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Steidtmann D, McBride S, Mishkind M, Shore J. Examining Burnout and Perspective on Videoconferencing in the Mental Health Workforce. Telemed J E Health 2024. [PMID: 38588556 DOI: 10.1089/tmj.2024.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Objective: To examine burnout and perspectives on videoconferencing over time for the mental health workforce. Methods: Members of an academic psychiatry department completed two anonymous surveys about virtual work and burnout 18 months apart (T1n = 274, response rate = 66.8%; T2n = 227, response rate = 36.7%). A subset completed the burnout subscale of the Stanford Professional Fulfillment Index (T1n = 145; T2n = 127). Results: Respondents were well satisfied with videoconferencing at both time points and satisfaction was higher at T2. Videoconferencing was not perceived to contribute to feelings of fatigue at either time point and burnout levels decreased from T1 to T2. Conclusions: Videoconferencing is well received by the mental health workforce and is not widely perceived to contribute to feelings of fatigue. Longer use of videoconferencing coincided with decreased levels of burnout. There are likely benefits to virtual work for the mental health workforce and virtual work may be protective from burnout.
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Affiliation(s)
- Dana Steidtmann
- Department of Psychiatry, School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Psychiatry, Helen and Arthur E. Johnson Depression Center, Aurora, Colorado, USA
- Brain and Behavior Innovation Center, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Samantha McBride
- Department of Psychiatry, School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Psychiatry, Helen and Arthur E. Johnson Depression Center, Aurora, Colorado, USA
| | - Matthew Mishkind
- Department of Psychiatry, School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Psychiatry, Helen and Arthur E. Johnson Depression Center, Aurora, Colorado, USA
- Brain and Behavior Innovation Center, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jay Shore
- Department of Psychiatry, School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
- Brain and Behavior Innovation Center, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
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Yellowlees PM, Burke MM, Gonzalez AD, Fisher A, Chan SR, Hilty DM, McCarron RM, Scher LM, Sciolla AF, Shore J, Xiong G, Fine J, Bannister J, Iosif AM. Patient and Provider Satisfaction with Asynchronous Versus Synchronous Telepsychiatry in Primary Care: A Secondary Mixed-Methods Analysis of a Randomized Controlled Trial. Telemed J E Health 2024; 30:e1049-e1063. [PMID: 38011623 PMCID: PMC11035926 DOI: 10.1089/tmj.2023.0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Asynchronous telepsychiatry (ATP) consultations are a novel form of psychiatric consultation. Studies comparing patient and provider satisfaction for ATP with that for synchronous telepsychiatry (STP) do not exist. Methods: This mixed-methods study is a secondary analysis of patients' and primary care providers' (PCPs) satisfaction from a randomized clinical trial of ATP compared with STP. Patients and their PCPs completed satisfaction surveys, and provided unstructured feedback about their experiences with either ATP or STP. Differences in patient satisfaction were assessed using mixed-effects logistic regression models, and the qualitative data were analyzed using thematic analysis with an inductive coding framework. Results: Patient satisfaction overall was high with 84% and 97% of respondents at 6 months reported being somewhat or completely satisfied with ATP and STP, respectively. Patients in the STP group were more likely to report being completely satisfied, to recommend the program to a friend, and to report being comfortable with their care compared with ATP (all p < 0.05). However, there was no difference between the patients in ATP and STP in perceived change in clinical outcomes (p = 0.51). The PCP quantitative data were small, and thus only summarized descriptively. Conclusions: Patients expressed their overall satisfaction with both STP and ATP. Patients in ATP reported more concerns about the process, likely because feedback after ATP was slower than that after STP consultations. PCPs had no apparent preference for STP or ATP, and reported implementing the psychiatrists' recommendations for both groups when such recommendations were made, which supports our previous findings. Trial Registration: ClinicalTrials.gov NCT02084979; https://clinicaltrials.gov/ct2/show/NCT02084979.
