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Palay J, Bolton JM, Sareen J, Hensel JM. Increasing access to specialist care with group medical visits: summary of a pilot in a post-crisis psychiatric clinic. FRONTIERS IN HEALTH SERVICES 2023; 3:1127725. [PMID: 37435511 PMCID: PMC10332818 DOI: 10.3389/frhs.2023.1127725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/14/2023] [Indexed: 07/13/2023]
Abstract
Background Group medical visits (GMVs) have strong evidence of acceptability and effectiveness in the management of chronic medical diseases. Adaptation of GMVs for psychiatric care has potential to increase access, decrease stigma and save costs. Despite promise, this model has not been widely adopted. Methods A novel GMV pilot was implemented for psychiatric care post-crisis among patients with primary mood or anxiety disorders who required medication management. Participants filled out PHQ-9 and GAD-7 scales at each visit in order to track their progress. After discharge, charts were reviewed for demographics, medication changes and symptom changes. Patient characteristics were compared between those who attended and those who didn't. Changes in total PHQ-9 and GAD-7 scores among attendees were assessed with paired t-tests. Results Forty-eight patients were enrolled between October 2017 and the end of December 2018, 41 of whom consented to participate. Of those, 10 did not attend, 8 attended but did not complete, and 23 completed. Baseline PHQ-9 and GAD-7 scores did not differ significantly between groups. Significant and meaningful reductions in PHQ-9 and GAD-7 scores from baseline to last visit attended occurred among those who attended at least 1 visit (decrease of 5.13 and 5.26 points, respectively). Conclusions This GMV pilot demonstrated feasibility of the model as well as positive outcomes for patients recruited in a post-crisis setting. This model has the potential to increase access to psychiatric care in the face of limited resources, however the failure of the pilot to sustain highlights challenges to be addressed in future pivots.
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Davison KM, Thakkar V, Lin S(L, Stabler L, MacPhee M, Carroll S, Collins B, Rezler Z, Colautti J, Xu C(C, Fuller-Thomson E, Hey B, Kelly K, Mullaly L, Remick R, Ravindran A, Paric A, D’Andreamatteo C, Smye V. Interventions to Support Mental Health among Those with Health Conditions That Present Risk for Severe Infection from Coronavirus Disease 2019 (COVID-19): A Scoping Review of English and Chinese-Language Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7265. [PMID: 34299716 PMCID: PMC8303838 DOI: 10.3390/ijerph18147265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 12/02/2022]
Abstract
This study aimed to address knowledge gaps related to the prevention and management of mental health responses among those with a condition that presents risk of severe COVID-19 infection. A scoping review that mapped English and Chinese-language studies (2019-2020) located in MEDLINE (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Sociological Abstracts, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Airiti Library was undertaken. Search terms related to COVID-19, mental health, and physical health were used and articles that included all three of these factors were extracted (n = 77). With the exception of one hospital-based pilot study, there were no intervention studies targeting mental health in those at risk of severe COVID-19 infection. Promising practices such as integrated care models that appropriately screen for mental health issues, address health determinants, and include use of digital resources were highlighted. Patient navigator programs, group online medical visits, peer support, and social prescribing may also support those with complex needs. Future policies need to address digital health access inequities and the implementation of multi-integrated health and social care. Furthermore, research is needed to comprehensively assess multi-integrated interventions that are resilient to public health crises.
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Affiliation(s)
- Karen M. Davison
- Health Science Program, Kwantlen Polytechnic University, 12666 72 Ave, Surrey, BC V3W 2M8, Canada;
| | - Vidhi Thakkar
- Health Science Program, Kwantlen Polytechnic University, 12666 72 Ave, Surrey, BC V3W 2M8, Canada;
| | - Shen (Lamson) Lin
- Factor-Inwentash Faculty of Social Work, University of Toronto, 46 Bloor St W, Toronto, ON M5S 1V4, Canada; (S.L.); (E.F.-T.)
| | - Lorna Stabler
- CASCADE Children’s Social Care Research and Development Centre, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF10 3BD, UK;
| | - Maura MacPhee
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada;
| | - Simon Carroll
- Department of Sociology, Cornett Building, University of Victoria, A333, Victoria, BC V8W 3P5, Canada;
| | - Benjamin Collins
- Department of Anthropology, University of Manitoba, 432 Fletcher Argue Building, 15 Chancellor Circle, Winnipeg, MB R3T 2N2, Canada;
| | - Zachary Rezler
- Health Sciences Program, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; (Z.R.); (J.C.); (C.X.)
| | - Jake Colautti
- Health Sciences Program, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; (Z.R.); (J.C.); (C.X.)
| | - Chaoqun (Cherry) Xu
- Health Sciences Program, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; (Z.R.); (J.C.); (C.X.)
