should be explored as an intervention for treating depression for racial/ethnic minority patients in primary care. Questions remain as to what elements of cultural adaptation are most helpful, factors behind the difficulty in recruiting minority patients for these studies, and how the inclusion of virtual components changes access to and delivery of care. Future research should also recruit individuals from less studied populations.
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Affiliation(s)
- Jennifer Hu
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA.
| | - Tina Wu
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA.
| | - Swathi Damodaran
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
| | - Karen M Tabb
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Amy Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Hsiang Huang
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
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Abstract
PURPOSE OF REVIEW This review discusses the role of the patient-centered medical home (PCMH) in treating depression, focusing on findings from primary care-based studies and their implications for the PCMH. RECENT FINDINGS Pharmacotherapy, psychotherapy, and collaborative care are evidence-based treatments for depression that can be delivered in primary care and extended to diverse populations. Recent research aligns with the core components of the PCMH model. The core components of the PCMH are critical elements of depression treatment. Comprehensive care within the PCMH addresses medical and behavioral health concerns, including depression. Psychiatric and psychological care must be flexibly delivered so services remain accessible yet patient-centered. To ensure the quality and safety of treatment, depression symptoms must be consistently monitored. Coordination within and occasionally outside of the PCMH is needed to ensure patients receive the appropriate level of care. More research is needed to empirically evaluate depression treatment within the PCMH.
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