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Whitfield J, Owens S, Bhat A, Felker B, Jewell T, Chwastiak L. Successful ingredients of effective Collaborative Care programs in low- and middle-income countries: A rapid review. Glob Ment Health (Camb) 2023; 10:e11. [PMID: 37854388 PMCID: PMC10579696 DOI: 10.1017/gmh.2022.60] [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: 08/11/2022] [Revised: 11/01/2022] [Accepted: 11/22/2022] [Indexed: 03/19/2023] Open
Abstract
Integrating mental health care in primary healthcare settings is a compelling strategy to address the mental health treatment gap in low- and middle-income countries (LMICs). Collaborative Care is the integrated care model with the most evidence supporting its effectiveness, but most research has been conducted in high-income countries. Efforts to implement this complex multi-component model at scale in LMICs will be enhanced by understanding the model components that have been effective in LMIC settings. Following Cochrane Rapid Reviews Methods Group recommendations, we conducted a rapid review to identify studies of the effectiveness of Collaborative Care for priority adult mental disorders of mhGAP (mood and anxiety disorders, psychosis, substance use disorders and epilepsy) in outpatient medical settings in LMICs. Article screening and data extraction were performed using Covidence software. Data extraction by two authors utilized a checklist of key components of effective interventions. Information was aggregated to examine how frequently the components were applied. Our search yielded 25 articles describing 20 Collaborative Care models that treated depression, anxiety, schizophrenia, alcohol use disorder or epilepsy in nine different LMICs. Fourteen of these models demonstrated statistically significantly improved clinical outcomes compared to comparison groups. Successful models shared key structural and process-of-care elements: a multi-disciplinary care team with structured communication; standardized protocols for evidence-based treatments; systematic identification of mental disorders, and a stepped-care approach to treatment intensification. There was substantial heterogeneity across studies with respect to the specifics of model components, and clear evidence of the importance of tailoring the model to the local context. This review provides evidence that Collaborative Care is effective across a range of mental disorders in LMICs. More work is needed to demonstrate population-level and longer-term outcomes, and to identify strategies that will support successful and sustained implementation in routine clinical settings.
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Affiliation(s)
- Jessica Whitfield
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
| | - Shanise Owens
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Bradford Felker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Teresa Jewell
- University of Washington Health Sciences Library, University of Washington, Seattle, WA, USA
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA
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The effectiveness of inpatient consultation-liaison psychiatry service models: A systematic review of randomized trials. Gen Hosp Psychiatry 2021; 71:11-19. [PMID: 33906098 DOI: 10.1016/j.genhosppsych.2021.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/10/2021] [Accepted: 04/15/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To systematically review randomized trials of the effectiveness of inpatient Consultation-Liaison (C-L) Psychiatry service models in improving patient outcomes, reducing length of hospital stay and decreasing healthcare costs. METHOD We searched databases including Ovid Medline, Ovid Embase, Ovid PsycINFO and EBSCO CINAHL for relevant trials. Two independent reviewers assessed articles and extracted data. The review is registered with PROSPERO, number CRD42019120827. RESULTS Eight trials were eligible for inclusion. All had methodological limitations and all were published more than ten years ago. None reported clear evidence that the C-L Psychiatry service model evaluated was more effective than usual medical care alone. All the service models tested focused on providing a consultation for patients identified by screening. Clinical heterogeneity precluded meta-analysis. CONCLUSION Whilst we found no evidence that any of the inpatient C-L Psychiatry service models evaluated is effective, the sparseness of the literature and its methodological limitations preclude strong conclusions. The trials do, however, suggest that purely consultation-based service models may not be effective. A new generation of robust clinical trials of a wider range of C-L Psychiatry service models is now required to inform future service developments.