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Affiliation(s)
- Peter M. Yellowlees
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Michelle M. Burke
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Alvaro D. Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Alice Fisher
- Department of Public Health Sciences, University of California, Davis, California, USA
| | - Steven R. Chan
- Stanford University School of Medicine, Stanford, California, USA
- Veterans Administration Palo Alto Healthcare System, Palo Alto, California, USA
| | | | - Robert M. McCarron
- Department of Psychiatry, University of California, Irvine, California, USA
| | - Lorin M. Scher
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Andres F. Sciolla
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Jay Shore
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Glen Xiong
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Jeffrey Fine
- Department of Public Health Sciences, University of California, Davis, California, USA
| | - Jennifer Bannister
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Ana-Maria Iosif
- Department of Public Health Sciences, University of California, Davis, California, USA
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Shore J, Waugh M, Harding J, Roupas G, Pepi N, Ryan P. Value-Based Proposition of an Adapted Integrated Care Telehealth Service for Accountable Care Organization Members. Psychiatr Serv 2024:appips20230287. [PMID: 38532690 DOI: 10.1176/appi.ps.20230287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
The authors describe a real-world application of virtually integrated primary and behavioral health care implemented within an accountable care organization (ACO) system. Cost-of-care data from before and after a 6-month intervention were analyzed for 121 Medicaid and Child Health Plan Plus ACO members. The intervention was associated with a significant shift in the distribution of health care costs, from inpatient and emergency care to outpatient and preventive care. The program demonstrates a flexible and replicable approach to integration that can help expand effective primary care.
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Affiliation(s)
- Jay Shore
- AccessCare Services, Aurora, Colorado (Shore, Roupas); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora (Shore); Evaluation Department, Colorado Access, Aurora (Waugh, Harding, Pepi, Ryan); Quandary Consulting & Analytics, Denver (Waugh)
| | - Maryann Waugh
- AccessCare Services, Aurora, Colorado (Shore, Roupas); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora (Shore); Evaluation Department, Colorado Access, Aurora (Waugh, Harding, Pepi, Ryan); Quandary Consulting & Analytics, Denver (Waugh)
| | - Justin Harding
- AccessCare Services, Aurora, Colorado (Shore, Roupas); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora (Shore); Evaluation Department, Colorado Access, Aurora (Waugh, Harding, Pepi, Ryan); Quandary Consulting & Analytics, Denver (Waugh)
| | - George Roupas
- AccessCare Services, Aurora, Colorado (Shore, Roupas); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora (Shore); Evaluation Department, Colorado Access, Aurora (Waugh, Harding, Pepi, Ryan); Quandary Consulting & Analytics, Denver (Waugh)
| | - Neil Pepi
- AccessCare Services, Aurora, Colorado (Shore, Roupas); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora (Shore); Evaluation Department, Colorado Access, Aurora (Waugh, Harding, Pepi, Ryan); Quandary Consulting & Analytics, Denver (Waugh)
| | - Peter Ryan
- AccessCare Services, Aurora, Colorado (Shore, Roupas); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora (Shore); Evaluation Department, Colorado Access, Aurora (Waugh, Harding, Pepi, Ryan); Quandary Consulting & Analytics, Denver (Waugh)
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Jervis LL, Kleszynski K, TallBull G, Porter O, Shore J, Bair B, Manson S, Kaufman CE. Rural Native Veterans' Perceptions of Care in the Context of Navigator Program Development. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01955-9. [PMID: 38498116 DOI: 10.1007/s40615-024-01955-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION American Indian and Alaska Natives serve in the military at one of the highest rates of all racial and ethnic groups. For Veterans, the already significant healthcare disparities Natives experience are aggravated by barriers to accessing care, care navigation, and coordination of health care within the Veterans Health Administration (VHA) between the VHA and tribal health systems. To mitigate these barriers, the VHA is developing a patient navigation program designed specifically for rural Native Veterans. We describe formative work aimed at understanding and addressing barriers to VHA care from the perspective of rural Native Veterans and those who facilitate their care. METHODS Thirty-four individuals participated in semi-structured interviews (22 Veterans, 6 family members, and 6 Veteran advocates) drawn from 9 tribal communities across the US. RESULTS Participants described many barriers to using the VHA, including perceptions of care scarcity, long travel distances to the VHA, high travel costs, and bureaucratic barriers including poor customer service, scheduling issues, and long waits for appointments. Many Veterans preferred IHS/tribal health care over the VHA due to its proximity, simplicity, ease of use, and quality. CONCLUSION Rural Native Veterans must see a clear benefit to using the VHA given the many obstacles to its use. Veteran recommendations for addressing barriers to VHA care within a navigation program include assistance enrolling in, scheduling, and navigating VHA systems; paperwork assistance; cost reimbursement; and care coordination with the IHS/tribal health care.
