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Hardy C, Green B, Little V, Vanderwood K. Clinical Variables Associated with Successful Treatment of Depression or Anxiety in Collaborative Care. J Behav Health Serv Res 2024; 51:599-608. [PMID: 38955986 DOI: 10.1007/s11414-024-09892-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/04/2024]
Abstract
Collaborative Care, an evidence-based model, has proven effective in treating depression and anxiety in healthcare settings. However, limited attention has been paid to exploring treatment outcome differences by clinical variables and diagnosis within this model. While previous research suggests that early and frequent contacts and swift treatment access lead to positive outcomes for depression and anxiety, these aspects have not been comprehensively examined in Collaborative Care. This study investigates the impact of clinical variables on treatment completion in patients primarily diagnosed with anxiety or depression who received collaborative care treatment as a treatment program. Analysis was completed as an observational study of patients (n =2018) with behavioral health diagnoses spanning from 2016 to 2023. Classification analysis offers insights into optimal practices for implementing Collaborative Care across diverse healthcare populations from pediatric to geriatric. Identifying clinical characteristics associated with successful treatment in Collaborative Care has far-reaching implications for model adoption and enhancing patient outcomes. Across all results, patients who received more clinical support and had shorter enrollment durations showed a strong association with successful treatment completion.
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2
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Austin EJ, Briggs ES, Cheung A, LePoire E, Blanchard BE, Bauer AM, Al Achkar M, Powers DM. Understanding and Navigating the Unique Barriers Rural Primary Care Settings Face when Implementing Collaborative Care for Mental Health. Community Ment Health J 2024:10.1007/s10597-024-01348-6. [PMID: 39240482 DOI: 10.1007/s10597-024-01348-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/17/2024] [Indexed: 09/07/2024]
Abstract
Rural primary care (RPC) clinics may face unique barriers to implementing the Collaborative Care Model (CoCM). We used mixed methods to explore RPC staff and practice facilitator (PF) perspectives on CoCM implementation. PFs reported on barriers and facilitators experienced after each monthly meeting with clinics (n = 459 surveys across 23 clinics). Data were analyzed descriptively and informed qualitative interviews with a purposive sample (n = 11) of clinic staff and PFs. Interviews were analyzed using Rapid Assessment Process and triangulated with quantitative data. The most prominent barriers experienced were: (1) the COVID-19 pandemic, (2) limited availability of site staff to participate in implementation activities, and (3) hiring of new CoCM staff. Qualitative data further characterized the ways these barriers uniquely influenced RPC settings and promising implementation strategies. RPC settings face unique challenges to CoCM implementation, but several promising implementation strategies - when tailored to RPC contexts - may help.
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Affiliation(s)
- Elizabeth J Austin
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Ave NE, Box 351621, Seattle, WA, 98105, USA.
| | - Elsa S Briggs
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Ave NE, Box 351621, Seattle, WA, 98105, USA
| | - Angel Cheung
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Erin LePoire
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
| | - Brittany E Blanchard
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
| | - Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
| | - Morhaf Al Achkar
- Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Diane M Powers
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
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3
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Aubrey-Basler K, Bursey K, Pike A, Penney C, Furlong B, Howells M, Al-Obaid H, Rourke J, Asghari S, Hall A. Interventions to improve primary healthcare in rural settings: A scoping review. PLoS One 2024; 19:e0305516. [PMID: 38990801 PMCID: PMC11239038 DOI: 10.1371/journal.pone.0305516] [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: 09/06/2023] [Accepted: 06/01/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Residents of rural areas have poorer health status, less healthy behaviours and higher mortality than urban dwellers, issues which are commonly addressed in primary care. Strengthening primary care may be an important tool to improve the health status of rural populations. OBJECTIVE Synthesize and categorize studies that examine interventions to improve rural primary care. ELIGIBILITY CRITERIA Experimental or observational studies published between January 1, 1996 and December 2022 that include an historical or concurrent control comparison. SOURCES OF EVIDENCE Pubmed, CINAHL, Cochrane Library, Embase. CHARTING METHODS We extracted and charted data by broad category (quality, access and efficiency), study design, country of origin, publication year, aim, health condition and type of intervention studied. We assigned multiple categories to a study where relevant. RESULTS 372 papers met our inclusion criteria, divided among quality (82%), access (20%) and efficiency (13%) categories. A majority of papers were completed in the USA (40%), Australia (15%), China (7%) or Canada (6%). 35 (9%) papers came from countries in Africa. The most common study design was an uncontrolled before-and-after comparison (32%) and only 24% of studies used randomized designs. The number of publications each year has increased markedly over the study period from 1-2/year in 1997-99 to a peak of 49 papers in 2017. CONCLUSIONS Despite substantial inequity in health outcomes associated with rural living, very little attention is paid to rural primary care in the scientific literature. Very few studies of rural primary care use randomized designs.
