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Joo JH, Davey-Rothwell M, Choi N, Gallo J, Mace RA, Xie A. Increasing the Repertoire for Depression Care: Methods and Challenges of a Randomized Controlled Trial of Peer Support for Vulnerable Older Adults. Am J Geriatr Psychiatry 2023; 31:586-595. [PMID: 36842891 PMCID: PMC10329981 DOI: 10.1016/j.jagp.2023.01.023] [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: 12/02/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Low-income White and older adults of color face barriers to depression care. Our purpose is to describe the methods and challenges encountered during the implementation of a randomized controlled trial to test the effectiveness of a peer support depression care intervention for low-income White and older adults of color during the COVID-19 pandemic. METHODS Peer Enhanced Depression Care (Peers) is an 8-week community-based intervention that uses peer mentors who are trained and supervised to provide social support and self-care skills to depressed older adults. The effectiveness of the intervention in reducing depression will be evaluated by following a sample of older adults recruited in the community over a 12-month period. Target enrollment is 160 older adults. We hypothesize that participants randomized to the Peer Enhanced Depression Care intervention will experience greater decrease in depressive symptoms compared to participants randomized to the social interaction control. We provide lessons learned regarding the recruitment of BIPOC and White low-income older adults and peer mentors during the COVID-19 pandemic. RESULTS Recruitment challenges occurred in primary care clinics that were unable to accommodate recruitment efforts during the pandemic. This led to focused outreach to community-based organizations serving older adults. Challenges to participant recruitment have included barriers related to stigma, distrust, as well as unfamiliarity with research. Peer mentor recruitment was facilitated by existing government-supported resources. CONCLUSIONS This study will provide knowledge regarding the effectiveness, mechanism, and processes of delivering an informal psychosocial intervention such as peer support to a vulnerable older adult population.
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Affiliation(s)
- Jin Hui Joo
- Department of Psychiatry (JHJ, AX), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Health, Society and Behavior, Bloomberg School of Public Health (MDR), Johns Hopkins University, Baltimore, MD; The University of Texas at Austin (NC), Steve Hicks School of Social Work, Austin, TX; Department of Mental Health, School of Public Health (JG), Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (RAM), Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Melissa Davey-Rothwell
- Department of Psychiatry (JHJ, AX), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Health, Society and Behavior, Bloomberg School of Public Health (MDR), Johns Hopkins University, Baltimore, MD; The University of Texas at Austin (NC), Steve Hicks School of Social Work, Austin, TX; Department of Mental Health, School of Public Health (JG), Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (RAM), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Namkee Choi
- Department of Psychiatry (JHJ, AX), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Health, Society and Behavior, Bloomberg School of Public Health (MDR), Johns Hopkins University, Baltimore, MD; The University of Texas at Austin (NC), Steve Hicks School of Social Work, Austin, TX; Department of Mental Health, School of Public Health (JG), Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (RAM), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Joseph Gallo
- Department of Psychiatry (JHJ, AX), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Health, Society and Behavior, Bloomberg School of Public Health (MDR), Johns Hopkins University, Baltimore, MD; The University of Texas at Austin (NC), Steve Hicks School of Social Work, Austin, TX; Department of Mental Health, School of Public Health (JG), Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (RAM), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ryan A Mace
- Department of Psychiatry (JHJ, AX), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Health, Society and Behavior, Bloomberg School of Public Health (MDR), Johns Hopkins University, Baltimore, MD; The University of Texas at Austin (NC), Steve Hicks School of Social Work, Austin, TX; Department of Mental Health, School of Public Health (JG), Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (RAM), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Alice Xie
- Department of Psychiatry (JHJ, AX), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Health, Society and Behavior, Bloomberg School of Public Health (MDR), Johns Hopkins University, Baltimore, MD; The University of Texas at Austin (NC), Steve Hicks School of Social Work, Austin, TX; Department of Mental Health, School of Public Health (JG), Johns Hopkins University, Baltimore, MD; Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (RAM), Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Portela D, Amaral R, Rodrigues PP, Freitas A, Costa E, Fonseca JA, Sousa-Pinto B. Unsupervised algorithms to identify potential under-coding of secondary diagnoses in hospitalisations databases in Portugal. HEALTH INF MANAG J 2023:18333583221144663. [PMID: 36802958 DOI: 10.1177/18333583221144663] [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: 02/20/2023]
Abstract
BACKGROUND Quantifying and dealing with lack of consistency in administrative databases (namely, under-coding) requires tracking patients longitudinally without compromising anonymity, which is often a challenging task. OBJECTIVE This study aimed to (i) assess and compare different hierarchical clustering methods on the identification of individual patients in an administrative database that does not easily allow tracking of episodes from the same patient; (ii) quantify the frequency of potential under-coding; and (iii) identify factors associated with such phenomena. METHOD We analysed the Portuguese National Hospital Morbidity Dataset, an administrative database registering all hospitalisations occurring in Mainland Portugal between 2011-2015. We applied different approaches of hierarchical clustering methods (either isolated or combined with partitional clustering methods), to identify potential individual patients based on demographic variables and comorbidities. Diagnoses codes were grouped into the Charlson an Elixhauser comorbidity defined groups. The algorithm displaying the best performance was used to quantify potential under-coding. A generalised mixed model (GML) of binomial regression was applied to assess factors associated with such potential under-coding. RESULTS We observed that the hierarchical cluster analysis (HCA) + k-means clustering method with comorbidities grouped according to the Charlson defined groups was the algorithm displaying the best performance (with a Rand Index of 0.99997). We identified potential under-coding in all Charlson comorbidity groups, ranging from 3.5% (overall diabetes) to 27.7% (asthma). Overall, being male, having medical admission, dying during hospitalisation or being admitted at more specific and complex hospitals were associated with increased odds of potential under-coding. DISCUSSION We assessed several approaches to identify individual patients in an administrative database and, subsequently, by applying HCA + k-means algorithm, we tracked coding inconsistency and potentially improved data quality. We reported consistent potential under-coding in all defined groups of comorbidities and potential factors associated with such lack of completeness. CONCLUSION Our proposed methodological framework could both enhance data quality and act as a reference for other studies relying on databases with similar problems.
