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Huo S, Bruckner TA, Xiong GL, Cooper E, Wade A, Neikrug AB, Gagliardi JP, McCarron R. Antidepressant Prescription Behavior Among Primary Care Clinician Providers After an Interprofessional Primary Care Psychiatric Training Program. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:926-935. [PMID: 37598371 PMCID: PMC10543424 DOI: 10.1007/s10488-023-01290-x] [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] [Accepted: 07/30/2023] [Indexed: 08/22/2023]
Abstract
Primary care providers (PCPs) are increasingly called upon to screen for and treat depression. However, PCPs often lack the training to diagnose and treat depression. We designed an innovative 12-month evidence and mentorship-based primary care psychiatric training program entitled the University of California, Irvine (UCI) School of Medicine Train New Trainers Primary Care Psychiatry (TNT PCP) Fellowship and examined whether this training impacted clinician prescription rates for antidepressants. We retrieved information on 18,844 patients and 192 PCPs from a publicly insured health program in Southern California receiving care between 2017 and 2021. Of the 192 PCPs, 42 received TNT training and 150 did not. We considered a patient as exposed to the provider's TNT treatment if they received care from a provider after the provider completed the 1-year fellowship. We utilized the number of antidepressant prescriptions per patient, per quarter-year as the dependent variable. Linear regression models controlled for provider characteristics and time trends. Robustness checks included clustering patients by provider identification. After PCPs completed TNT training, "exposed" patients received 0.154 more antidepressant prescriptions per quarter-year relative to expected levels (p < 0.01). Clustering of standard errors by provider characteristics reduced precision of the estimate (p < 0.10) but the direction and magnitude of the results were unchanged. Early results from the UCI TNT PCP Fellowship demonstrate enhanced antidepressant prescription behavior in PCPs who have undergone TNT training. A novel, and relatively low-cost, clinician training program holds the potential to empower PCPs to optimally deliver depression treatment.
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Affiliation(s)
- Shutong Huo
- University of California Irvine, Program in Public Health, Irvine, CA USA
| | - Tim A. Bruckner
- University of California Irvine, Program in Public Health, Irvine, CA USA
- Public Health & Planning, Policy and Design, University of California, Irvine, CA USA
| | - Glen L. Xiong
- University of California, Davis, Psychiatry and Behavioral Sciences, Sacramento, CA USA
| | - Emma Cooper
- University of California Irvine Department of Psychiatry and Human Behavior, Orange, CA USA
| | - Amy Wade
- Inland Empire Health Plan, Rancho Cucamonga, CA USA
| | - Ariel B. Neikrug
- University of California Irvine School of Medicine, Irvine, CA USA
| | - Jane P. Gagliardi
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC USA
| | - Robert McCarron
- University of California Irvine School of Medicine, Irvine, CA USA
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Braam MWG, Rasing SPA, Heijs DAM, Lokkerbol J, van Bergen DD, Creemers DHM, Spijker J. Closing the gap between screening and depression prevention: a qualitative study on barriers and facilitators from the perspective of public health professionals in a school-based prevention approach. BMC Public Health 2023; 23:884. [PMID: 37173740 PMCID: PMC10176867 DOI: 10.1186/s12889-023-15705-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The prevalence of depression has increased among adolescents in western countries. Prevention is needed to reduce the number of adolescents who experience depression and to avoid negative consequences, including suicide. Several preventive interventions are found to be promising, especially multi-modal approaches, for example combining screening and preventive intervention. However, an important bottleneck arises during the implementation of preventive intervention. Only a small percentage of adolescents who are eligible for participation actually participate in the intervention. To ensure that more adolescents can benefit from prevention, we need to close the gap between detection and preventive intervention. We investigated the barriers and facilitators from the perspective of public health professionals in screening for depressive and suicidal symptoms and depression prevention referral in a school-based setting. METHODS We conducted 13 semi-structured interviews with public health professionals, who execute screening and depression prevention referral within the Strong Teens and Resilient Minds (STORM) approach. The interviews were recorded, transcribed verbatim, and coded in several cycles using ATLAS.ti Web. RESULTS Three main themes of barriers and facilitators emerged from the interviews, namely "professional capabilities," "organization and collaboration," and "beliefs about depressive and suicidal symptoms and participation in prevention". The interviews revealed that professionals do not always feel sufficiently equipped in terms of knowledge, skills and supporting networks. Consequently, they do not always feel well able to execute the process of screening and prevention referral. In addition, a lack of knowledge and support in schools and other cooperating organizationorganizations was seen to hinder the process. Last, the beliefs of public health professionals, school staff, adolescents, and parents -especially stigma and taboo-were found to make the screening and prevention referral process more challenging. CONCLUSIONS To further improve the process of screening and prevention referral in a school-based setting, enhancing professional competence and a holding work environment for professionals, a strong collaboration and a joint approach with schools and other cooperating organizations and society wide education about depressive and suicidal symptoms and preventive intervention are suggested. Future research should determine whether these recommendations actually lead to closing the gap between detection and prevention.