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Ankersen PV, Steffensen RG, Blæhr EE, Beedholm K. Bumpy road: implementing integrated psychiatric and somatic care in joint-specialty emergency departments: a mixed-method study using Normalization Process Theory. JOURNAL OF INTEGRATED CARE 2021. [DOI: 10.1108/jica-07-2020-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeLife expectancy is 15–20 years shorter for individuals with than for people without mental illness. Assuming that undiagnosed and undertreated somatic conditions are significant causes, the Central Denmark Region set out to implement joint psychiatric and somatic emergency departments (EDs) to support integrated psychiatric/somatic care as an effort to prolong the lifetime of individuals with mental illness. Through the lens of Normalization Process Theory, the authors examine healthcare frontline staff’s perceptions of and work with the implementation of integrated psychiatric/somatic care in the first joint-specialty ED in Denmark.Design/methodology/approachA single-case mixed-methods study using Normalization Process Theory (NPT) as an analytic framework to evaluate implementation of psychiatric/somatic integrated care (IC) in a joint-specialty emergency department. Data were generated from observations, qualitative interviews and questionnaires distributed to the frontline staff.FindingsImplementation was characterized by a diffuse normalization leading to an adaption of the IC in a fuzzy alignment with existing practice. Especially, confusion among the staff regarding how somatic examination in the ED would ensure prolonged lifetime for people with mental illness was a barrier to sense-making and development of coherence among the staff. The staff questioned the accuracy of IC in the ED even though they recognized the need for better somatic care for individuals with mental illness.Practical implicationsThis study highlights that a focus on outcomes (prolonging lifetime for people with mental illness and reducing stigmatization) can be counterproductive. Replacing the outcome focus with an output focus, in terms of how to develop and implement psychiatric/somatic IC with the patient perspective at the center, would probably be more productive.Originality/valueIn 2020, the Danish Health Authorities published new whole-system recommendations for emergency medicine (EM) highlighting the need for intensifying integrated intra and interorganizational care including psychiatric/somatic IC (ref). Even though this study is not conclusive, it points to subjects that can help to identify resources needed to implement psychiatric/somatic IC and to pitfalls. The authors argue that the outcome focus, prolonging the lifetime for individuals with mental illness by identifying somatic illness, was counterproductive. In accordance with the recommendations of contemporary implementation studies, the authors recommend a shift in focus from outcome to output focus; how to develop and implement psychiatric/somatic IC.
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Sharpe M, Toynbee M, Walker J. Proactive Integrated Consultation-Liaison Psychiatry: A new service model for the psychiatric care of general hospital inpatients. Gen Hosp Psychiatry 2020; 66:9-15. [PMID: 32592995 DOI: 10.1016/j.genhosppsych.2020.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe a new service model for the psychiatric care of general hospital inpatients, called Proactive Integrated Consultation-Liaison Psychiatry ('Proactive Integrated Psychological Medicine' in the UK). METHOD The new service model was developed especially for general hospital inpatient populations with multimorbidity, such as older medical inpatients. Its design was informed by the published literature and the clinical experience of C-L psychiatrists. It was operationalized by a process of iterative piloting. RESULTS The rationale for the new model and the principles underpinning it are outlined. Details of how to implement it, including a service manual and associated workbook, are provided. The training of clinicians to deliver it is described. The effectiveness and cost-effectiveness of this new service model is being evaluated. Whilst we have found it feasible to deliver and well-accepted by ward teams, potential challenges to its wider implementation are discussed. CONCLUSION Proactive Integrated Consultation-Liaison Psychiatry (PICLP) is a fusion of proactive consultation and integrated care, operationalized in a field-tested service manual. Initial experience indicates that it is feasible to deliver. Its effectiveness and cost effectiveness for older patients on acute medical wards is currently being evaluated in a large multicentre randomized controlled trial (The HOME Study).