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Affiliation(s)
- Kris Aubrey-Basler
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Krystal Bursey
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Andrea Pike
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Carla Penney
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Bradley Furlong
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Mark Howells
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Harith Al-Obaid
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - James Rourke
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Amanda Hall
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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4
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Turi E, Courtwright SE, Dixon J, O'Neill I, Marchiano M, Poghosyan L. Primary Care Models and Depression Outcomes in Rural Adult Populations: A Systematic Review. RURAL MENTAL HEALTH 2024; 48:145-155. [PMID: 39246454 PMCID: PMC11376465 DOI: 10.1037/rmh0000261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
Rural populations rely on primary care services for depression care due to shortages and maldistributions of specialty mental health care favoring urban areas. Yet, it is unknown which primary care models are effective at reducing depressive symptoms and emergency department (ED) use for depression among rural populations. The purpose of this systematic review is to synthesize the effectiveness of primary care models on depressive symptoms and ED utilization for depression in rural populations. PubMed, PsycINFO, CINAHL, and reference lists of included studies were searched. Eligible articles focused on the impact of primary care models on depressive symptoms or ED utilization for depression among rural populations in the United States. Seventeen studies met the inclusion criteria. Three care models were identified in the studies, including collaborative care (i.e., team-based integrated care that tracks patient populations with a registry; n = 7), tele-psychotherapy (i.e., identification of patients in primary care and referral to virtual psychotherapy; n = 6), or self-management support (i.e., identification of patients in primary care and referral to community support for depression self-management; n = 4). These care models were associated with improved patient-reported depressive symptoms such as Patient-Health Questionnaire reported remission of depression (score < 5). No studies assessed depression ED utilization as an outcome. Collaborative care, tele-psychotherapy, and self-management support may be effective at reducing depressive symptoms, specifically in rural populations and should be implemented at the practice level. Research focused on primary care models and ED utilization for depression among rural populations is needed.
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Affiliation(s)
- Eleanor Turi
- Columbia University School of Nursing, New York, NY
| | | | | | | | | | - Lusine Poghosyan
- Columbia University School of Nursing, New York, NY
- Columbia University Mailman School of Public Health, New York, NY
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5
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Hempel S, Bolshakova M, Turner BJ, Dinalo J, Rose D, Motala A, Fu N, Clemesha CG, Rubenstein L, Stockdale S. Evidence-Based Quality Improvement: a Scoping Review of the Literature. J Gen Intern Med 2022; 37:4257-4267. [PMID: 36175760 PMCID: PMC9708973 DOI: 10.1007/s11606-022-07602-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Quality improvement (QI) initiatives often reflect approaches based on anecdotal evidence, but it is unclear how initiatives can best incorporate scientific literature and methods into the QI process. Review of studies of QI initiatives that aim to systematically incorporate evidence review (termed evidence-based quality improvement (EBQI)) may provide a basis for further methodological development. METHODS In this scoping review (registration: https://osf.io/hr5bj ) of EBQI, we searched the databases PubMed, CINAHL, and SCOPUS. The review addressed three central questions: How is EBQI defined? How is evidence used to inform evidence-informed QI initiatives? What is the effectiveness of EBQI? RESULTS We identified 211 publications meeting inclusion criteria. In total, 170 publications explicitly used the term "EBQI." Published definitions emphasized relying on evidence throughout the QI process. We reviewed a subset of 67 evaluations of QI initiatives in primary care, including both studies that used the term "EBQI" with those that described an evidence-based initiative without using EBQI terminology. The most frequently reported EBQI components included use of evidence to identify previously tested effective QI interventions; engaging stakeholders; iterative intervention development; partnering with frontline clinicians; and data-driven evaluation of the QI intervention. Effectiveness estimates were positive but varied in size in ten studies that provided data on patient health outcomes. CONCLUSIONS EBQI is a promising strategy for integrating relevant prior scientific findings and methods systematically in the QI process, from the initial developmental phase of the IQ initiative through to its evaluation. Future QI researchers and practitioners can use these findings as the basis for further development of QI initiatives.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, CA, USA.,Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, USA.,RAND Health, RAND Corporation, Santa Monica, CA, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, CA, USA
| | - Barbara J Turner
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, USA
| | | | - Danielle Rose
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, CA, USA.,Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, USA.,RAND Health, RAND Corporation, Santa Monica, CA, USA
| | - Ning Fu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, CA, USA. .,School of Economics, Shanghai University of Finance and Economics, Shanghai, China.