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Affiliation(s)
- Diana Portela
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, 26706University of Porto, Portugal
- ACES Entre o Douro e Vouga I - Feira/Arouca, Portugal
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, 26706University of Porto, Portugal
| | - Rita Amaral
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, 26706University of Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, 26706University of Porto, Portugal
- ESS, IPP - Porto Health School, Polytechnic Institute of Porto, Portugal
| | - Pedro P Rodrigues
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, 26706University of Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, 26706University of Porto, Portugal
| | - Alberto Freitas
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, 26706University of Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, 26706University of Porto, Portugal
| | - Elísio Costa
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, 26706University of Porto, Portugal
- Research Unit on Applied Molecular Biosciences (UCIBIO-REQUIMTE), Faculty of Pharmacy, 26706University of Porto, Portugal
| | - João A Fonseca
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, 26706University of Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, 26706University of Porto, Portugal
| | - Bernardo Sousa-Pinto
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, 26706University of Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, 26706University of Porto, Portugal
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Svenningsson I, Hange D, Udo C, Törnbom K, Björkelund C, Petersson EL. The care manager meeting the patients' unique needs using the care manager model-A qualitative study of experienced care managers. BMC FAMILY PRACTICE 2021; 22:175. [PMID: 34474682 PMCID: PMC8414763 DOI: 10.1186/s12875-021-01523-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/18/2021] [Indexed: 11/10/2022]
Abstract
Background Implementation of a care manager in a collaborative care team in Swedish primary care via a randomized controlled trial showed successful outcome. As four years have elapsed since the implementation of care managers, it is important to gain knowledge about the care managers’ long-term skills and experiences. The purpose was to examine how long-term experienced care managers perceived and experienced their role and how they related to and applied the care manager model. Method Qualitative study with a focus group and interviews with nine nurses who had worked for more than two years as care managers for common mental disorders. The analysis used Systematic Text Condensation. Results Four codes arose from the analysis: Person-centred; Acting outside the comfort zone; Successful, albeit some difficulties; Pride and satisfaction. The care manager model served as a handrail for the care manager, providing a trustful and safe environment. Difficulties sometimes arose in the collaboration with other professionals. Conclusion This study shows that long-term experience of working as a care manager contributed to an in-depth insight and understanding of the care manager model and enabled care managers to be flexible and act outside the comfort zone when providing care and support to the patient. A new concept emerged during the analytical process, i.e. the Anchored Care Manager, which described the special competencies gained through experience. Trial registration NCT02378272 Care Manager—Coordinating Care for Person Centered Management of Depression in Primary Care (PRIM—CARE).
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Affiliation(s)
- Irene Svenningsson
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden.
| | - Dominique Hange
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Camilla Udo
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Center for Clinical Research, Dalarna, Sweden
| | - Karin Törnbom
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Björkelund
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Eva-Lisa Petersson
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
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Rivera JMB, Puyat JH, Wiedmeyer ML, Lavergne MR. Primary Care and Access to Mental Health Consultations among Immigrants and Nonimmigrants with Mood or Anxiety Disorders: Soins de première ligne et accès aux consultations en santé mentale chez les immigrants et les non-immigrants souffrant de troubles de l'humeur ou anxieux. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:540-550. [PMID: 32878459 PMCID: PMC8138741 DOI: 10.1177/0706743720952234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the association between usual place of primary care and mental health consultation among those with self-reported mood or anxiety disorders. We also describe access to mental health services among people who are recent immigrants, longer-term immigrants, and nonimmigrants and determine whether the association with place of primary care differs by immigration group. METHODS We used data from the Canadian Community Health Survey (2015 to 2016) to identify a representative sample of individuals with self-reported mood or anxiety disorders. We used logistic regression, with models stratified by immigration group (recent, longer-term, nonimmigrant), to examine the association between usual place of primary care and receiving a mental health consultation in the previous 12 months. RESULTS Higher percentages of recent and longer-term immigrants see a doctor in solo practice, and a higher percentage of recent immigrants use walk-in clinics as a usual place of care. Compared with people whose usual place of care was a community health center or interdisciplinary team, adjusted odds of a mental health consultation were significantly lower for people whose usual place of care was a solo practice doctor's office (AOR = 0.71; 95% CI, 0.62 to 0.82), a walk-in clinic (AOR = 0.75; 95% CI, 0.66 to 0.85), outpatient clinic/other place (AOR = 0.72 95% CI, 0.59 to 0.88), and lowest among people reporting no usual place other than the emergency room (AOR = 0.59; 95% CI, 0.51 to 0.67). Differences in access to mental health consultations by usual place of primary care were greatest among immigrants, especially recent immigrants. CONCLUSIONS People with mood or anxiety disorders who have access to team-based primary care are more likely to report mental health consultations, and this is especially true for immigrants. Expanded access to team-based primary health care may help reduce barriers to mental health services, especially among immigrants.