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Affiliation(s)
- Marloes W G Braam
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands.
- GGZ Oost Brabant, Oss, the Netherlands.
| | - Sanne P A Rasing
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
- GGZ Oost Brabant, Oss, the Netherlands
| | | | | | | | - Daan H M Creemers
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
- GGZ Oost Brabant, Oss, the Netherlands
| | - Jan Spijker
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
- Pro Persona, Nijmegen, the Netherlands
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Hoskote AR, Croce E, Johnson KE. The Evolution of the Role of U.S. School Nurses in Adolescent Mental Health at the Individual, Community, and Systems Level: An Integrative Review. J Sch Nurs 2023; 39:51-71. [PMID: 35019803 DOI: 10.1177/10598405211068120] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
School nurses are crucial to addressing adolescent mental health, yet evidence concerning their evolving role has not been synthesized to understand interventions across levels of practice (i.e., individual, community, systems). We conducted an integrative review of school nurse roles in mental health in the U.S. related to depressive symptoms, anxiety, and stress. Only 18 articles were identified, published from 1970 to 2019, and primarily described school nurses practicing interventions at the individual level, yet it was unclear whether they were always evidence-based. Although mental health concerns have increased over the years, the dearth of rigorous studies made it difficult to determine the impact of school nurse interventions on student mental health outcomes and school nurses continue to feel unprepared and under supported in this area. More research is needed to establish best practices and systems to support school nursing practice in addressing mental health at all levels of practice.
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Affiliation(s)
- Ashwini R Hoskote
- Robert Wood Johnson Foundation Future of Nursing Scholar, 12330University of Texas at Austin School of Nursing
| | - Emily Croce
- 12330The University of Texas at Austin School of Nursing; Dell Children's Medical Group, Austin, TX
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Davis M, Hoskins K, Phan M, Hoffacker C, Reilly M, Fugo PB, Young JF, Beidas RS. Screening Adolescents for Sensitive Health Topics in Primary Care: A Scoping Review. J Adolesc Health 2022; 70:706-713. [PMID: 34955356 PMCID: PMC9038619 DOI: 10.1016/j.jadohealth.2021.10.028] [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: 06/30/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/15/2022]
Abstract
We sought to aggregate common barriers and facilitators to screening adolescents for sensitive health topics (e.g., depression, chlamydia) in primary care, as well as those that are unique to a given health topic. We conducted a literature search of three databases (PsycInfo, MEDLINE, and CINAHL) and reference lists of included articles. Studies focused on barriers and facilitators to screening adolescents (ages 12-17 years) for sensitive health topics in primary care that are recommended by national guidelines. Articles were peer-reviewed, presented empirical data, and were published in English in 2006-2021. We coded barriers and facilitators using the Consolidated Framework for Implementation Research, a well-established framework within implementation science. In total, 39 studies met inclusion criteria and spanned several health topics: depression, suicide, substance use, HIV, and chlamydia. We found common barriers and facilitators to screening across health topics, with most relating to characteristics of the primary care clinics (e.g., time constraints). Other factors relevant to screening implementation ranged from confidentiality concerns to clinician knowledge. Barriers and facilitators specific to certain health topics, such as the availability of on-site laboratories for HIV screening, were also noted. Findings can guide refinements to screening implementation.