| | | | | | - Susan Stockdale
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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6
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Lee RS, Brown HK, Salih S, Benoit AC. Systematic review of Indigenous involvement and content in mental health interventions and their effectiveness for Indigenous populations. Aust N Z J Psychiatry 2022; 56:1230-1251. [PMID: 35379008 PMCID: PMC9513504 DOI: 10.1177/00048674221089837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the effects of psychological, psychosocial, educational and alternative interventions on mental health outcomes of Indigenous adult populations in Australia, Canada, New Zealand and the United States and the Indigenous involvement and content in each study. METHODS We systematically searched databases, key journals and gray literature, for records until June 2020. Eligible studies were in English or French and examined the impact of interventions on mental health outcomes including anxiety disorders, posttraumatic stress disorder, depression, psychological distress or stress for Indigenous adults (⩾16 years). Data were extracted using a modified Cochrane Data Extraction Form and the Template for Intervention Description and Replication. Quality was evaluated using the Effective Public Health Practice Project quality assessment form. RESULTS In total, 21 studies were eligible, comprising 8 randomized controlled trials, 10 single-group pre-post studies and 3 pre-post studies with comparison groups. Twenty studies had Indigenous individuals or organizations involved in some decision-making capacity, though extent of involvement varied widely. In total, 9 studies were rated moderate and 12 weak in the Effective Public Health Practice Project quality assessment. Eight studies measuring depression, three measuring posttraumatic stress disorder, three measuring psychological distress and two measuring stress showed statistically significant improvements following the intervention. CONCLUSION A wide range of interventions demonstrated mental health improvements. However, it is difficult to draw generalizable conclusions on intervention effectiveness, given heterogeneity among studies. Studies should employ a thorough assessment of the Indigenous involvement and content of their interventions for reporting and for critical consideration of the implications of their research and whether they address Indigenous determinants of mental health.
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Affiliation(s)
- Rachel Seungyun Lee
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Hilary K Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Department of Health and Society, University of Toronto Scarborough, Scarborough, ON, Canada,Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - Sarah Salih
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anita C Benoit
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Department of Health and Society, University of Toronto Scarborough, Scarborough, ON, Canada,Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, ON, Canada,Anita C Benoit, Department of Health and Society, University of Toronto Scarborough, 1265 Military Trail, Toronto, ON M1C 1A4, Canada.
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7
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Rafla-Yuan E, Moore S, Carvente-Martinez H, Yang P, Balasuriya L, Jackson K, McMickens C, Robles-Ramamurthy B. Striving for Equity in Community Mental Health: Opportunities and Challenges for Integrating Care for BIPOC Youth. Child Adolesc Psychiatr Clin N Am 2022; 31:295-312. [PMID: 35361366 DOI: 10.1016/j.chc.2021.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Supporting the mental health of youth who identify as Black, Indigenous, or Persons of Color (BIPOC) continues to be a challenge for clinicians and policymakers alike. Children and adolescents are a vulnerable population, and for BIPOC youth, these vulnerabilities are magnified by the effects of structural, interpersonal, and internalized racism. Integration of psychiatric care into other medical settings has emerged as an evidence-based method to improve access to psychiatric care, but to bridge the gap experienced by BIPOC youth, care must extend beyond medical settings to other child-focused sectors, including local governments, education, child welfare, juvenile legal systems, and beyond. Intentional policy decisions are needed to incentivize and support these systems, which typically rely on coordination and collaboration between clinicians and other stakeholders. Clinicians must be trauma-informed and strive for structural competency to successfully navigate and advocate for collaborative systems that benefit BIPOC youth.
