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Jackson J, Dangal R, Dangal B, Gupta T, Jirel S, Khadka S, Rimal P, Acharya B. Implementing Collaborative Care in Low-Resource Government, Research, and Academic Settings in Rural Nepal. Psychiatr Serv 2022; 73:1073-1076. [PMID: 35172595 DOI: 10.1176/appi.ps.202100421] [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] [Indexed: 11/30/2022]
Abstract
The collaborative care model (CoCM) is a strategy of integrating behavioral health into primary care to expand access to high-quality mental health services in areas with few psychiatrists. CoCM is multifaceted, and its implementation is accelerating in high-resource settings. However, in low-resource settings, it may not be feasible to implement all CoCM components. Guidance is lacking on CoCM implementation when only some of its components are feasible. In this column, the authors used a cost-benefit approach to refine strategies for addressing common implementation challenges, incorporating the authors' experiences in what was gained and what was lost at each implementation step in three CoCM programs in diverse clinical settings in rural Nepal.
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Affiliation(s)
- James Jackson
- Department of Medicine, HEAL Initiative, University of California, San Francisco (Jackson, Gupta, Rimal, Acharya); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Jackson, Acharya); Dhulikhel Hospital, Kathmandu University, Dhulikhel, Nepal (R. Dangal, Khadka); Charikot Provincial Public Hospital, Dolakha, Nepal (B. Dangal, Jirel); Possible, Kathmandu, Nepal (Rimal). Kathleen M. Pike, Ph.D., Matías Irarrázaval, M.D., M.P.H., and Lola Kola, Ph.D., are editors of this column
| | - Rajkumar Dangal
- Department of Medicine, HEAL Initiative, University of California, San Francisco (Jackson, Gupta, Rimal, Acharya); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Jackson, Acharya); Dhulikhel Hospital, Kathmandu University, Dhulikhel, Nepal (R. Dangal, Khadka); Charikot Provincial Public Hospital, Dolakha, Nepal (B. Dangal, Jirel); Possible, Kathmandu, Nepal (Rimal). Kathleen M. Pike, Ph.D., Matías Irarrázaval, M.D., M.P.H., and Lola Kola, Ph.D., are editors of this column
| | - Binod Dangal
- Department of Medicine, HEAL Initiative, University of California, San Francisco (Jackson, Gupta, Rimal, Acharya); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Jackson, Acharya); Dhulikhel Hospital, Kathmandu University, Dhulikhel, Nepal (R. Dangal, Khadka); Charikot Provincial Public Hospital, Dolakha, Nepal (B. Dangal, Jirel); Possible, Kathmandu, Nepal (Rimal). Kathleen M. Pike, Ph.D., Matías Irarrázaval, M.D., M.P.H., and Lola Kola, Ph.D., are editors of this column
| | - Tula Gupta
- Department of Medicine, HEAL Initiative, University of California, San Francisco (Jackson, Gupta, Rimal, Acharya); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Jackson, Acharya); Dhulikhel Hospital, Kathmandu University, Dhulikhel, Nepal (R. Dangal, Khadka); Charikot Provincial Public Hospital, Dolakha, Nepal (B. Dangal, Jirel); Possible, Kathmandu, Nepal (Rimal). Kathleen M. Pike, Ph.D., Matías Irarrázaval, M.D., M.P.H., and Lola Kola, Ph.D., are editors of this column
| | - Sunita Jirel
- Department of Medicine, HEAL Initiative, University of California, San Francisco (Jackson, Gupta, Rimal, Acharya); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Jackson, Acharya); Dhulikhel Hospital, Kathmandu University, Dhulikhel, Nepal (R. Dangal, Khadka); Charikot Provincial Public Hospital, Dolakha, Nepal (B. Dangal, Jirel); Possible, Kathmandu, Nepal (Rimal). Kathleen M. Pike, Ph.D., Matías Irarrázaval, M.D., M.P.H., and Lola Kola, Ph.D., are editors of this column
| | - Sangeeta Khadka
- Department of Medicine, HEAL Initiative, University of California, San Francisco (Jackson, Gupta, Rimal, Acharya); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Jackson, Acharya); Dhulikhel Hospital, Kathmandu University, Dhulikhel, Nepal (R. Dangal, Khadka); Charikot Provincial Public Hospital, Dolakha, Nepal (B. Dangal, Jirel); Possible, Kathmandu, Nepal (Rimal). Kathleen M. Pike, Ph.D., Matías Irarrázaval, M.D., M.P.H., and Lola Kola, Ph.D., are editors of this column
| | - Pragya Rimal
- Department of Medicine, HEAL Initiative, University of California, San Francisco (Jackson, Gupta, Rimal, Acharya); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Jackson, Acharya); Dhulikhel Hospital, Kathmandu University, Dhulikhel, Nepal (R. Dangal, Khadka); Charikot Provincial Public Hospital, Dolakha, Nepal (B. Dangal, Jirel); Possible, Kathmandu, Nepal (Rimal). Kathleen M. Pike, Ph.D., Matías Irarrázaval, M.D., M.P.H., and Lola Kola, Ph.D., are editors of this column
| | - Bibhav Acharya
- Department of Medicine, HEAL Initiative, University of California, San Francisco (Jackson, Gupta, Rimal, Acharya); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Jackson, Acharya); Dhulikhel Hospital, Kathmandu University, Dhulikhel, Nepal (R. Dangal, Khadka); Charikot Provincial Public Hospital, Dolakha, Nepal (B. Dangal, Jirel); Possible, Kathmandu, Nepal (Rimal). Kathleen M. Pike, Ph.D., Matías Irarrázaval, M.D., M.P.H., and Lola Kola, Ph.D., are editors of this column