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Affiliation(s)
- Michael Sharpe
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.
| | - Mark Toynbee
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Jane Walker
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
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- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
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Impact of Behavioral Health Comorbidities on Health Care Costs Among Japanese Patients With Cancer. J Acad Consult Liaison Psychiatry 2020; 62:228-233. [PMID: 32665152 DOI: 10.1016/j.psym.2020.06.008] [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: 05/21/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Little is known about how behavioral health (BH) conditions affect health care costs of patients with cancer in Japan. OBJECTIVE The purpose of this study is to evaluate the magnitude of general medical claims expenditures for individuals with cancer who use or do not use BH services in Japan. METHODS The study used a health insurance claims database for more than 3 million enrollees in Japan. All health plan enrollees (18 y or older) who had tumors without metastasis or metastatic solid tumors defined by the Charlson Comorbidity Index were included in the study (n = 20,260). Measurements included total claims expenditures for BH and medical services. RESULTS The proportion of enrollees using BH services was 12.8%. BH service users accounted for 17.7% of total health service spending. Mean annual cost of total health care services were 1.5 times higher in BH users than those with no BH use, whereas the median was 1.8 times higher. Mean annual medical cost alone for BH users was 1.3 times higher than that for non-BH users, whereas the median was 1.5 times higher. CONCLUSIONS The findings suggest the importance for the Japanese medical system to address BH needs of patients with cancer and introduce fiscal efficiencies to cancer care. Strategic implementation of effective integrated care services for patients with cancer should be considered in Japan.
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Bayoumi I, Schultz SE, Glazier RH. Primary care reform and funding equity for mental health disorders in Ontario: a retrospective observational population-based study. CMAJ Open 2020; 8:E455-E461. [PMID: 32561592 PMCID: PMC7850171 DOI: 10.9778/cmajo.20190153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Mental health disorders are associated with high morbidity and reduced life expectancy, and are largely managed in primary care. We sought to assess the equity of distribution of new alternative payment models and teams introduced under primary care reform in Ontario for patients with mental health disorders. METHODS We conducted a retrospective observational study using population-level administrative data for insured Ontario adults (age ≥ 18 yr) to identify all primary care payments to physicians that were allocated to individual patients in 2002/03 and 2011/12. We identified patients with mental health disorders using validated algorithms, and modelled the relations between per capita primary care costs and mental health disorders over time, stratified by type of mental health or substance use disorder and type of primary care payment. In an adjusted model, we adjusted for age, sex, rurality, neighbourhood income quintile, immigrant status, comorbidity and primary care model. For comparative purposes, we also examined the distribution of primary care payments for people with diabetes mellitus. RESULTS Total per capita primary care payments increased more slowly over the study period for patients with mental health disorders (62.0%) than for the general population (88.3%). Total payments for patients with substance use disorders increased by 142.7%, largely owing to urine drug testing in opioid substitution clinics. Adjusted total payments for those with versus without mental health disorders decreased by 10% between 2002/03 and 2011/12, driven by lower alternative payments. Similar decreases, also driven by lower alternative payments, were found for all mental health disorder subgroups except substance use and for diabetes. INTERPRETATION Payment and team reforms were associated with inequitable resource allocation to people with mental health disorders. The findings suggest the need for monitoring reforms for their impact on high-needs populations and making appropriate adjustments.
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Affiliation(s)
- Imaan Bayoumi
- Department of Family Medicine (Bayoumi), Queen's University, Kingston, Ont.; ICES (Bayoumi, Schultz, Glazier); Department of Family and Community Medicine (Glazier), University of Toronto; Department of Family and Community Medicine (Glazier), St. Michael's Hospital, Toronto, Ont.