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Affiliation(s)
- Eric Rafla-Yuan
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, #0851, San Diego, CA 92093, USA.
| | - Shavon Moore
- Department of Psychiatry, UC San Diego Health Psychiatry - La Jolla, 8950 Villa La Jolla Drive, Suite C101, MC 9057, La Jolla, CA 92037, USA
| | | | - Phillip Yang
- Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7985, San Antonio, TX 78229, USA
| | - Lilanthi Balasuriya
- Yale University School of Medicine, 333 Cedar Street, SHM IE-66, PO Box 208088, New Haven, CT 06510-8088, USA
| | - Kamilah Jackson
- PerformCare, 300 Horizon Drive Suit 306, Trenton, NJ 08691, USA
| | - Courtney McMickens
- North Carolina, Eleanor Health, 610 Pembroke Road, Greensboro, NC 27408-7608, USA
| | - Barbara Robles-Ramamurthy
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7792, San Antonio, TX 78229, USA
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8
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Fleury MJ, Grenier G, Gentil L, Roberge P. Deployment of the consultation-liaison model in adult and child-adolescent psychiatry and its impact on improving mental health treatment. BMC FAMILY PRACTICE 2021; 22:82. [PMID: 33926390 PMCID: PMC8086343 DOI: 10.1186/s12875-021-01437-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/06/2021] [Indexed: 11/21/2022]
Abstract
Background Little information exists on the perceptions of psychiatrists regarding the implementation and various impacts of the consultation-liaison model. This model has been used in Quebec (Canada) through the function of specialist respondent-psychiatrists (SRP) since 2009. This study assessed the main activities, barriers or facilitators, and impact of SRP in adult and child-adolescent psychiatry on the capacity of service providers in primary care and youth centers to treat patients with mental health disorders (MHD). Methods Data included 126 self-administered questionnaires from SRP and semi-structured interviews from 48 SRP managers. Mixed methods were used, with qualitative findings from managers complementing the SRP survey. Comparative analyses of SRP responses in adult versus child-adolescent psychiatry were also conducted. Results Psychiatrists dedicated a median 24.12 h/month to the SRP function, mainly involving case discussions with primary care teams or youth centers. They were confident about the level of support they provided and satisfied with their influence in clinical decision-making, but less satisfied with the support provided by their organizations. SRP evaluated their impacts on clinical practice as moderate, particularly among general practitioners (GP). SRP working in child-adolescent psychiatry were more comfortable, motivated, and positive about their overall performance and impact than in adult psychiatry. Organizational barriers (e.g. team instability) were most prevalent, followed by system-level factors (e.g. network size and complexity, lack of resources, model inflexibility) and individual factors (e.g. GP reluctance to treat patients with MHD). Organizational facilitators included support from family medicine group directors, collaboration with university family medicine groups and coordination by liaison nurses; at the system level, pre-existing relationships and working in the same institution; while individual-level facilitators included SRP personality and strong organizational support. Conclusion Quebec SRP were implemented sparingly in family medicine groups and youth centers, while SRP viewed their overall impact as moderate. Results were more positive in child-adolescent psychiatry than in adult psychiatry. Increased support for the SRP function, adapting the model to GP in need of more direct support, and resolving key system issues may improve SRP effectiveness in terms of team stability, coordination among providers, access to MH services and readiness to implement innovations. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01437-5.