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 46 Bloor St W, Toronto, ON M5S 1V4, Canada; (S.L.); (E.F.-T.)
| | - Brandon Hey
- COVID 19 Policy, Programs and Priorities, Mental Health Commission of Canada, 350 Albert Street, Suite 1210, Ottawa, ON K1R 1A4, Canada;
| | - Krystal Kelly
- Mental Health Advancement, Mental Health Commission of Canada, 350 Albert Street, Suite 1210, Ottawa, ON K1R 1A4, Canada; (L.M.); (K.K.)
| | - Laura Mullaly
- Mental Health Advancement, Mental Health Commission of Canada, 350 Albert Street, Suite 1210, Ottawa, ON K1R 1A4, Canada; (L.M.); (K.K.)
| | - Ron Remick
- Lookout Housing and Health Society, 544 Columbia St, New Westminster, BC V3L 1B1, Canada;
| | - Arun Ravindran
- Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON M6J 1H4, Canada; (A.R.); (A.P.)
| | - Angela Paric
- Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON M6J 1H4, Canada; (A.R.); (A.P.)
| | - Carla D’Andreamatteo
- Department of Food and Human Nutritional Sciences, University of Manitoba, 209 Human Ecology Building, Winnipeg, MB R3T 2N2, Canada;
| | - Victoria Smye
- Arthur Labatt School of Nursing, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada;
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Impact of a Rapid-Access Ambulatory Psychiatry Encounter on Subsequent Emergency Department Utilization. Community Ment Health J 2021; 57:973-978. [PMID: 32808081 DOI: 10.1007/s10597-020-00702-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
The authors sought to determine whether providing a rapid-access ambulatory psychiatry encounter correlated with emergency department utilization during a 6-month follow-up period. Electronic medical records of patients who accessed ambulatory psychiatric care through an urgent care psychiatry clinic that offers treatment exclusively on a walk-in basis over a 1-year period (N = 157) were reviewed retrospectively to track emergency department encounters with and without a psychiatric chief complaint in the 6 months before and after the initial psychiatry evaluation. Among patients who had not previously received ambulatory psychiatric care (N = 88), emergency department utilization decreased from 0.68 visits per patient to 0.36, and this difference was statistically significant (p = 0.0147). No statistically significant differences were found between the average number of emergency department encounters in the 6 months before and after the rapid-access ambulatory psychiatry encounter, regardless of chief complaint, when all patients were included in the analysis. Providing a rapid-access ambulatory psychiatry encounter may reduce subsequent emergency department utilization among patients who have not previously received ambulatory psychiatric care.
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Bergmans Y, Ninkovic D, Sunderji N, Simpson-Barrette D. Client Evaluation of an Interprofessional Urgent Mental Health Care Program. J Psychosoc Nurs Ment Health Serv 2018; 57:17-24. [PMID: 30376584 DOI: 10.3928/02793695-20181019-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/07/2018] [Indexed: 11/20/2022]
Abstract
Urgent psychiatric care programs are hospital- or community-based outpatient services that expedite access to mental health care for high-risk individuals, yet these services are rarely evaluated from the perspectives of clients. A qualitative thematic analysis of 13 participant interviews of a psychiatric urgent care program allowed researchers to address this gap. Communication, responsiveness, and continuous availability were identified as critical in helping clients articulate their perceived self-stigma, needs, and preferences. A well-coordinated interprofessional team proactively reaching out to facilitate client engagement in care was noted as helpful. Successful transitions to ongoing care partially mitigated the frustration of a time-limited program. Researchers found that an interprofessional team enabled timely and ongoing contact, assistance with system navigation, and the ability to meet a broader range of urgent client needs, including addressing social determinants of health. Recommendations to improve the service included extended hours, improved access to psychotherapy, and integrated telephone crisis support. [Journal of Psychosocial Nursing and Mental Health Services, 57(3), 17-24.].