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Affiliation(s)
- Lori L Jervis
- Department of Anthropology and Center for Applied Social Research, University of Oklahoma, Norman, OK, USA.
| | - Keith Kleszynski
- Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Gloria TallBull
- Center for Applied Social Research, University of Oklahoma, Norman, OK, USA
| | - Olivia Porter
- Department of Anthropology, University of Oklahoma, Norman, OK, USA
| | - Jay Shore
- Veterans Rural Health Resource Center, Salt Lake City, UT, USA
- Centers for American Indian and Alaska Native Health, Colorado School for Public Health, Aurora, CO, USA
| | - Byron Bair
- Veterans Rural Health Resource Center, Salt Lake City, UT, USA
| | - Spero Manson
- Centers for American Indian and Alaska Native Health, Colorado School for Public Health, Aurora, CO, USA
| | - Carol E Kaufman
- Veterans Rural Health Resource Center, Salt Lake City, UT, USA
- Centers for American Indian and Alaska Native Health, Colorado School for Public Health, Aurora, CO, USA
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Edwards M, Graziadio S, Shore J, Schmitz ND, Galvain T, Danker WA, Kocaman M, Pournaras DJ, Bowley DM, Hardy KJ. Plus Sutures for preventing surgical site infection: a systematic review of clinical outcomes with economic and environmental models. BMC Surg 2023; 23:300. [PMID: 37789307 PMCID: PMC10548560 DOI: 10.1186/s12893-023-02187-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 09/07/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Surgical site infections (SSIs) represent ~ 20% of all hospital-acquired infections in surgical patients and are associated with prolonged hospital stay, admission to intensive care, and mortality. We conducted a systematic review with economic and environmental models to assess whether triclosan-coated sutures (Plus Sutures) provide benefits over non-coated sutures in the reduction of SSI risk. METHODS Searches were conducted in fifteen databases. A total of 1,991 records were retrieved. Following deduplication and screening by two independent reviewers, 31 randomized controlled trials in adults and children were included in the review. Similarity of the studies was assessed by narrative review and confirmed by quantitative assessment. A fixed effects meta-analysis of SSI incidence model including all groups of patients estimated a risk ratio of 0.71 (95% confidence interval: 0.64 to 0.79) indicating those in the Plus Sutures group had a 29% reduction in the risk of developing an SSI compared with those in the control group (p < 0.001). Safety outcomes were analysed qualitatively. RESULTS The economic model estimated the use of Plus Sutures to result in average cost savings of £13.63 per patient. Plus Sutures remained cost-saving in all subgroup analyses with cost-savings ranging between £11 (clean wounds) and £140 (non-clean wounds). The environmental impact of SSI is substantial, and the model suggests that the introduction of Plus Sutures could result in potential environmental benefits. CONCLUSIONS The evidence suggests that Plus Sutures are associated with a reduced incidence of SSI across all surgery types alongside cost savings when compared with standard sutures.