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Affiliation(s)
- M-J Fleury
- Department of Psychiatry, McGill University, Montreal, QC, Canada. .,Douglas Mental Health University Institute Research Center, Montréal, QC, Canada.
| | - G Grenier
- Douglas Mental Health University Institute Research Center, Montréal, QC, Canada
| | - L Gentil
- Douglas Mental Health University Institute Research Center, Montréal, QC, Canada
| | - P Roberge
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
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9
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Harry ML, Coley RY, Waring SC, Simon GE. Evaluating the Cross-Cultural Measurement Invariance of the PHQ-9 between American Indian/Alaska Native Adults and Diverse Racial and Ethnic Groups. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 4:100121. [PMID: 34142103 PMCID: PMC8208497 DOI: 10.1016/j.jadr.2021.100121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Patient Health Questionnaire-9 (PHQ-9), a self-reported depression screening instrument for measurement-based care (MBC), may have cross-cultural measurement invariance (MI) with a regional group of American Indian/Alaska Native (AI/AN) and non-Hispanic White adults. However, to ensure health equity, research was needed on the cross-cultural MI of the PHQ-9 between other groups of AI/AN peoples and diverse populations. METHODS We assessed the MI of the one-factor PHQ-9 model and five previously identified two-factor models between non-Hispanic AI/AN adults (ages 18-64) from healthcare systems A (n=1,759) and B (n=2,701) using secondary data and robust maximum likelihood estimation. We then tested either fully or partially invariant models for MI between either combined or separate AI/AN groups, respectively, and Hispanic (n=7,974), White (n=7,974), Asian (n=6,988), Black (n=6,213), and Native Hawaiian/Pacific Islander (n=1,370) adults from healthcare system B. All had mental health or substance use disorder diagnoses and were seen in behavioral health or primary care from 1/1/2009-9/30/2017. RESULTS The one-factor PHQ-9 model was partially invariant, with two-factor models partially, or in one case fully, invariant between AI/AN groups. The one-factor model and three two-factor models were partially invariant between all seven groups, while a two-factor model was fully invariant and another partially invariant between a combined AI/AN group and other racial and ethnic groups. CONCLUSIONS Achieving health equity in MBC requires ensuring the cross-cultural validity of measurement tools. Before comparing mean scores, PHQ-9 models should be assessed for individual racial and ethnic group fit for adults with mental health or substance use disorders.
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Affiliation(s)
- Melissa L. Harry
- Essentia Health, Essentia Institute of Rural Health, 502 East Second Street, Duluth, MN 55805
| | - R. Yates Coley
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466
| | - Stephen C. Waring
- Essentia Health, Essentia Institute of Rural Health, 502 East Second Street, Duluth, MN 55805
| | - Gregory E. Simon
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466
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10
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Courtnage T, Bates NE, Armstrong AA, Seitz MK, Weitzman TS, Fann JR. Enhancing integrated psychosocial oncology through leveraging the oncology social worker's role in collaborative care. Psychooncology 2020; 29:2084-2090. [DOI: 10.1002/pon.5582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/21/2020] [Accepted: 10/07/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Tiffany Courtnage
- Department of Psychosocial Oncology Seattle Cancer Care Alliance Seattle Washington USA
| | - Nicole E. Bates
- Department of Psychosocial Oncology Seattle Cancer Care Alliance Seattle Washington USA
- Department of Psychiatry and Behavioral Sciences University of Washington Seattle Washington USA
| | - Anne A. Armstrong
- Department of Psychosocial Oncology Seattle Cancer Care Alliance Seattle Washington USA
| | - M. Katherine Seitz
- Department of Psychosocial Oncology Seattle Cancer Care Alliance Seattle Washington USA
| | - Tammy S. Weitzman
- Department of Psychosocial Oncology Seattle Cancer Care Alliance Seattle Washington USA
| | - Jesse R. Fann
- Department of Psychosocial Oncology Seattle Cancer Care Alliance Seattle Washington USA
- Department of Psychiatry and Behavioral Sciences University of Washington Seattle Washington USA
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11
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Al Achkar M, Bennett IM, Chwastiak L, Hoeft T, Normoyle T, Vredevoogd M, Patterson DG. Telepsychiatric Consultation as a Training and Workforce Development Strategy for Rural Primary Care. Ann Fam Med 2020; 18:438-445. [PMID: 32928760 PMCID: PMC7489960 DOI: 10.1370/afm.2561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 02/25/2020] [Accepted: 03/09/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE There is a shortage of rural primary care personnel with expertise in team care for patients with common mental disorders. Building the workforce for this population is a national priority. We investigated the feasibility of regular systematic case reviews through telepsychiatric consultation, within collaborative care for depression, as a continuous training and workforce development strategy in rural clinics. METHODS We developed and pilot-tested a qualitative interview guide based on a conceptual model of training and learning. We