| | - Susan E Schultz
- Department of Family Medicine (Bayoumi), Queen's University, Kingston, Ont.; ICES (Bayoumi, Schultz, Glazier); Department of Family and Community Medicine (Glazier), University of Toronto; Department of Family and Community Medicine (Glazier), St. Michael's Hospital, Toronto, Ont
| | - Richard H Glazier
- Department of Family Medicine (Bayoumi), Queen's University, Kingston, Ont.; ICES (Bayoumi, Schultz, Glazier); Department of Family and Community Medicine (Glazier), University of Toronto; Department of Family and Community Medicine (Glazier), St. Michael's Hospital, Toronto, Ont
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Leue C, van Schijndel M, Keszthelyi D, van Koeveringe G, Ponds R, Kathol R, Rutten B. The multi-disciplinary arena of psychosomatic medicine – Time for a transitional network approach. EUROPEAN JOURNAL OF PSYCHIATRY 2020. [DOI: 10.1016/j.ejpsy.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Oliver K, Lorenc T, Tinkler J, Bonell C. Understanding the unintended consequences of public health policies: the views of policymakers and evaluators. BMC Public Health 2019; 19:1057. [PMID: 31387560 PMCID: PMC6685223 DOI: 10.1186/s12889-019-7389-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background Public health policies sometimes have unexpected effects. Understanding how policies and interventions lead to outcomes is essential if policymakers and researchers are to intervene effectively and reduce harmful and other unintended consequences (UCs) of their actions. Yet, evaluating complex mechanisms and outcomes is challenging, even before considering how to predict assess and understand outcomes and UCs when interventions are scaled up. We aimed to explore with UK policymakers why some policies have UCs, and how researchers and policymakers should respond. Methods We convened a one-day workshop with 14 people involved in developing, implementing or evaluating social and public health policies, and/or evaluating possible unintended effects. This included senior evaluators, policymakers from government and associated agencies, and researchers, covering policy domains from public health, social policy, poverty, and international development. Results Policymakers suggested UCs happen for a range of reasons: poor policy design, unclear articulation of policy mechanisms or goals, or unclear or inappropriate evidence use, including evaluation techniques. While not always avoidable, it was felt that UCs could be partially mitigated by better use of theory and evidence, better involvement of stakeholders in concurrent design and evaluation of policies, and appropriate evaluation systems. Conclusions UCs can be used to explore the mechanisms underpinning social change caused by public health policies. Articulating these mechanisms is essential for truly evidence-informed decision-making, to enable informed debate about policy options, and to develop evaluation techniques. Future work includes trying to develop a holistic stakeholder-led evaluation process.
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Affiliation(s)
- Kathryn Oliver
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Theo Lorenc
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
| | - Jane Tinkler
- Department of Sociology, Social Policy and Criminology, University of Stirling, London, UK
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Pudalov LR, Swogger MT, Wittink M. Towards integrated medical and mental healthcare in the inpatient setting: what is the role of psychology? Int Rev Psychiatry 2018; 30:210-223. [PMID: 30821187 DOI: 10.1080/09540261.2018.1552125] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Integrated medical and psychiatric hospital units hold great promise for improving the value and quality of care for patients with severe mental illness and concomitant acute medical needs. It is important to explore the utility of providing a range of multidisciplinary inpatient services to meet patients' complex needs. Within this context, services typically provided by psychologists have received little research attention. To address this gap in the literature, this study assessed inpatient clinicians' perceptions of the need for specific behavioural services on a medical psychiatric unit, exploring their overlap with established psychological services. Results indicate the potential utility of specific psychological services, including psychological assessments, direct psychosocial interventions, and psychoeducational training. While reimbursement and billing barriers still exist for psychologists to be routinely incorporated into hospital settings, the movement towards value-based care could provide the opportunity to think about the value added. Embedding evidence-based psychological services has the potential to promote high quality, well-rounded care that aligns with the established mission of multidisciplinary teamwork on integrated medical and psychiatric inpatient units.