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Affiliation(s)
- Joanna Marie B Rivera
- Faculty of Health Sciences, 1763Simon Fraser University, Burnaby, British Columbia, Canada
| | - Joseph H Puyat
- Faculty of Medicine, Centre for Health Evaluation & Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mei-Ling Wiedmeyer
- Faculty of Health Sciences, 1763Simon Fraser University, Burnaby, British Columbia, Canada.,Faculty of Medicine, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Gender & Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada
| | - M Ruth Lavergne
- Faculty of Health Sciences, 1763Simon Fraser University, Burnaby, British Columbia, Canada.,Centre for Gender & Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada
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Udo C, Svenningsson I, Björkelund C, Hange D, Jerlock M, Petersson E. An interview study of the care manager function-Opening the door to continuity of care for patients with depression in primary care. Nurs Open 2019; 6:974-982. [PMID: 31367421 PMCID: PMC6650652 DOI: 10.1002/nop2.277] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 02/13/2019] [Accepted: 03/12/2019] [Indexed: 12/11/2022] Open
Abstract
AIM To explore experiences among patients with depression of contact with a care manager at a primary care centre. DESIGN A qualitative explorative study. METHODS During spring and summer 2016, 20 individual face-to-face interviews were conducted with patients with experience of care manager contact. The material was analysed using systematic text condensation. RESULTS The participants described that having contact with a care manager was a support in their recovery process. Care became more available, and the structured continuous contact and the care manager's availability contributed to a trusting relationship. Having someone to share their burden with was a relief. However, it was described as negative when the care manager was perceived as inflexible and not open to issues that the participants felt a need to discuss. For the care manager contact to be successful, there is a need for flexibility and individually tailored contact.
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Affiliation(s)
- Camilla Udo
- School of Education, Health and Social StudiesDalarna UniversityFalunSweden
- Center for Clinical Research DalarnaDalarnaSweden
| | - Irene Svenningsson
- Department of Primary Health Care, Institute of MedicineThe Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Närhälsan Research and Development, Primary Health Care RegionVästra GötalandSweden
| | - Cecilia Björkelund
- Department of Primary Health Care, Institute of MedicineThe Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Dominique Hange
- Department of Primary Health Care, Institute of MedicineThe Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Margareta Jerlock
- Department of Primary Health Care, Institute of MedicineThe Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Eva‐Lisa Petersson
- Department of Primary Health Care, Institute of MedicineThe Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Närhälsan Research and Development, Primary Health Care RegionVästra GötalandSweden
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Svenningsson I, Udo C, Westman J, Nejati S, Hange D, Björkelund C, Petersson EL. Creating a safety net for patients with depression in primary care; a qualitative study of care managers' experiences. Scand J Prim Health Care 2018; 36:355-362. [PMID: 30314415 PMCID: PMC6381518 DOI: 10.1080/02813432.2018.1529018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore nurses' experiences and perceptions of working as care managers at primary care centers. DESIGN Qualitative, focus group study. Systematic text condensation was used to analyze the data. SETTING Primary health care in the region of Västra Götaland and region of Dalarna in Sweden. SUBJECTS Eight nurses were trained during three days including treatment of depression and how to work as care managers. The training was followed by continuous support. MAIN OUTCOME MEASURES The nurses' experiences and perceptions of working as care managers at primary care centers. RESULTS The care managers described their role as providing additional support to the already existing care at the primary care center, working in teams with a person-centered focus, where they were given the opportunity to follow, support, and constitute a safety net for patients with depression. Further, they perceived that the care manager increased continuity and accessibility to primary care for patients with depression. CONCLUSION The nurses perceived that working as care managers enabled them to follow and support patients with depression and to maintain close contact during the illness. The care manager function helped to provide continuity in care which is a main task of primary health care. Key Points The care managers described their role as an additional support to the already existing care at the primary care center. • They emphasized that as care managers, they had a person-centered focus and constituted a safety net for patients with depression. • Their role as care managers enabled them to follow and support patients with depression over time, which made their work more meaningful. • Care managers helped to achieve continuity and accessibility to primary health care for patients with depression.
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Affiliation(s)
- Irene Svenningsson
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
- Primary Health Care, Närhälsan Research and Development, Region Västra Götaland, Sweden;
- CONTACT Irene Svenningsson Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenPrimary Health Care, Närhälsan Research and Development, Region Västra Götaland, Sweden
| | - Camilla Udo
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden;
- Centre for Clinical Research, Dalarna, Sweden;
| | - Jeanette Westman
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Shabnam Nejati
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
| | - Dominique Hange
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
| | - Cecilia Björkelund
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
| | - Eva-Lisa Petersson
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
- Primary Health Care, Närhälsan Research and Development, Region Västra Götaland, Sweden;
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Olugbile O, Zachariah MP, Coker O, Kuyinu O, Isichei B. Provision of mental health services in Nigeria. Int Psychiatry 2018. [DOI: 10.1192/s1749367600005555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Nigeria, like other African countries, is short of personnel trained in mental healthcare. Efforts to tackle the problem have often focused on increasing the numbers of psychiatrists and nurses in the field. These efforts, over the past 20 years, have not appeared to have greatly improved service delivery at the grass roots. Most of the specialist centres where such highly trained personnel work are in urban areas and for a large part of the population access to them is limited by distance and cost.