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Affiliation(s)
- Molly Davis
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Katelin Hoskins
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary Phan
- Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, Utah
| | - Carlin Hoffacker
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Megan Reilly
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Perrin B Fugo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jami F Young
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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Boyda D, McFeeters D, Dhingra K, Kelleher I. A Population-Based Analysis of Interpersonal Trauma, Psychosis, and Suicide: Evidence, Pathways, and Implications. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:912-934. [PMID: 32326857 DOI: 10.1177/0886260520912591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Subthreshold psychotic experiences (PEs) are known to confer a risk for suicidality. Yet, despite evidence of a strong etiological trauma-psychosis pathway, the coalesced effect of such concurrences on suicide risk is largely discounted. Our aims were to examine the impact of different manifestations of life span trauma and PEs on the risk of suicidal thoughts and attempts, using an exploratory person-centered approach. Data from the Adult Psychiatric Morbidity Survey (N = 7,403) were analyzed. PEs were assessed using the Psychosis Screening Questionnaire (PSQ) alongside items probing childhood and adult trauma, in addition to 12-month suicide thoughts and attempt. A manual three-step latent class analysis elicited four distinct profiles, namely, a socially disconnected/high PE, a sexual victimization/moderate PE, a life span trauma/low PE, and a baseline class. The socially disconnected class, characterized by a moderate likelihood of social disconnection, a high probability of various PE endorsements, yet a low likelihood of other significant trauma, showed the greatest risk of 12-month suicide ideation (odds ratio [OR] = 13.0, 95% confidence interval [CI] = [8.539, 19.021) and attempt (OR = 24.2, 95% CI = [10.349, 56.860). Neither multiple nor recurrent traumatic experiences invariably result in the emergence of PEs. Instead, a sense of social disconnection may be either resultant of PEs or alone sufficient to cultivate such symptom presentations, even in the absence of prior traumas. Moreover, just as traumatic encounters increase the risk of suicidality, so too might seemingly more innocuous adversities, such as poor-quality social relationships, further elevate the risk, particularly when proximal and coupled with the simultaneity of PEs.
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Affiliation(s)
| | | | | | - Ian Kelleher
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Johnson KE, Hoskote AR, Rolin DG, Kesler SR. Correlates of mental health problems among students in Texas alternative high schools and school-level efforts to address mental health. Res Nurs Health 2021; 45:183-193. [PMID: 34822199 DOI: 10.1002/nur.22197] [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] [Received: 06/28/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/28/2022]
Abstract
Students in alternative high schools (AHSs) are an understudied population who experience disproportionate levels of risk factors that contribute to mental health problems. Using logistic regression, we explored associations between mental health problems and risk and protective factors among students in Texas AHSs (n = 515; mean age 17.1 years; 51% female, 78% youth of color, 64% eligible for free/reduced lunch). Principals (n = 14) and lead health educators (n = 14) reported on school-level efforts to address mental health. Students reported, on average, 1.55 of 4 mental health problems in the past year. Logistic regression indicated that greater number of adverse childhood experiences, lower self-esteem, female gender, and sleep disruption (getting <8 h of sleep per night) were common contributors to symptoms of depression, anxiety, suicidal ideation, and PTSD with models showing medium-to-large effects (AUC: 0.73-0.81). We assessed school-level efforts to address mental health using descriptive statistics. At the school level, most (>50%) principals reported having policies and services to support student mental health, with the exception of having mental health/social services staff represented on school health councils (36%) and having Gay-Straight Alliances (21%). Most lead health educators (86%) reported educating AHS students about mental health, and many (57%) reported receiving professional development in mental health. Future research with a larger number of schools is needed to analyze whether school policies are statistically associated with student-level mental health outcomes. Such multi-level research can inform policies and practices for AHS student mental health.