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Affiliation(s)
- Lauren R Pudalov
- a Chronic Pain Rehabilitation Program and Bariatric & Metabolic Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Marc T Swogger
- b Department of Psychiatry, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
| | - Marsha Wittink
- c Departments of Family Medicine and Psychiatry, University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
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Okafor M, Ede V, Kinuthia R, Satcher D. Explication of a Behavioral Health-Primary Care Integration Learning Collaborative and Its Quality Improvement Implications. Community Ment Health J 2018; 54:1109-1115. [PMID: 29327162 DOI: 10.1007/s10597-017-0230-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 12/27/2017] [Indexed: 11/27/2022]
Abstract
In an effort to tackle fragmented care in the US healthcare delivery system, we explored the use of learning collaborative (LC) to advance integration of behavioral health and primary care as one of the potential solutions to a holistic approach to the delivery of quality healthcare to individuals with physical and mental illness. How a diverse group of primary care and behavioral health providers formed a Community of Practice (CoP) with a common purpose and shared vision to advance integrated care using a LC approach is described. An account of their learning experience, key components of their quality improvement, practice changes, clinical processes, and improved outcomes are explained. This paper aims at describing the history, creative design, processes, roles of the CoP and impact of the LC on the advancement of integrated care practice and quality improvements for further exploration and replications.
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Affiliation(s)
- Martha Okafor
- Yale University School of Nursing, New Heaven, CT, USA.,Frank H. Netter School of Medicine, Quinnipiac University, North Haven, CT, USA.,Division of Behavioral Health, The Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, USA
| | - Victor Ede
- Division of Behavioral Health, The Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, USA.
| | - Rosemary Kinuthia
- Division of Behavioral Health, The Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, USA.,Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - David Satcher
- The Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, USA
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McFarland D, Gorman E, Kim S, Rothwell A, Saunders P, Tindle S, de la Vega-Diaz I, Steinberg A. Psychiatric evaluations prior to stem cell transplant - a survey of National Marrow Donor Programs. Psychooncology 2015; 25:877-9. [PMID: 26356138 DOI: 10.1002/pon.3955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/10/2015] [Accepted: 08/05/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel McFarland
- Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elaine Gorman
- Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Kim
- Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex Rothwell
- Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Patricia Saunders
- Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sharon Tindle
- Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Imelda de la Vega-Diaz
- Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amir Steinberg
- Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Coverdale J, Roberts LW, Balon R, Beresin EV. Pedagogical Implications of Partnerships Between Psychiatry and Obstetrics-Gynecology in Caring for Patients with Major Mental Disorders. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:430-436. [PMID: 26059737 DOI: 10.1007/s40596-015-0364-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Because there are no formal reviews, the authors set out to identify and describe programs that serve female patients with major mental disorders by integrating mental health care with services in obstetrics and gynecology and to describe the pedagogical implications of those programs. METHOD The authors searched PubMed for all articles describing a program in which psychiatry was formally integrated with obstetric or gynecological services, other than standard consultation-liaison programs, in the care of patients with major mental disorders. The search terms used included interdisciplinary, interprofessional, integrated, collaborative care, psychiatry, and obstetrics-gynecology or psychosomatic obstetrics-gynecology. RESULTS The authors found six distinct integrated programs. These included family planning clinics that were integrated into inpatient psychiatry services; inpatient and outpatient psychiatry services for pregnant mentally ill women in close collaboration with obstetric services; a day hospital for pregnant women with psychiatric disorders in an obstetric setting; an interdisciplinary training site providing care for predominantly depressed, low-income, and minority women; a primary care HIV service for women integrated with departments of obstetrics-gynecology and psychiatry; and an obstetrics-gynecology clinic-based collaborative depression care intervention for socially disadvantaged women. Residents' involvement was described in four of the programs. CONCLUSIONS These innovative and integrated programs potentially enhance the care of vulnerable and culturally diverse women with major mental disorders. The authors discuss how these programs may contribute to the education of residents in psychiatry and obstetrics-gynecology.
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Lahijani S, Rosenthal LJ. Insights from Collaborative Care: A Review of the Evidence for Depression and Diabetes. Psychiatr Ann 2015. [DOI: 10.3928/00485713-20150803-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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