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Greene MC, Huang TTK, Giusto A, Lovero KL, Stockton MA, Shelton RC, Dos Santos P, Saúte F, Wainberg ML. Leveraging Systems Science to Promote the Implementation and Sustainability of Mental Health and Psychosocial Interventions in Low- and Middle-Income Countries. Harv Rev Psychiatry 2021; 29:262-277. [PMID: 34241978 PMCID: PMC9162158 DOI: 10.1097/hrp.0000000000000306] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT Advancements in global mental health implementation research have revealed promising strategies for improving access to evidence-based mental health care. These advancements have not translated, however, into a reduced prevalence of mental disorders. In this review we examine the relationships between determinants (i.e., barriers and facilitators) and outcomes of mental health services in low- and middle-income countries to identify opportunities for improving the population-level impact and sustainability of innovations in global mental health. We identified three key implementation and services outcomes that influenced the prevalence of mental disorders in the 56 included review articles: supply (access, implementation), demand (help seeking, utilization), and quality (effectiveness, quality of care) of mental health services. Determinants of these outcomes revealed seven themes: community stakeholder engagement; cultural relevance; stigma; human resource capacity; organization of services; governance, policy, and financing; and sociopolitical and community context. We developed a causal loop diagram to illustrate the relationships among these determinants and outcomes. The causal loop diagram revealed the central role of community stakeholder engagement in bridging implementation and patient outcomes, the importance of addressing stigma and social determinants of mental health, and the need to complement supply-side implementation strategies with approaches to equilibrate demand and improve the quality of services. Applying systems science methodologies to global mental health research presents an opportunity to examine the complex relationships among community and health system factors that influence implementation of evidence-based interventions in order to identify sustainable approaches to improve the population-level impact of mental health services in low- and middle-income countries.
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Affiliation(s)
- M Claire Greene
- From the Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health (Dr. Greene) and Department of Sociomedical Science (Dr. Shelton), Columbia University Mailman School of Public Health; Center for Systems and Community Design and Department of Health Policy and Management, City University of New York Graduate School of Public Health and Health Policy (Dr. Huang); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons & New York State Psychiatric Institute (Drs. Giusto, Lovero, Stockton, and Wainberg); Mental Health Department, Center for Applied Psychology and Psychometric Tests, Mozambique Ministry of Health (Dr. dos Santos); Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique (Dr. Saúte)
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Mirabella AC, McAmis NE, Kiassat C, Feinn R, Singh G. Preferences to improve rounding efficiency amongst hospitalists: a survey analysis. J Community Hosp Intern Med Perspect 2021; 11:501-506. [PMID: 34211657 PMCID: PMC8221154 DOI: 10.1080/20009666.2021.1929047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: There is no ‘gold standard’ method of rounding for hospitalists. This study investigates hospitalist rounding preferences to improve efficiency based on resources categorized under work assignment and communication. Methods: An anonymous survey containing demographics and questions on preferences for rounding efficiently by hospitalists were widely distributed online. Res6ponses were presented using descriptive statistics and SPSS v26. Results: There were 143 respondents, majority male (60%) with (40%) female. Most (80%) expect higher patient volumes when working with an advanced practitioner (AP). Half (50%) preferred rounding independently, (34%) with an AP, and majority (62%) with a resident. Geographic rounding was most efficient at 85%. Text messaging for paging was preferred (70.1%) to pagers (23.4%). Respondents preferred calling a consultant (52%) or text messaging (40%). Majority have not used a WOW yet (74%) believe WOWs could improve efficiency. Majority prefer dictation via Dragon (47%) to the phone application (23%). Only 29% believe their EMR is too complex to navigate. Preference difference due to age was insignificant. Discussion and Conclusion: In this study, 143 hospitalists provided preferences for improving rounding efficiency based on elements from work assignment and communication. This analysis can provide insights on designing best practices for hospitalists rounding efficiently.
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Affiliation(s)
- Angela C Mirabella
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Nicole E McAmis
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Corey Kiassat
- School of Engineering, Quinnipiac University, Hamden, CT, USA
| | - Richard Feinn
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Gagan Singh
- Department of Hospital Medicine , Hartford Hospital, Hartford, CT, USA
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