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Affiliation(s)
- M Edwards
- York Health Economics Consortium, University of York, Enterprise House, Innovation Way, York, YO10 5NQ, UK.
| | - S Graziadio
- York Health Economics Consortium, University of York, Enterprise House, Innovation Way, York, YO10 5NQ, UK
| | - J Shore
- York Health Economics Consortium, University of York, Enterprise House, Innovation Way, York, YO10 5NQ, UK
| | - N D Schmitz
- Johnson & Johnson MEDICAL GmbH, Robert-Koch-Strasse 1, 22851, Norderstedt, Germany
| | - T Galvain
- Global Health Economics, Johnson & Johnson Medical Devices, New Brunswick, NJ, USA
| | - W A Danker
- Ethicon Inc., 1000 US-202, Raritan, NJ, 08869, USA
| | - M Kocaman
- Johnson & Johnson Medical Limited, Berkshire, UK
| | - D J Pournaras
- Department of Bariatric and Metabolic Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - D M Bowley
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - K J Hardy
- Derbyshire Pathology, University Hospitals Derby and Burton NHS Trust, Royal Derby Hospital, Derby, UK
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Kusters IS, Amspoker AB, Frosio K, Day SC, Day G, Ecker A, Hogan J, Lindsay JA, Shore J. Rural-Urban Disparities in Video Telehealth Use During Rapid Mental Health Care Virtualization Among American Indian/Alaska Native Veterans. JAMA Psychiatry 2023; 80:1055-1060. [PMID: 37494050 PMCID: PMC10372753 DOI: 10.1001/jamapsychiatry.2023.2285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/15/2023] [Indexed: 07/27/2023]
Abstract
Importance American Indian/Alaska Native veterans experience a high risk for health inequities, including mental health (MH) care access. Rapid virtualization of MH care in response to the COVID-19 pandemic facilitated care continuity across the Veterans Health Administration (VHA), but the association between virtualization of care and health inequities among American Indian/Alaska Native veterans is unknown. Objective To examine differences in video telehealth (VTH) use for MH care between American Indian/Alaska Native and non-American Indian/Alaska Native veterans by rurality and urbanicity. Design, Setting, and Participants In this cohort study, VHA administrative data on VTH use among a veteran cohort that received MH care from October 1, 2019, to February 29, 2020 (prepandemic), and April 1 to December 31, 2020 (early pandemic), were examined. Exposures At least 1 outpatient MH encounter during the study period. Main Outcomes and Measures The main outcome was use of VTH among all study groups (ie, American Indian/Alaska Native, non-American Indian/Alaska Native, rural, or urban) before and during the early pandemic. American Indian/Alaska Native veteran status and rurality were examined as factors associated with VTH utilization through mixed models. Results Of 1 754 311 veterans (mean [SD] age, 54.89 [16.23] years; 85.21% male), 0.48% were rural American Indian/Alaska Native; 29.04%, rural non-American Indian/Alaska Native; 0.77%, urban American Indian/Alaska Native; and 69.71%, urban non-American Indian/Alaska Native. Before the pandemic, a lower percentage of urban (b = -0.91; SE, 0.02; 95% CI, -0.95 to -0.87; P < .001) and non-American Indian/Alaska Native (b = -0.29; SE, 0.09; 95% CI, -0.47 to -0.11; P < .001) veterans used VTH. During the early pandemic period, a greater percentage of urban (b = 1.37; SE, 0.05; 95% CI, 1.27-1.47; P < .001) and non-American Indian/Alaska Native (b = 0.55; SE, 0.19; 95% CI, 0.18-0.92; P = .003) veterans used VTH. There was a significant interaction between rurality and American Indian/Alaska Native status during the early pandemic (b = -1.49; SE, 0.39; 95% CI, -2.25 to -0.73; P < .001). Urban veterans used VTH more than rural veterans, especially American Indian/Alaska Native veterans (non-American Indian/Alaska Native: rurality b = 1.35 [SE, 0.05; 95% CI, 1.25-1.45; P < .001]; American Indian/Alaska Native: rurality b = 2.91 [SE, 0.38; 95% CI, 2.17-3.65; P < .001]). The mean (SE) increase in VTH was 20.34 (0.38) and 15.35 (0.49) percentage points for American Indian/Alaska Native urban and rural veterans, respectively (difference in differences [DID], 4.99 percentage points; SE, 0.62; 95% CI, 3.77-6.21; t = -7.999; df, 11 000; P < .001), and 12.97 (0.24) and 11.31 (0.44) percentage points for non-American Indian/Alaska Native urban and rural veterans, respectively (DID, 1.66; SE, 0.50; 95% CI, 0.68-2.64; t = -3.32; df, 15 000; P < .001). Conclusions and Relevance In this cohort study, although rapid virtualization of MH care was associated with greater VTH use in all veteran groups studied, a significant difference in VTH use was seen between rural and urban populations, especially among American Indian/Alaska Native veterans. The findings suggest that American Indian/Alaska Native veterans in rural areas may be at risk for VTH access disparities.