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Affiliation(s)
- Karen E Johnson
- University of Texas at Austin School of Nursing, Austin, Texas, USA
| | | | - Donna G Rolin
- University of Texas at Austin School of Nursing, Austin, Texas, USA
| | - Shelli R Kesler
- University of Texas at Austin School of Nursing, Austin, Texas, USA
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Li Y, Jones CB. Care received by patients from nurse practitioners and physicians in U.S. primary care settings. Nurs Outlook 2021; 69:826-835. [PMID: 33814158 DOI: 10.1016/j.outlook.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 01/24/2021] [Accepted: 02/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Nurse practitioners (NPs) and physicians serve in both usual source of care (USC) and supplement roles to each other in the provision of primary care to patients. Yet little is known about the care that patients receive from providers in these roles. This study examined the care individuals received when NPs and physicians served in USC and supplemental roles. DATA SOURCES Pooled data from the Household Component of the Medical Expenditure Panel Survey 2002-2013. STUDY DESIGN Cross-sectional, secondary data analysis using propensity score matching and multinomial logistic regression. DATA COLLECTION Data were collected from a national subsample of households. PRINCIPAL FINDINGS Regardless of provider role, patients reported receiving more therapeutic or preventive care from NPs but more diagnostic care and biomedical treatments from physicians. Patients reported having similar diagnoses when seen by NPs and physicians serving in USC roles, but different diagnoses when NPs and physicians served in supplemental roles. CONCLUSIONS NPs and physicians providing different care when serving in the same role. Findings can inform policy-makers as they develop policies for serving patients and utilizing the relevant expertise of NPs and physicians.
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Affiliation(s)
- Yin Li
- Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.
| | - Cheryl B Jones
- Professor, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Terrizzi DA, Khan HA, Paulson A, Abuwalla Z, Solis N, Bolotin M, Burke B, Toner E, de Forest SA, Lee M, Goodwin B, Fogel J, Gladstone TRG, Van Voorhees BW. Understanding Adolescent Expressions of Sadness: A Qualitative Exploration. Res Theory Nurs Pract 2020; 34:321-339. [PMID: 33199406 DOI: 10.1891/rtnp-d-19-00103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Primary care providers are positioned to identify adolescents at risk for depression and prevent major depressive disorder. To identify subthreshold depression, we examined the language adolescents use to describe their symptoms. METHODS Adolescents ages 13-18 with elevated levels on the Center for Epidemiologic Studies Depression (CES-D) scale and/or a history of depression who were part of a large randomized clinical trial to prevent depressive disorder were included. We used content analysis to analyze transcripts of semi-structured interviews. RESULTS Saturation was reached at 37 interviews. Adolescents self-identified as African American (N = 15), Hispanic (N = 10), and White (N = 21). Three domains were revealed; external sources of stress, adolescent expressions of sadness, and seeking help and care. Within these domains, 12 distinct themes emerged contextualizing these domains. No variations in the expression of the themes identified for subthreshold depression were found between the three ethno-cultural groups. IMPLICATIONS FOR PRACTICE Our study identifies, in adolescents' own words, how adolescents with subthreshold depression express feelings and cope with symptoms, and may guide primary care providers to recognize subthreshold depression early. These findings are a step toward filling the gap in the empirical literature needed to improve identification of adolescents at risk for depression in nonspecialist settings.
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Affiliation(s)
- Daniela A Terrizzi
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Huma A Khan
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Allison Paulson
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Zach Abuwalla
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Nitza Solis
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Megan Bolotin
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Brendan Burke
- Department of Pediatrics, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Emma Toner
- Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah A de Forest
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Miae Lee
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Brady Goodwin
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Joshua Fogel
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois.,Department of Business Management, Brooklyn College, Brooklyn, New York
| | - Tracy R G Gladstone
- The Robert S. and Grace W. Stone Primary Prevention Initiatives, Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts
| | - Benjamin W Van Voorhees
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
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Chowdhury T, Champion JD. Outcomes of Depression Screening for Adolescents Accessing Pediatric Primary Care-Based Services. J Pediatr Nurs 2020; 52:25-29. [PMID: 32135479 DOI: 10.1016/j.pedn.2020.02.036] [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: 08/27/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Assess outcomes of depression screening among adolescents accessing pediatric primary care-based services. These findings will contribute to development of clinical protocols for depression screening and intervention in primary care settings. DESIGN AND METHODS Retrospective chart review conducted via electronic medical records at a pediatric primary care-based clinic to extract PHQ-9 data for adolescents screened from 1/17/2018 to 4/18/2018. De-identified data included age, gender, ethnicity, provider, PHQ-9, and referral/follow-up/medication status. RESULTS Data included 1213 adolescents of whom N = 600 were depressed without additional comorbidities; 96 adolescents had PHQ-9 scores >5. Descriptive analyses by age, gender, ethnicity, referral type, follow-up, and provider services identified targeted primary care-based interventions for depression and referral. Depression screening occurred primarily at well child visits. 82.5% of those with PHQ-9 scores >5 were not currently receiving treatment. Overall, referrals by physicians (45.8%) and nurse practitioners (42.9%) were equivalent with more referrals for adolescents with moderate-severe depression. Nurse practitioners provided more counseling than physicians among adolescents with mild to moderate depression. CONCLUSIONS Adolescent mental health necessitates an enhanced continuum of care. Primary care-based interventions provided by pediatric nurse practitioners are imperative to address adolescent mental health needs. Findings provide practical means to incorporate protocols for depression enhancing primary care-based mental health access. PRACTICE IMPLICATIONS Need for incorporation of practical modalities for depression assessment and follow up as recommended by American Academy of Pediatrics. Future study for comparison of methods (phone/text reminder, follow up appointment, online resource reminder, telehealth), indicated to enhance follow-up care for adolescents experiencing depression.