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Puyat JH, Kazanjian A, Goldner EM, Wong H. How Often Do Individuals with Major Depression Receive Minimally Adequate Treatment? A Population-Based, Data Linkage Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:394-404. [PMCID: PMC4910409 DOI: 10.1177/0706743716640288] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Objective: Depression is usually treated with antidepressants, psychotherapy, or both. In this study, we examined the extent to which individuals with depression receive minimally adequate treatment with regard to the use of antidepressants and psychotherapy. Method: Using population-based administrative data, we identified individuals with inpatient or outpatient diagnoses of depression and tracked their use of publicly funded mental health services within a 12-month period. We used mixed-effects logistic regression to assess the influence of patient-level characteristics and physician-level variations on the receipt of minimally adequate treatment. Results: A total of 108 101 individuals, predominantly women (65%) and urban residents (89%), were diagnosed with depression in 2010–2011. Of these, 13% received minimally adequate counseling/psychotherapy with higher proportions observed among men, younger individuals, and urban residents. In contrast, there were more who received minimally adequate antidepressant therapy (48%), with women, older individuals, and rural residents having the highest proportions. Overall, about 53% received either type of treatment, and the pattern of use was similar to that of antidepressant therapy. Mixed-effects logistic regression results indicate that these factors remain independent predictors of the receipt of minimally adequate depression care. Significant practice variations also exist, which determine patients’ receipt of minimally adequate care, particularly with respect to counseling or psychotherapy. Conclusions: Only about half of those with depression receive either minimally adequate counseling/psychotherapy or minimally adequate antidepressant therapy. Disparities also persist, affecting mostly men and younger individuals. A multifactorial approach is needed to improve access to and reduce variations in receipt of minimally adequate depression care.
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Affiliation(s)
- Joseph H. Puyat
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arminee Kazanjian
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elliot M. Goldner
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Hubert Wong
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Peng M, Southern DA, Williamson T, Quan H. Under-coding of secondary conditions in coded hospital health data: Impact of co-existing conditions, death status and number of codes in a record. Health Informatics J 2016; 23:260-267. [DOI: 10.1177/1460458216647089] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study examined the coding validity of hypertension, diabetes, obesity and depression related to the presence of their co-existing conditions, death status and the number of diagnosis codes in hospital discharge abstract database. We randomly selected 4007 discharge abstract database records from four teaching hospitals in Alberta, Canada and reviewed their charts to extract 31 conditions listed in Charlson and Elixhauser comorbidity indices. Conditions associated with the four study conditions were identified through multivariable logistic regression. Coding validity (i.e. sensitivity, positive predictive value) of the four conditions was related to the presence of their associated conditions. Sensitivity increased with increasing number of diagnosis code. Impact of death on coding validity is minimal. Coding validity of conditions is closely related to its clinical importance and complexity of patients’ case mix. We recommend mandatory coding of certain secondary diagnosis to meet the need of health research based on administrative health data.
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Goldner EM. Random but Controlled Thoughts on Mental Health Epidemiology and Services Research. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:407-11. [PMID: 26454729 PMCID: PMC4574717 DOI: 10.1177/070674371506000906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 03/01/2015] [Indexed: 01/16/2023]
Affiliation(s)
- Elliot M Goldner
- Professor, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia; Director, Centre for Applied Research in Mental Health & Addiction (CARMHA), Vancouver, British Columbia
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11
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Petersen JJ, König J, Paulitsch MA, Mergenthal K, Rauck S, Pagitz M, Schmidt K, Haase L, Gerlach FM, Gensichen J. Long-term effects of a collaborative care intervention on process of care in family practices in Germany: a 24-month follow-up study of a cluster randomized controlled trial. Gen Hosp Psychiatry 2014; 36:570-4. [PMID: 25135191 DOI: 10.1016/j.genhosppsych.2014.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aims of this study were (1) to assess the long-term effects of a collaborative care intervention for patients with depression on process of care outcomes, and (2) to describe whether case management was continued after the end of the original one-year intervention. METHODS This 24-month follow-up of a randomized controlled trial took place 12 months after the end of the 1-year intervention. Data collection occurred by means of self-rating questionnaires and from medical records. We calculated linear mixed and logistic generalized estimating equation models. RESULTS Of the 626 patients included at baseline, 439 (70.1%) participated in this follow-up. Intervention recipients gave higher ratings than control recipients in terms of mean overall Patient Assessment of Chronic Illness Care (PACIC) scores (3.12 vs. 2.86; P = .019), but no difference was found in medication adherence (mean Morisky score 2.59 vs. 2.65, P = .56), prescribed antidepressant medications (60.2% vs. 55.1%; P = .25), visits to the family physician (15.96 vs. 14.46, P = .58) or mental health specialist (3.01 vs. 2.94, P = .94) over the 12 month follow-up period. Case management was continued for 47 (22.5%) selected intervention patients after the original intervention had ended. CONCLUSION At 24 months, intervention and control recipients had different PACIC ratings, but other process of care outcomes did not differ. PRACTICE IMPLICATIONS The main effects of the intervention are apparent at 12 months.
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Affiliation(s)
- Juliana J Petersen
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany.