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Affiliation(s)
- Isabelle S. Kusters
- Department of Clinical, Health, and Applied Sciences, University of Houston–Clear Lake, Houston, Texas
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Amber B. Amspoker
- Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
| | - Kristen Frosio
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, US Department of Veterans Affairs
| | - Stephanie C. Day
- Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, US Department of Veterans Affairs
| | - Giselle Day
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, US Department of Veterans Affairs
| | - Anthony Ecker
- Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, US Department of Veterans Affairs
| | - Julianna Hogan
- Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, US Department of Veterans Affairs
| | - Jan A. Lindsay
- Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, US Department of Veterans Affairs
- Baker Institute for Public Policy, Rice University, Houston, Texas
| | - Jay Shore
- Veterans Rural Health Resource Center, Veterans Health Administration Office of Rural Health, Salt Lake City, Utah
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, Aurora
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Howland M, Tennant M, Bowen DJ, Bauer AM, Fortney JC, Pyne JM, Shore J, Cerimele JM. Psychiatrist and Psychologist Experiences with Telehealth and Remote Collaborative Care in Primary Care: A Qualitative Study. J Rural Health 2021; 37:780-787. [PMID: 33022079 PMCID: PMC8518862 DOI: 10.1111/jrh.12523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Availability of mental health services is limited in the rural United States. Two promising models to reach patients with limited access to care are telehealth referral and collaborative care. The objective of this study was to assess telepsychiatrist- and telepsychologist-level facilitators and barriers to satisfaction with and implementation of these 2 telehealth models in rural settings. METHODS Focus groups were held in 2019 using a semistructured interview guide. Participants were off-site telepsychiatrists (N = 10) and telepsychologists (N = 4) for primary care clinics across 3 states (Washington, Michigan, and Arkansas) involved in a recent pragmatic comparative effectiveness trial. Qualitative analysis occurred inductively by 2 independent coders. FINDINGS Participants were satisfied with the models partly owing to good patient rapport and expanding access to care. Teamwork was highlighted as a facilitator in collaborative care and was often related to work with care managers. However, participants described communication with primary care providers as a challenge, especially in the telehealth referral arm. Barriers centered on variability of logistical processes (eg, symptom monitoring, scheduling, electronic medical record processes, and credentialing) among sites. Staff turnover, variable clinic investment, and inadequacy of training were possible explanations for these barriers. CONCLUSIONS Participants described high motivation to provide team-based, remote care for patients, though they experienced operational challenges. Centralized credentialing, scheduling, and record keeping are possible solutions. These findings are important because consulting psychiatrists and psychologists may play a leadership role in the dissemination of these models.