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Affiliation(s)
- Taskina Chowdhury
- School of Nursing, University of Texas at Austin, United States of America.
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Fallucco EM, Joseph MM, Leung K, Smotherman C, Robertson Blackmore E. Post-Parkland Shooting: Development and Assessment of Experiential Training in Adolescent Depression and Post-Traumatic Stress Disorder for Primary Care Providers. Acad Pediatr 2020; 20:430-432. [PMID: 31704042 DOI: 10.1016/j.acap.2019.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/23/2019] [Accepted: 10/26/2019] [Indexed: 01/25/2023]
Abstract
Primary care pediatric providers (PCPs) could facilitate early intervention for youth impacted by trauma, yet lack appropriate training. Experiential training for PCPs following a school shooting helped improve PCP confidence and practices in caring for youth with depression and post-traumatic stress disorder.
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Affiliation(s)
- Elise M Fallucco
- Department of Psychiatry, University of Florida College of Medicine-Jacksonville (EM Fallucco and K Leung), Jacksonville, Fla.
| | - Madeline M Joseph
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville (MM Joseph), Jacksonville, Fla
| | - Kitty Leung
- Department of Psychiatry, University of Florida College of Medicine-Jacksonville (EM Fallucco and K Leung), Jacksonville, Fla
| | - Carmen Smotherman
- Center for Health Equity and Quality Research, University of Florida College of Medicine-Jacksonville (C Smotherman), Jacksonville, Fla
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Fallucco EM, James L, Smotherman C, Greco P. Impact of Experiential Training With Standardized Patients on Screening and Diagnosis of Adolescent Depression in Primary Care. J Adolesc Health 2019; 65:57-62. [PMID: 30879884 DOI: 10.1016/j.jadohealth.2018.12.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/21/2018] [Accepted: 12/26/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE Primary care providers (PCPs) report inadequate training in depression care. The objective of this study was to examine the long-term impact of PCP training with standardized patients on screening and diagnosis of adolescent depression in primary care. METHODS A retrospective review of electronic medical and billing records for adolescent (aged 12-18 years) well-visits assessed the frequency of screening and new diagnoses of depression. Twenty-five PCPs participated in training. The study included all adolescent well-visits in the 12 months before and after PCP training. Adolescents with a previous diagnosis of depression were excluded from the sample. Univariate and multivariable analyses were used to assess associations with screening. Odds ratios were used to describe the magnitude of associations. RESULTS The analysis included 7,108 well-visits for adolescents (mean age 14.5 years, standard deviation 1.7 years; gender: 52% male; race: 65% white, 13% black, 22% other races; ethnicity: 25% Hispanic; insurance: 67% commercial). Depression screening rate increased significantly after training from 51% to 80% of adolescents seen at well-visits (adjusted odds ratio 40.8, 95% confidence interval 32.6-51.0, p < .0001). Although the likelihood of being screened for depression increased post-training, there was variation based on patient's insurance. A significantly greater percentage of adolescents were newly diagnosed with depression after training (2.22% vs. .89%, p < .0001). CONCLUSIONS PCPs who participated in experiential training using standardized patients were more likely to screen for and diagnose adolescent depression in the 12 months after training. Future studies are needed to examine the effects of PCP training on patient outcomes.