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Mainz, Obere Zahlbacher Str. 69, 55131 Mainz, Germany
| | - Michael A Paulitsch
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Sandra Rauck
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Manuel Pagitz
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Konrad Schmidt
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University, Bachstraße 18, 07743 Jena, Germany
| | - Lydia Haase
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University, Bachstraße 18, 07743 Jena, Germany
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Jochen Gensichen
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany; Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University, Bachstraße 18, 07743 Jena, Germany
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Keeley RD, West DR, Tutt B, Nutting PA. A qualitative comparison of primary care clinicians' and their patients' perspectives on achieving depression care: implications for improving outcomes. BMC FAMILY PRACTICE 2014; 15:13. [PMID: 24428952 PMCID: PMC3907132 DOI: 10.1186/1471-2296-15-13] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 01/05/2014] [Indexed: 01/05/2023]
Abstract
Background Improving the patient experience of primary care is a stated focus of efforts to transform primary care practices into “Patient-centered Medical Homes” (PCMH) in the United States, yet understanding and promoting what defines a positive experience from the patient’s perspective has been de-emphasized relative to the development of technological and communication infrastructure at the PCMH. The objective of this qualitative study was to compare primary care clinicians’ and their patients’ perceptions of the patients’ experiences, expectations and preferences as they try to achieve care for depression. Methods We interviewed 6 primary care clinicians along with 30 of their patients with a history of depressive disorder attending 4 small to medium-sized primary care practices from rural and urban settings. Results Three processes on the way to satisfactory depression care emerged: 1. a journey, often from fractured to connected care; 2. a search for a personal understanding of their depression; 3. creation of unique therapeutic spaces for treating current depression and preventing future episodes. Relative to patients’ observations regarding stigma’s effects on accepting a depression diagnosis and seeking treatment, clinicians tended to underestimate the presence and effects of stigma. Patients preferred clinicians who were empathetic listeners, while clinicians worried that discussing depression could open “Pandora’s box” of lengthy discussions and set them irrecoverably behind in their clinic schedules. Clinicians and patients agreed that somatic manifestations of mental distress impeded the patients’ ability to understand their suffering as depression. Clinicians reported supporting several treatment modalities beyond guideline-based approaches for depression, yet also displayed surface-level understanding of the often multifaceted support webs their patient described. Conclusions Improving processes and outcomes in primary care may demand heightened ability to understand and measure the patients’ experiences, expectations and preferences as they receive primary care. Future research would investigate a potential mismatch between clinicians’ and patients’ perceptions of the effects of stigma on achieving care for depression, and on whether time spent discussing depression during the clinical visit improves outcomes. Improving care and outcomes for chronic disorders such as depression may require primary care clinicians to understand and support their patients’ unique ‘therapeutic spaces.’
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Affiliation(s)
- Robert D Keeley
- Department of Family Medicine, University of Colorado, Denver, Mail Stop F-496, Academic Office 1, 12631 E, 17th Ave, Aurora, CO 80045, USA.
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Johansen MA, Berntsen GKR, Schuster T, Henriksen E, Horsch A. Electronic symptom reporting between patient and provider for improved health care service quality: a systematic review of randomized controlled trials. part 2: methodological quality and effects. J Med Internet Res 2012; 14:e126. [PMID: 23032363 PMCID: PMC3510713 DOI: 10.2196/jmir.2216] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 07/11/2012] [Accepted: 07/12/2012] [Indexed: 02/03/2023] Open
Abstract
Background We conducted in two parts a systematic review of randomized controlled trials (RCTs) on electronic symptom reporting between patients and providers to improve health care service quality. Part 1 reviewed the typology of patient groups, health service innovations, and research targets. Four innovation categories were identified: consultation support, monitoring with clinician support, self-management with clinician support, and therapy. Objective To assess the methodological quality of the RCTs, and summarize effects and benefits from the methodologically best studies. Methods We searched Medline, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and IEEE Xplore for original studies presented in English-language articles between 1990 and November 2011. Risk of bias and feasibility were judged according to the Cochrane recommendation, and theoretical evidence and preclinical testing were evaluated according to the Framework for Design and Evaluation of Complex Interventions to Improve Health. Three authors assessed the risk of bias and two authors extracted the effect data independently. Disagreement regarding bias assessment, extraction, and interpretation of results were resolved by consensus discussions. Results Of 642 records identified, we included 32 articles representing 29 studies. No articles fulfilled all quality requirements. All interventions were feasible to implement in a real-life setting, and theoretical evidence was provided for almost all studies. However, preclinical testing was reported in only a third of the articles. We judged three-quarters of the articles to have low risk for random sequence allocation and approximately half of the articles to have low risk for the following biases: allocation concealment, incomplete outcome data, and selective reporting. Slightly more than one fifth of the articles were judged as low risk for blinding of outcome assessment. Only 1 article had low risk of bias for blinding of participants and personnel. We excluded 12 articles showing high risk or unclear risk for both selective reporting and blinding of outcome assessment from the effect assessment. The authors’ hypothesis was confirmed for 13 (65%) of the 20 remaining articles. Articles on self-management support were of higher quality, allowing us to assess effects in a larger proportion of studies. All except one self-management interventions were equally effective to or better than the control option. The self-management articles document substantial benefits for patients, and partly also for health professionals and the health care system. Conclusion Electronic symptom reporting between patients and providers is an exciting area of development for health services. However, the research generally is of low quality. The field would benefit from increased focus on methods for conducting and reporting RCTs. It appears particularly important to improve blinding of outcome assessment and to precisely define primary outcomes to avoid selective reporting. Supporting self-management seems to be especially promising, but consultation support also shows encouraging results.
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Affiliation(s)
- Monika Alise Johansen
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
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14
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Bilsker D, Goldner EM, Anderson E. Supported self-management: a simple, effective way to improve depression care. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:203-9. [PMID: 22480584 DOI: 10.1177/070674371205700402] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To introduce supported self-management (SSM) for depression, examine it through the use of a quality assessment framework, and show its potential for enhancing the Canadian health care system. METHOD SSM is examined in terms of quality criteria: relevance, effectiveness, appropriateness, efficiency, safety, acceptability, and sustainability. Critical research is highlighted, and a case study is presented to illustrate the use of SSM with depressed patients. RESULTS SSM is defined by access to a self-management guide (workbook or website) plus encouragement and coaching by health care provider, family member, or other supporter. It has high relevance to depression care in Canada, high cost-effectiveness, high appropriateness for most people with depression, and high safety. Acceptability of this intervention is more problematic: many providers remain doubtful of its acceptability to their poorly motivated patients. Sustainability of SSM as a component of mental health care will require ongoing knowledge exchange among policy-makers, health care providers, and researchers. CONCLUSION The introduction of SSM represents a unique opportunity to enhance the delivery of depression care in Canada. Actively engaging the distressed individual in changing depressive patterns can improve outcomes without mobilizing substantial new resources. Over time, we will learn more about making SSM compatible with constraints on provider time, increasing access to self-management tools, and evaluating the benefit to everyday clinical work.