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Rai M, Vigod SN, Hensel JM. Barriers to Office-Based Mental Health Care and Interest in E-Communication With Providers: A Survey Study. JMIR Ment Health 2016; 3:e35. [PMID: 27480108 PMCID: PMC4985609 DOI: 10.2196/mental.6068] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/06/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND With rising availability and use of Internet and mobile technology in society, the demand and need for its integration into health care is growing. Despite great potential within mental health care and growing uptake, there is still little evidence to guide how these tools should be integrated into traditional care, and for whom. OBJECTIVE To examine factors that might inform how e-communication should be implemented in our local outpatient mental health program, including barriers to traditional office-based care, patient preferences, and patient concerns. METHODS We conducted a survey in the waiting room of our outpatient mental health program located in an urban, academic ambulatory hospital. The survey assessed (1) age, mobile phone ownership, and general e-communication usage, (2) barriers to attending office-based appointments, (3) preferences for, and interest in, e-communication for mental health care, and (4) concerns about e-communication use for mental health care. We analyzed the data descriptively and examined associations between the presence of barriers, identifying as a social media user, and interest level in e-communication. RESULTS Respondents (N=68) were predominantly in the age range of 25-54 years. The rate of mobile phone ownership was 91% (62/68), and 59% (40/68) of respondents identified as social media users. There was very low existing use of e-communication between providers and patients, with high levels of interest endorsed by survey respondents. Respondents expressed an interest in using e-communication with their provider to share updates and get feedback, coordinate care, and get general information. In regression analysis, both a barrier to care and identifying as a social media user were significantly associated with e-communication interest (P=.03 and P=.003, respectively). E-communication interest was highest among people who both had a barrier to office-based care and were a social media user. Despite high interest, there were also many concerns including privacy and loss of in-person contact. CONCLUSIONS A high burden of barriers to attending office-based care paired with a high interest in e-communication supports the integration of e-communication within our outpatient services. There may be early adopters to target: those with identified barriers to office-based care and who are active on social media. There is also a need for caution and preservation of existing services for those who choose not to, or cannot, access e-services.
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Affiliation(s)
- Minnie Rai
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada
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Adams DJ, Remick RA, Davis JC, Vazirian S, Khan KM. Exercise as medicine-the use of group medical visits to promote physical activity and treat chronic moderate depression: a preliminary 14-week pre-post study. BMJ Open Sport Exerc Med 2015; 1:e000036. [PMID: 27900130 PMCID: PMC5117054 DOI: 10.1136/bmjsem-2015-000036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/16/2022] Open
Abstract
Objective The evidence that regular physical activity can treat depressive disorders is increasingly robust. However, motivating patients with depression to engage in physical activity can be challenging. Interdisciplinary group medical visits (GMVs) with an integrated physical activity component may be a novel means to support patients in becoming more active. Methods We conducted a ‘pre–post’ pilot study within a primary care setting. Participants were adults (≥18 years) with a chronic major depressive disorder or a bipolar 2 disorder (depression; chronic). A psychiatrist and exercise therapist co-led a series of 14 weekly 2 h GMVs. Each group visit combined specific medical advice, physical activity, patient discussions and a targeted educational component. Participants also attended 11 weekly hatha yoga classes. Primary outcome was ‘steps’ as measured by accelerometer (SenseWear) as well as depression (Patient Health Questionnaire, PHQ-9) and anxiety (Generalised Anxiety Disorder, GAD-7) ratings. Results 14 of 15 participants (93.3%) completed the 14-week programme. After 3 months postintervention, median depression scales (PHQ-9) decreased 38% from 16 to 10 (p<0.01; IQR pre/post 8/12); and median anxiety scales (GAD-7) decreased 50% from 13 to 6.5 (p<0.05; IQR 8.5/9). Median daily ‘steps’ increased 71% from 3366 to 5746 (IQR 2610/6237), though this was not significant (p>0.10). Conclusions While other studies have examined the efficacy of GMVs in addressing chronic illnesses and the promotion of lifestyle changes, none to our knowledge have embedded physical activity within the actual patient visits. Interdisciplinary GMVs (eg, psychiatrist/exercise professional) may be a means to decrease depression and anxiety ratings within clinical care while improving physical activity.
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Affiliation(s)
- David J Adams
- Department of Family Practice (DFP) , University of British Columbia , Vancouver, British Columbia , Canada
| | - Ronald A Remick
- Mood Disorders Association of BC , Vancouver, British Columbia , Canada
| | - Jennifer C Davis
- UBC School of Population and Public Health/Centre for Hip Health & Mobility (CHHM)
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