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Affiliation(s)
- Elise M Fallucco
- Department of Psychiatry, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida.
| | - Lauren James
- Department of Psychiatry, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Carmen Smotherman
- Center for Health Equity and Quality Research, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Peggy Greco
- Division of Psychology, Department of Pediatrics, Nemours Children's Healthcare System, Jacksonville, Florida
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Abstract
PURPOSE OF REVIEW To review the clinical practice guideline landscape for depression screening in pediatric primary care and to identify current gaps in knowledge. RECENT FINDINGS Various organizations have recommendations that support screening for depression in pediatric primary care, although some differ based on the age of the child. To date, guidelines have been made based on indirect evidence of efficacy. For example, indirect evidence shows that several screening tools exist for use in primary care, and various primary care-administered or referred treatments for childhood depression have some evidence of efficacy (particularly among adolescents). In addition to determining the applicability of this evidence to younger children, more research is needed on the direct net benefits of screening and to identify factors that facilitate its effective implementation. Indirect evidence supports the benefits of screening for depression in pediatric primary care; most organizations that publish screening guidelines recommend its use.
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Bhatta S, Champion JD, Young C, Loika E. Outcomes of Depression Screening Among Adolescents Accessing School-based Pediatric Primary Care Clinic Services. J Pediatr Nurs 2018; 38:8-14. [PMID: 29167086 DOI: 10.1016/j.pedn.2017.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 09/28/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Implementation of routine Patient Health Questionnaires (PHQ-9) screening among adolescents aged 12-18year, accessing school-based pediatric primary care clinic services for identification of adolescents at potential risk for Major Depressive disorder (MDD). DESIGN AND METHODS Retrospective chart review (N=256 cases) documented PHQ-9 depression screening outcomes among adolescents accessing school-based pediatric primary care clinic services for episodic illness and wellness visits. Data analyses included descriptive statistical methods. RESULTS Chart review included 137 (53.5%) females and 119 (46.5%) males. PHQ-9 depression screening was identified for 56.3% (n=144) of charts with scores ≥10 for 12.5% (n=18) among those screened. Mental health referrals were made for 83.3% (n=15) with PHQ-9 scores ≥10. Dysthymia related concerns were reported among 20.1% (n=29) of which 55.2% (n=16) received mental health referrals. Female adolescents reported more sleep problems (χ2=9.174, p=0.002) and tiredness (χ2=6.165, p=0.013) than males. The 15-18year age group (χ2=5.443, p=0.020) was more likely to experience sleep problem and low self-esteem than 12-14year age group (χ2=5.143, p=0.023). CONCLUSION Implementation of PHQ-9 depression screening protocol identified MDD among adolescent accessing pediatric school-based primary care clinic services facilitating referrals to mental health providers, potentially improving morbidity and mortality among adolescents. PRACTICE IMPLICATIONS MDD is common among adolescents and associated with functional impairments and increased morbidity and mortality. Due to its high prevalence, it is imperative to improve screening and treatment access in this population via school-based clinics.
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Affiliation(s)
- Sarmila Bhatta
- Family Nurse Practitioner, School of Nursing, The University of Texas at Austin, USA.
| | - Jane Dimmitt Champion
- Lee and Joseph D. Jamail Endowed Professorship in Nursing, School of Nursing, The University of Texas at Austin, Austin, USA.
| | - Cara Young
- School of Nursing, The University of Texas at Austin, Austin, USA.
| | - Elizabeth Loika
- Clinical Associate Professor, School of Nursing, The University of Texas at Austin, Austin, USA.