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Affiliation(s)
- Dan Bilsker
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia.
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15
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Gensichen J, Güthlin C, Kleppel V, Jäger C, Mergenthal K, Gerlach FM, Petersen JJ. Practice-based depression case management in primary care: a qualitative study on family doctors' perspectives. Fam Pract 2011; 28:565-71. [PMID: 21459771 DOI: 10.1093/fampra/cmr014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Case management provided by health care assistants (HCAs) is effective in improving primary care for depressive patients. Little is known on the implementation-related aspects of case management performed in small family practices. OBJECTIVE To explore family doctors' perspectives on clinical and organizational aspects of implementation of case management and perceived practice-related aspects associated with patient care after 1 year's experience of HCAs providing case management for depressive patients in their practices. METHODS This qualitative study was nested in a cluster-randomized trial on case management provided by practice-based HCAs for patients with major depression in Germany. We used semi-structured interview guides and performed audio-taped interviews with family doctors. Full transcription and thematic content analysis were carried out. RESULTS Twenty-three family doctors were interviewed. The family doctors perceived case management as beneficial to patients and reported that it improved their consultation styles and doctor-patient relationships. They implemented case management elements into their everyday day work using 'concrete', 'subsumed' or 'progressive' implementation styles. CONCLUSIONS Family doctors perceived practice-based case management by HCAs as beneficial for patient care. Different implementation styles may be appropriate, depending on the health care setting, and this requires further evaluation.
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Affiliation(s)
- J Gensichen
- Institute of General Practice, Jena University Hospital, Germany.
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16
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Goldner EM, Jones W, Fang ML. Access to and waiting time for psychiatrist services in a Canadian urban area: a study in real time. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:474-80. [PMID: 21878158 DOI: 10.1177/070674371105600805] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To obtain improved quality information regarding psychiatrist waiting times by use of a novel methodological approach in which accessibility and wait times are determined by a real-time patient referral procedure. METHOD An adult male patient with depression was referred for psychiatric assessment by a family physician. Consecutive calls were made to all registered psychiatrists (n = 297) in Vancouver. A semistructured call procedure was used to collect information about the psychiatrists' availability for receipt of this and similar referrals, identify factors that affect psychiatrist accessibility, and determine the availability of cognitive-behavioural therapy (CBT). RESULTS Efforts were made to contact 297 psychiatrists and 230 (77%) were reached successfully. Among the 230 psychiatrists contacted, 160 (70%) indicated that they were unable to accept the referral. Although 70 (30%) indicated that they might be able to consider accepting a referral, 64 (91% of those who would consider accepting the referral) indicated that they would need to review detailed, written referral information and could not provide estimates of the length of wait times if the patient was to be accepted. Only 6 (3% of the 230 psychiatrists contacted) offered immediate appointment times and their wait times ranged from 4 to 55 days. When asked whether they could provide CBT, most (56%) psychiatrists in clinical practice answered maybe. CONCLUSIONS Substantial barriers exist for family physicians attempting to refer patients for psychiatric referral. Consolidated efforts to improve access to psychiatric assessment are needed.
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Affiliation(s)
- Elliot M Goldner
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia.
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Meglic M, Furlan M, Kuzmanic M, Kozel D, Baraga D, Kuhar I, Kosir B, Iljaz R, Novak Sarotar B, Dernovsek MZ, Marusic A, Eysenbach G, Brodnik A. Feasibility of an eHealth service to support collaborative depression care: results of a pilot study. J Med Internet Res 2010; 12:e63. [PMID: 21172765 PMCID: PMC3057312 DOI: 10.2196/jmir.1510] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 06/08/2010] [Accepted: 06/09/2010] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Treatments and organizational changes supported by eHealth are beginning to play an important role in improving disease treatment outcome and providing cost-efficient care management. "Improvehealth.eu" is a novel eHealth service to support the treatment of patients with depressive disorder. It offers active patient engagement and collaborative care management by combining Web- and mobile-based information and communication technology systems and access to care managers. OBJECTIVES Our objective was to assess the feasibility of a novel eHealth service. METHODS The intervention--the "Improvehealth.eu" service--was explored in the course of a pilot study comparing two groups of patients receiving treatment as usual and treatment as usual with eHealth intervention. We compared patients' medication adherence and outcome measures between both groups and additionally explored usage and overall perceptions of the intervention in intervention group. RESULTS The intervention was successfully implemented in a pilot with 46 patients, of whom 40 were female. Of the 46 patients, 25 received treatment as usual, and 21 received the intervention in addition to treatment as usual. A total of 55% (12/25) of patients in the former group and 45% (10/21) in the latter group finished the 6-month pilot. Available case analysis indicated an improvement of adherence in the intervention group (odds ratio [OR] = 10.0, P = .03). Intention-to-treat analysis indicated an improvement of outcome in the intervention group (ORs ranging from 0.35 to 18; P values ranging from .003 to .20), but confidence intervals were large due to small sample sizes. Average duration of use of the intervention was 107 days. The intervention was well received by 81% (17/21) of patients who reported feeling actively engaged, in control of their disease, and that they had access to a high level of information. In all, 33% (7/21) of the patients also described drawbacks of the intervention, mostly related to usability issues. CONCLUSIONS The results of this pilot study indicate that the intervention was well accepted and helped the patients in the course of treatment. The results also suggest the potential of the intervention to improve both medication adherence and outcome measures of treatment, including reduction of depression severity and patients becoming "healthy."