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Affiliation(s)
- Molly Howland
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashington
| | - McKenna Tennant
- Department of Public Health GeneticsUniversity of Washington School of Public HealthSeattleWashington
| | - Deborah J. Bowen
- Department of Bioethics and HumanitiesUniversity of WashingtonSeattleWashington
| | - Amy M. Bauer
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashington
| | - John C. Fortney
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashington
- Department of Veterans Affairs, HSR&D Center of Innovation for Veteran‐Centered and Value‐Driven CareVA Puget Sound Health Care SystemSeattleWashington
- Department of Health ServicesUniversity of Washington School of Public HealthSeattleWashington
| | - Jeffrey M. Pyne
- Department of Psychiatry and Behavioral Sciences, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansas
| | - Jay Shore
- Helen and Arthur E. Johnson Depression Center, Anschutz Medical Campus, Departments of Psychiatry and Family MedicineUniversity of Colorado School of MedicineAuroraColorado
- Centers for American Indian and Alaska Native Health, Colorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraColorado
| | - Joseph M. Cerimele
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashington
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Yellowlees PM, Parish MB, Gonzalez AD, Chan SR, Hilty DM, Yoo BK, Leigh JP, McCarron RM, Scher LM, Sciolla AF, Shore J, Xiong G, Soltero KM, Fisher A, Fine JR, Bannister J, Iosif AM. Clinical Outcomes of Asynchronous Versus Synchronous Telepsychiatry in Primary Care: Randomized Controlled Trial. J Med Internet Res 2021; 23:e24047. [PMID: 33993104 PMCID: PMC8335606 DOI: 10.2196/24047] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/26/2021] [Accepted: 05/16/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Asynchronous telepsychiatry (ATP; delayed-time) consultations are a novel form of psychiatric consultation in primary care settings. Longitudinal studies comparing clinical outcomes for ATP with synchronous telepsychiatry (STP) are lacking. OBJECTIVE This study aims to determine the effectiveness of ATP in improving clinical outcomes in English- and Spanish-speaking primary care patients compared with STP, the telepsychiatry usual care method. METHODS Overall, 36 primary care physicians from 3 primary care clinics referred a heterogeneous sample of 401 treatment-seeking adult patients with nonurgent psychiatric disorders. A total of 184 (94 ATP and 90 STP) English- and Spanish-speaking participants (36/184, 19.6% Hispanic) were enrolled and randomized, and 160 (80 ATP and 80 STP) of them completed baseline evaluations. Patients were treated by their primary care physicians using a collaborative care model in consultation with the University of California Davis Health telepsychiatrists, who consulted with patients every 6 months for up to 2 years using ATP or STP. Primary outcomes (the clinician-rated Clinical Global Impressions [CGI] scale and the Global Assessment of Functioning [GAF]) and secondary outcomes (patients' self-reported physical and mental health and depression) outcomes were assessed every 6 months. RESULTS For clinician-rated primary outcomes, ATP did not promote greater improvement than STP at 6-month follow-up (ATP vs STP, adjusted difference in follow-up at 6 months vs baseline differences for CGI: 0.2, 95% CI -0.2 to 0.6; P=.28; and GAF: -0.6, 95% CI -3.1 to 1.9; P=.66) or 12-month follow-up (ATP vs STP, adjusted difference in follow-up at 12 months vs baseline differences for CGI: 0.4, 95% CI -0.04 to 0.8; P=.07; and GAF: -0.5, 95% CI -3.3 to 2.2; P=.70), but patients in both arms had statistically and clinically significant improvements in both outcomes. There were no significant differences in improvement from baseline between ATP and STP on any patient self-reported ratings at any follow-up (all P values were between .17 and .96). Dropout rates were higher than predicted but similar between the 2 arms. Of those with baseline visits, 46.8% (75/160) did not have a follow-up at 1 year, and 72.7% (107/147) did not have a follow-up at 2 years. No serious adverse events were associated with the intervention. CONCLUSIONS This is the first longitudinal study to demonstrate that ATP can improve clinical outcomes in English- and Spanish-speaking primary care patients. Although we did not find evidence that ATP is superior to STP in improving clinical outcomes, it is potentially a key part of stepped mental health interventions available in primary care. ATP presents a possible solution to the workforce shortage of psychiatrists and a strategy for improving existing systems of care. TRIAL REGISTRATION ClinicalTrials.gov NCT02084979; https://clinicaltrials.gov/ct2/show/NCT02084979.