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15
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O'Brien D, Harvey K, Howse J, Reardon T, Creswell C. Barriers to managing child and adolescent mental health problems: a systematic review of primary care practitioners' perceptions. Br J Gen Pract 2016; 66:e693-707. [PMID: 27621291 PMCID: PMC5033306 DOI: 10.3399/bjgp16x687061] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/07/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Mental health problems are common and typically have an early onset. Effective treatments for mental health problems in childhood and adolescence are available, yet only a minority of children who are affected access them. This is of serious concern, considering the far-reaching and long-term negative consequences of such problems. Primary care is usually the first port of call for concerned parents so it is important to understand how primary care practitioners manage child and adolescent mental health problems and the barriers they face. AIM To ascertain primary care practitioners' perceptions of the barriers that prevent effective management of child and adolescent mental health problems. DESIGN AND SETTING A systematic review of qualitative and quantitative literature in a primary care setting. METHOD A database search of peer-reviewed articles using PsycINFO, MEDLINE(®), Embase, and Web of Science, from inception (earliest 1806) until October 2014, was conducted. Additional studies were identified through hand searches and forward-citation searches. Studies needed to have at least one search term in four categories: primary care, childhood/adolescence, mental health, and barriers. RESULTS A total of 4151 articles were identified, of which 43 were included (30 quantitative studies and 13 qualitative studies). The majority of the barriers related to identification, management, and/or referral. Considerable barriers included a lack of providers and resources, extensive waiting lists, and financial restrictions. CONCLUSION The identification of a broad range of significant barriers highlights the need to strengthen the ability to deal with these common difficulties in primary care. There is a particular need for tools and training to aid accurate identification and management, and for more efficient access to specialist services.
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Affiliation(s)
- Doireann O'Brien
- School of Psychology and Clinical Language Sciences, University of Reading, Reading
| | - Kate Harvey
- School of Psychology and Clinical Language Sciences, University of Reading, Reading
| | - Jessica Howse
- School of Psychology and Clinical Language Sciences, University of Reading, Reading
| | - Tessa Reardon
- School of Psychology and Clinical Language Sciences, University of Reading, Reading
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading
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16
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Olfson M. The Rise of Primary Care Physicians in the Provision of US Mental Health Care. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2016; 41:559-583. [PMID: 27127264 DOI: 10.1215/03616878-3620821] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Primary care physicians have assumed an increasingly important role in US outpatient mental health care. They are providing an increasing volume of outpatient mental health services, prescribing a growing number and variety of psychotropic medications, and treating patients with a broader array of mental health conditions. These trends, which run counter to a general trend toward specialization and subspecialization within US health care, place new strains on the clinical competencies of primary care physicians. They also underscore the importance of implementing more effective models of collaboration between primary care physicians and mental health specialists. Several elements of the Affordable Care Act provide options for financing and organizing the delivery of integrated general medical and behavioral services. Such integrated services have the potential to improve access and quality of outpatient mental health care for a range of psychiatric disorders. Because people with severe and persisting mental disorders commonly require a higher-level medical expertise than is readily available within primary care as well as a complex array of social services, separate specialized mental health will likely continue to play a vitally important role in caring for this population.
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17
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Abstract
Depression is the most common mental health disorder in children and adolescents, and primary care is often the first point of contact for children and adolescents with depression. Depression impacts all areas of life, impairing academics and interactions with family and friends. The purpose of this article is to help NPs identify and treat children and adolescents presenting with depression in the primary care setting.
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Affiliation(s)
- Judy Haefner
- Judy Haefner is an assistant professor at the University of Michigan, Flint, Mich
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18
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Collaborative Care: a Pilot Study of a Child Psychiatry Outpatient Consultation Model for Primary Care Providers. J Behav Health Serv Res 2016; 44:386-398. [DOI: 10.1007/s11414-016-9513-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Van Cleave J, Le TT, Perrin JM. Point-of-Care Child Psychiatry Expertise: The Massachusetts Child Psychiatry Access Project. Pediatrics 2015; 135:834-41. [PMID: 25896844 PMCID: PMC4411776 DOI: 10.1542/peds.2014-0720] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Since 2005, after a pilot program, the Massachusetts Child Psychiatry Access Project (MCPAP) has provided point-of-care psychiatry expertise and referral assistance by telephone to primary care providers. We examined its adoption and use and the practice characteristics associated with different adoption timelines and use patterns. METHODS We merged data on calls to MCPAP in 2005 to 2011 with practice data (enrollment year, panel size, regional team assignment). We categorized practices' days from enrollment to first call (adoption) (0-100, 101-365, > 365 days) and quartile of call frequency (use) (annual highest, middle, and lowest quartiles of number of calls per 1000 empanelled patients). We determined associations between adoption and use and practice characteristics using multivariate models. RESULTS Among 285 practices, adoption and use varied: 55% called 0 to 100 days from enrollment and 16% called >365 days from enrollment. Practices in the highest quartile of use made a mean 15.5 calls/year per 1000 patients, whereas the lowest quartile made 0.4 calls/year per 1000 patients. Adoption within 100 days was associated with enrollment during or after 2007 (odds ratio [OR] 4.09, 95% confidence interval [CI] 2.23-7.49) and assignment to the team at the pilot site (OR 4.42, 95% CI 2.16-9.04 for central Massachusetts). Highest-quartile use was associated with team assignment (OR 3.58, 95% CI 1.86-6.87 for central Massachusetts) and panel size (OR 0.10, 95% CI 0.03-0.31 for ≥ 10,000 vs < 2000 patients). CONCLUSIONS Adoption and use of MCPAP varied widely. Timing of enrollment, assignment to the team from the program's pilot site, and panel size were associated with patterns of adoption and use. Findings may help other programs design effective implementation strategies.