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Affiliation(s)
- Matic Meglic
- Primorska Institute of Nature Science and Technology, University of Primorska, Koper, Slovenia.
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Patten SB. Problems encountered with the use of simulation in an attempt to enhance interpretation of a secondary data source in epidemiologic mental health research. BMC Res Notes 2010; 3:231. [PMID: 20796271 PMCID: PMC2941757 DOI: 10.1186/1756-0500-3-231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 08/26/2010] [Indexed: 11/25/2022] Open
Abstract
Background The longitudinal epidemiology of major depressive episodes (MDE) is poorly characterized in most countries. Some potentially relevant data sources may be underutilized because they are not conducive to estimating the most salient epidemiologic parameters. An available data source in Canada provides estimates that are potentially valuable, but that are difficult to apply in clinical or public health practice. For example, weeks depressed in the past year is assessed in this data source whereas episode duration would be of more interest. The goal of this project was to derive, using simulation, more readily interpretable parameter values from the available data. Findings The data source was a Canadian longitudinal study called the National Population Health Survey (NPHS). A simulation model representing the course of depressive episodes was used to reshape estimates deriving from binary and ordinal logistic models (fit to the NPHS data) into equations more capable of informing clinical and public health decisions. Discrete event simulation was used for this purpose. Whereas the intention was to clarify a complex epidemiology, the models themselves needed to become excessively complex in order to provide an accurate description of the data. Conclusions Simulation methods are useful in circumstances where a representation of a real-world system has practical value. In this particular scenario, the usefulness of simulation was limited both by problems with the data source and by inherent complexity of the underlying epidemiology.
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Affiliation(s)
- Scott B Patten
- Department of Community Health Sciences, University of Calgary, 4thFloor TRW Building, 3280 Hospital Drive N,W,, Calgary, Alberta, T2N 4N1, Canada.
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Patten SB, Kennedy SH, Lam RW, O'Donovan C, Filteau MJ, Parikh SV, Ravindran AV. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. I. Classification, burden and principles of management. J Affect Disord 2009; 117 Suppl 1:S5-14. [PMID: 19674796 DOI: 10.1016/j.jad.2009.06.044] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Accepted: 06/23/2009] [Indexed: 12/22/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is one of the most burdensome illnesses in Canada. The purpose of this introductory section of the 2009 revised CANMAT guidelines is to provide definitions of the depressive disorders (with an emphasis on MDD), summarize Canadian data concerning their epidemiology and describe overarching principles of managing these conditions. This section on "Classification, Burden and Principles of Management" is one of 5 guideline articles in the 2009 CANMAT guidelines. METHODS The CANMAT guidelines are based on a question-answer format to enhance accessibility to clinicians. An evidence-based format was used with updated systematic reviews of the literature and recommendations were graded according to the Level of Evidence using pre-defined criteria. Lines of Treatment were identified based on criteria that included evidence and expert clinical support. RESULTS Epidemiologic data indicate that MDD afflicts 11% of Canadians at some time in their lives, and approximately 4% during any given year. MDD has a detrimental impact on overall health, role functioning and quality of life. Detection of MDD, accurate diagnosis and provision of evidence-based treatment are challenging tasks for both clinicians and for the health systems in which they work. LIMITATIONS Epidemiologic and clinical data cannot be seamlessly linked due to heterogeneity of syndromes within the population. CONCLUSIONS In the eight years since the last CANMAT Guidelines for Treatment of Depressive Disorders were published, progress has been made in understanding the epidemiology and treatment of these disorders. Evidence supporting specific therapeutic interventions is summarized and evaluated in subsequent sections.
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Chokka P, Legault M. Escitalopram in the treatment of major depressive disorder in primary-care settings: an open-label trial. Depress Anxiety 2009; 25:E173-81. [PMID: 19006260 DOI: 10.1002/da.20458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The present trial was designed to assess the efficacy and safety of escitalopram prescribed to patients seeking treatment of major depressive disorder (MDD) in a Canadian primary-care setting. METHODS Investigators (mainly primary-care physicians) enrolled patients with MDD from their daily practice. Patients were treated with escitalopram (flexible dose 10-20 mg/day) for up to 24 weeks. Efficacy assessments included the Montgomery-Asberg Depression Rating Scale (MADRS), the Clinical Global Impression-Improvement and -Severity scales (CGI-I, CGI-S), the Patient Global Evaluation (PGE), and the Medical Outcome Study 36-item Short Form (SF-36). RESULTS Out of the 647 patients enrolled, 461 (71%) completed 24 weeks of treatment. The most common reason for discontinuation was adverse events (10%). The mean MADRS score decreased from 30.7 at baseline to 10.9 at the end of 24 weeks (last observation carried forward, LOCF). Remission (MADRS<or=12) was achieved by 65.5% of patients (LOCF). Symptom improvements were confirmed by global ratings of improvement made by physicians (CGI-I) as well as patients PGE. There was improvement on all dimensions of the SF-36, suggesting an overall improvement in quality of life. CONCLUSIONS Escitalopram was well tolerated, safe, and efficacious. Escitalopram can be used with confidence to treat patients with MDD in Canadian primary-care settings.