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Affiliation(s)
- Peter M Yellowlees
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Michelle Burke Parish
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Alvaro D Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Steven R Chan
- Stanford University School of Medicine, Stanford, CA, United States
- Veterans Administration Palo Alto Healthcare System, Palo Alto, CA, United States
| | - Donald M Hilty
- Northern California Veterans Administration, Mather, CA, United States
| | - Byung-Kwang Yoo
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
| | - J Paul Leigh
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
| | | | - Lorin M Scher
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Andres F Sciolla
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Jay Shore
- University of Colorado Anschutz Medical Campus, Denver, CO, United States
| | - Glen Xiong
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | | | - Alice Fisher
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
| | - Jeffrey R Fine
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
| | - Jennifer Bannister
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Ana-Maria Iosif
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
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9
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Franz D, Raschke M, Giannoudis PV, Leliveld M, Metsemakers WJ, Verhofstad MHJ, Craig JA, Shore J, Smith A, Muehlendyck C, Kerstan M, Fuchs T. Use of antibiotic coated intramedullary nails in open tibia fractures: A European medical resource use and cost-effectiveness analysis. Injury 2021; 52:1951-1958. [PMID: 34001375 DOI: 10.1016/j.injury.2021.04.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/01/2021] [Accepted: 04/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE In patients with open tibial fractures, bone and wound infections are associated with an increased hospital length of stay and higher costs. The infection risk increases with the use of implants. Innovations to reduce this risk include antibiotic-coated implants. This study models whether the use of a gentamicin-coated intramedullary tibial nail is cost-effective for trauma centers managing patients with a high risk of infection. EFFICACY Absolute infection risk and relative risk reduction, by fracture grade, for antibiotic-coated nails compared to standard nails for patients with open tibial fractures were estimated based on the results of a meta-analysis, which assessed the additional benefit of locally-administered prophylactic antibiotics in open tibia fractures treated with implants. The observed efficacy of antibiotic-coated nails in reducing infections was applied in an economic model. METHODS The model compared infection rates, inpatient days, theatre usage and costs in high risk patients, with a Gustilo-Anderson (GA) grade III open fracture, for two patient cohorts from a trauma center perspective, with a 1-year time horizon. In one cohort all GAIII patients received a gentamicin-coated nail whilst GAI and GAII patients received a standard nail. All patients in the comparator cohort received a standard nail. Four European trauma centers provided patient-level data (n=193) on inpatient days, procedures and related costs for patients with and without infections. RESULTS Using the gentamicin-coated nail in patients at high risk of infection (GAIII) was associated with 75% lower rate of infection and cost savings (€477 - €3.263) for all included centers; the higher cost of the implant was offset by savings from fewer infections, inpatient days (-26%) and re-operations (-10%). This result was confirmed by extensive sensitivity analyses. CONCLUSIONS Analyses demonstrated that infection rates and total costs for in-hospital treatment could be potentially reduced by 75% and up to 15% respectively, by using a gentamicin-coated nail in patients at high risk of infection. Fewer infections, reduced inpatient days and re-operations may be potentially associated with use of antibiotic-coated implants. Results are sensitive to the underlying infection risk, with greatest efficacy and cost-savings when the coated implant is used in high risk patients.
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Affiliation(s)
- D Franz
- Franz und Wenke, Beratung im Gesundheitswesen GbR, Technologiehof Mendelstraße 11, 48149 Münster, Germany.
| | - M Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Germany.
| | - P V Giannoudis
- Department of Trauma and Orthopaedic Surgery, University Hospital of Leeds, England.
| | - M Leliveld
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - W J Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, Belgium.
| | - M H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - J A Craig
- York Health Economics Consortium, University of York, York, UK, YO10 5NQ.
| | - J Shore
- York Health Economics Consortium, University of York, York, UK, YO10 5NQ.
| | - A Smith
- Health Economics Consortium, University of York, York, UK, YO10 5NQ.
| | - C Muehlendyck
- J&J, Hummelsbutteler Steindamm 71, 22851 Norderstedt, Germany.
| | - M Kerstan
- J&J, Synthes GmbH, Luzernstrasse 21, 4528 Zuchwil, Switzerland.
| | - T Fuchs
- Vivantes Klinikum im Friedrichshain, Zentrum für Muskuloskelettale Medizin, Klinik für Orthopädie, Unfall-, Hand- und Wiederherstellungschirurgie Standort Landsberger Allee 49, 10249 Berlin, Germany.