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Affiliation(s)
- Jeanne Van Cleave
- Division of General Academic Pediatrics/Center for Child and Adolescent Health Research & Policy, Massachusetts General Hospital for Children, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
| | - Thuy-Tien Le
- Department of Internal Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - James M. Perrin
- Division of General Academic Pediatrics/Center for Child and Adolescent Health Research & Policy, Massachusetts General Hospital for Children, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
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20
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Fallucco EM, Seago RD, Cuffe SP, Kraemer DF, Wysocki T. Primary care provider training in screening, assessment, and treatment of adolescent depression. Acad Pediatr 2015; 15:326-32. [PMID: 25824896 DOI: 10.1016/j.acap.2014.12.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 12/04/2014] [Accepted: 12/09/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Adolescent depression is underrecognized and undertreated. Primary care providers (PCP) require training to successfully identify adolescents with depression. We examined the effects of a PCP training program in the screening, assessment, and treatment of adolescent depression (SAT-D) on adolescents' reports of PCP screening for adolescent depression at annual well visits and PCP SAT-D confidence and knowledge. METHODS PCP (n = 31) attended one SAT-D training program consisting of a 60-minute SAT-D seminar and a 60-minute standardized patient session where PCP practiced SAT-D skills. A pre-post design evaluated effects of training on PCP depression screening practices as reported by 3 groups of adolescent patients at well visits (n = 582 before, n = 525 at 2 to 8 months after training, n = 208 at 18 to 24 months after training). A generalized linear mixed effects logistic regression controlled for provider and patient demographics that may have influenced depression screening. PCP SAT-D self-reported confidence and objectively tested knowledge were assessed at baseline, immediately after training, and at 4 to 6 months after training. RESULTS On the basis of the regression analysis, PCP screening for adolescent depression increased significantly from pretraining (49%) to 2 to 8 months after training (68%, odds ratio 2.78, 95% confidence interval 2.10-3.68) and 18 to 24 months after training (74%, odds ratio 3.17, 95% confidence interval 2.16-4.67; both P < .0001). PCP SAT-D confidence and knowledge also significantly improved. CONCLUSIONS PCP SAT-D training resulted in significant increases in primary care screening for adolescent depression that were maintained up to 24 months after training. Future studies should determine if changes in PCP screening improve identification of adolescent depression and patient outcomes for adolescents with depression.
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Affiliation(s)
- Elise M Fallucco
- Nemours Center for Health Care Delivery Science, University of Florida, Jacksonville, Fla; Division of Psychiatry and Psychology, Nemours Children's Clinic, University of Florida, Jacksonville, Fla.
| | - Robbin D Seago
- Nemours Center for Health Care Delivery Science, University of Florida, Jacksonville, Fla
| | - Steven P Cuffe
- Department of Psychiatry, University of Florida, Jacksonville, Fla
| | - Dale F Kraemer
- Center for Health Equity and Quality Research and Department of Neurology, University of Florida, University of Florida, Jacksonville, Fla
| | - Tim Wysocki
- Nemours Center for Health Care Delivery Science, University of Florida, Jacksonville, Fla
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