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Patten SB, Schopflocher D. Longitudinal epidemiology of major depression as assessed by the Brief Patient Health Questionnaire (PHQ-9). Compr Psychiatry 2009; 50:26-33. [PMID: 19059510 DOI: 10.1016/j.comppsych.2008.05.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 05/23/2008] [Accepted: 05/29/2008] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Most diagnostic interviews depend on recall of past symptoms and may be vulnerable to recall bias. The objective of this study was to describe the epidemiology of major depression using an approach that is less reliant on recall using an assessment scale, the 9-item Brief Patient Health Questionnaire (PHQ-9). The pattern observed is relevant both to understanding major depression epidemiology and to assessing a possible role for the PHQ-9 as a screening instrument. METHOD Random digit dialing was used to select a sample of 3304 community residents. Each respondent was assessed with a baseline interview followed by a series of 6 subsequent follow-up interviews 2 weeks apart. RESULTS Prevalence was between 2.5% and 3.3% during each interview, consistent with prior reports. The incidence of new episodes was surprisingly high, and many of the episodes were brief. Similarly, high rates of recovery (according to PHQ-9 scoring) were seen early in follow-up but declined subsequently. Episodes of major depression detected by the PHQ-9 tended to be preceded and followed by elevated levels of depressive symptoms. CONCLUSIONS The long-standing episodes of major depression typical of clinical practice appear to represent a minority of episodes occurring in the community. These results suggest that, in general population screening applications, the PHQ-9 will identify many respondents having brief and perhaps self-limited episodes. Although some episodes are characterized by large increases in symptoms, many respondents appear to move above and below the diagnostic threshold as a result of small changes in their symptom levels. Efforts to develop more effective approaches to screening may benefit from severity-based decision rules and serial measurement strategies.
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Affiliation(s)
- Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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Patten SB, Bilsker D, Goldner E. The evolving understanding of major depression epidemiology: implications for practice and policy. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:689-95. [PMID: 18940037 DOI: 10.1177/070674370805301008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Epidemiologic studies have confirmed that major depression (MD) is an extremely common condition, but also one that is associated with an unexpectedly broad spectrum of morbidity. It is no longer a tenable position to regard MD as being a simple indicator of treatment need, nor is a one-size-fits-all approach to treatment likely to be an effective guide to health care delivery. The objective of this commentary is to explore the implications of these new epidemiologic findings for policy and practice in Canada. METHOD This paper is a selective review and commentary. RESULTS Whereas the acute and long-term treatment needs of a subset of individuals with MD have received much attention in the literature, the needs of other groups have not. A sizable proportion of individuals with episodes meeting the Diagnostic and Statistical Manual of Mental Disorders-fourth edition definition in community populations may not need the intensive treatment emphasized by current Canadian practice guidelines. The strategy of watchful waiting may have a role in primary care. On the policy front, guided and perhaps self-guided management strategies deserve greater emphasis than they have received. Stepped-care strategies are an appealing option, but how best to effectively implement these in the Canadian context is unclear. CONCLUSIONS The spectrum of morbidity among individuals with MD in community populations is much wider than has been previously appreciated. The health system should respond with an appropriate spectrum of services, but many questions remain about how to facilitate this.
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Affiliation(s)
- Scott B Patten
- Department of Community Health Sciences and Hotchkiss Brain Institute, University of Calgary, Alberta.
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Bilsker D, Anderson J, Samra J, Goldner E, Streiner D. Behavioural Interventions in Primary Care: An Implementation Trial. ACTA ACUST UNITED AC 2008. [DOI: 10.7870/cjcmh-2008-0027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Developing effective strategies to keep health care providers' practice current with best practice guidelines has proven to be challenging. This trial was conducted to determine the potential for using brief educational sessions to generate significant change in physician delivery of mental health and substance use interventions in primary care. A 1-hour educational session outlining interventions for depression and risky alcohol use was delivered to a sample of 85 family physicians. The interventions used a supported self-management approach and included free patient access to appropriate selfmanagement resources. The study initially evaluated physicians' implementation of these interventions over a 2-month period. Physician uptake of the depression intervention was significantly greater than uptake of the risky-drinking intervention (32% versus 10%). A follow-up at 6-months posttraining (depression intervention only) demonstrated fairly good maintenance of intervention delivery. Implications of these findings are discussed.
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Affiliation(s)
- Dan Bilsker
- Simon Fraser University, Vancouver, British Columbia
| | | | - Joti Samra
- Simon Fraser University, Vancouver, British Columbia
| | | | - David Streiner
- Department of Psychiatry, University of Toronto, Ontario
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Patten SB. Major depression prevalence is very high, but the syndrome is a poor proxy for community populations' clinical treatment needs. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:411-9. [PMID: 18674395 DOI: 10.1177/070674370805300702] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Some basic questions about the epidemiology of major depression (MD) remain open to debate and interpretation. Prevalence is a case in point. There have been claims that prevalence has been both over- and underestimated. This review is an attempt to reconcile this apparent contradiction. METHOD A literature search was carried out using MEDLINE. Articles were screened for relevance in 2 stages and bibliographies were examined to identify additional relevant publications. RESULTS The claim that prevalence has been overestimated appears to hinge on a concern that current diagnostic criteria fail to adequately differentiate between pathological and nonpathological mood disturbances. These arguments pertain to the validity of diagnostic criteria rather than to the prevalence of the syndrome that the criteria define. Conversely, the claim that prevalence has been underestimated is based on studies providing evidence of recall bias. If DSM-IV criteria are accepted as a diagnostic definition, MD prevalence is considerably higher than usually cited figures. However, the same literature indicates that the spectrum of severity is much broader than is usually acknowledged. The DSM-IV criteria appear to be a poor proxy for treatment need in community populations. CONCLUSIONS Increasing evidence suggests that MD is very common but also that DSM-IV and ICD-10 definitions capture such a broad spectrum of morbidity that they should not be regarded as de facto indicators of need, at least not in community populations.
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Affiliation(s)
- Scott B Patten
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta.
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Bland R. Depression and its management in primary care. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2007; 52:75-6. [PMID: 17375861 DOI: 10.1177/070674370705200201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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