conducted individual semistructured interviews in 2018 with diverse clinical and nonclinical staff at 3 rural primary care sites in Washington state that used ongoing collaborative care and telepsychiatric consultation. Two qualitative researchers independently analyzed transcripts with iterative input from other research team members. RESULTS A total of 17 clinical, support, and administrative staff completed interviews. Participants' feedback supported the view that telepsychiatric case review-based consultation enhanced skills of diverse clinical team members over time, even those who had not directly participated in case reviews. All interviewees identified specific ways in which the consultations improved their capacity to identify and treat psychiatric disorders. Perceived benefits in implementation and sustainability included fidelity of the care process, team resilience despite member turnover, and enhanced capacity to use quality improvement methods. CONCLUSIONS Weekly systematic case reviews using telepsychiatric consultation served both as a model for patient care and as a training and workforce development strategy in rural primary care sites delivering collaborative care. These are important benefits to consider in implementing the collaborative care model of behavioral health integration.
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Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Ian M Bennett
- Department of Family Medicine, University of Washington, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Theresa Hoeft
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | | | - Melinda Vredevoogd
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Davis G Patterson
- Department of Family Medicine, University of Washington, Seattle, Washington
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12
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Hu J, Wu T, Damodaran S, Tabb KM, Bauer A, Huang H. The Effectiveness of Collaborative Care on Depression Outcomes for Racial/Ethnic Minority Populations in Primary Care: A Systematic Review. PSYCHOSOMATICS 2020; 61:632-644. [PMID: 32381258 DOI: 10.1016/j.psym.2020.03.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Racial/ethnic minorities experience a greater burden of mental health problems than white adults in the United States. The collaborative care model is increasingly being adopted to improve access to services and to promote diagnosis and treatment of psychiatric diseases. OBJECTIVE This systematic review seeks to summarize what is known about collaborative care on depression outcomes for racial/ethnic minorities in the United States. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. Collaborative care studies were included if they comprised adults from at least one racial/ethnic minority group, were located in primary care clinics in the United States, and had depression outcome measures. Core principles described by the University of Washington Advancing Integrated Mental Health Solutions Center were used to define the components of collaborative care. RESULTS Of 398 titles screened, 169 full-length articles were assessed for eligibility, and 19 studies were included in our review (10 randomized controlled trials, 9 observational). Results show there is potential that collaborative care, with or without cultural/linguistic tailoring, is effective in improving depression for racial/ethnic minorities, including those from low socioeconomic backgrounds. CONCLUSIONS Collaborative care should be explored as an intervention for treating depression for racial/ethnic minority patients in primary care. Questions remain as to what elements of cultural adaptation are most helpful, factors behind the difficulty in recruiting minority patients for these studies, and how the inclusion of virtual components changes access to and delivery of care. Future research should also recruit individuals from less studied populations.
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Affiliation(s)
- Jennifer Hu
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA.
| | - Tina Wu
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA.
| | - Swathi Damodaran
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
| | - Karen M Tabb
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Amy Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Hsiang Huang
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
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Abstract
PURPOSE OF REVIEW This review discusses the role of the patient-centered medical home (PCMH) in treating depression, focusing on findings from primary care-based studies and their implications for the PCMH. RECENT FINDINGS Pharmacotherapy, psychotherapy, and collaborative care are evidence-based treatments for depression that can be delivered in primary care and extended to diverse populations. Recent research aligns with the core components of the PCMH model. The core components of the PCMH are critical elements of depression treatment. Comprehensive care within the PCMH addresses medical and behavioral health concerns, including depression. Psychiatric and psychological care must be flexibly delivered so services remain accessible yet patient-centered. To ensure the quality and safety of treatment, depression symptoms must be consistently monitored. Coordination within and occasionally outside of the PCMH is needed to ensure patients receive the appropriate level of care. More research is needed to empirically evaluate depression treatment within the PCMH.
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