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10
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Parish MB, Gonzalez A, Hilty D, Chan S, Xiong G, Scher L, Liu D, Sciolla A, Shore J, McCarron R, Kahn D, Iosif AM, Yellowlees P. Asynchronous Telepsychiatry Interviewer Training Recommendations: A Model for Interdisciplinary, Integrated Behavioral Health Care. Telemed J E Health 2021; 27:982-988. [PMID: 33434453 DOI: 10.1089/tmj.2020.0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: Asynchronous telepsychiatry (ATP) is an integrative model of behavioral health service delivery that is applicable in a variety of settings and populations, particularly consultation in primary care. This article outlines the development of a training model for ATP clinician skills. Methods: Clinical and procedural training for ATP clinicians (n = 5) was provided by master's-level, clinical mental health providers developed by three experienced telepsychiatrists (P.Y. D.H., and J.S) and supervised by a tele-psychiatrist (PY, GX, DL) through seminar, case supervision, and case discussions. A training manual and one-on-one sessions were employed for initial training. Unstructured expert discussion and feedback sessions were conducted in the training phase of the study in year 1 and annually thereafter over the remaining 4 years of the study. The notes gathered during those sessions were synthesized into themes to gain a summary of the study telepsychiatrist training recommendations for ATP interviewers. Results: Expert feedback and discussion revealed three overarching themes of recommended skill sets for ATP interviewers: (1) comprehensive skills in brief psychiatric interviewing, (2) adequate knowledge base of behavioral health conditions and therapeutic techniques, and (3) clinical documentation, integrated care/consultation practices, and e-competency skill sets. The model of training and skill requirements from expert feedback sessions included these three skill sets. Technology training recommendations were also identified and included: (1) awareness of privacy/confidentiality for electronic data gathering, storage, management, and sharing; (2) technology troubleshooting; and (3) video filming/retrieval. Conclusions: We describe and provide a suggested training model for the use of ATP integrated behavioral health. The training needs for ATP clinicians were assessed on a limited convenience sample of experts and clinicians, and more rigorous studies of training for ATP and other technology-focused, behavioral health services are needed. Clinical Trials number: NCT03538860.
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Affiliation(s)
- Michelle Burke Parish
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
| | - Alvaro Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
| | - Donald Hilty
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
- Northern California Veterans Administration, Sacramento, California, USA
| | - Steven Chan
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
- School of Medicine, Stanford University, Palo Alto, California, USA
- Addiction Treatment Services, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Glen Xiong
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
| | - Lorin Scher
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
| | - David Liu
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
| | - Andres Sciolla
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
| | - Jay Shore
- University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Robert McCarron
- Department of Psychiatry, University of California, Irvine, California, USA
| | - Debra Kahn
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
| | - Ana-Maria Iosif
- Department of Public Health Sciences, University of California, Davis, Sacramento, California, USA
| | - Peter Yellowlees
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California, USA
- Division of Clinical Affairs, University of California, Davis, Sacramento, California, USA
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Abstract
Introduction: Alaska Native communities experience high rates of alcohol and substance abuse and face challenges accessing quality, culturally appropriate treatment. Telepsychiatry could help bridge this gap, but no publications have examined its impacts for alcohol and substance abuse treatment directed at Alaska Native communities. This study explores one telepsychiatry clinic's impact on a residential substance abuse treatment serving the Alaska Native community in Anchorage, Alaska. Methods: Using a matched case - control design, 103 cases receiving telepsychiatry services between 2007 and 2012 were matched with 103 controls who did not. Outcome measures included length of stay, discharge plans, emergency room visits, and hospital admissions; clinical history, including previous suicide attempts, history of violence, and trauma history; social stressors such as current legal issues, unemployment, and homelessness; mental health, medical, and substance abuse diagnoses; and number of telepsychiatry appointments and nature of telepsychiatry services rendered. Results: Both groups exhibited high rates of mental and medical illness, socioeconomic challenges, and substance abuse. However, the telepsychiatry group demonstrated a significantly higher rate of post-traumatic stress disorder, history of violence, ongoing legal issues, and children in outside custody. It also remained engaged in treatment longer, had fewer discharges against medical advice, and was more likely to complete treatment. Discussion/Conclusions: Our study highlights this telepsychiatry clinic's real-world difference serving the complex substance abuse treatment needs of Alaska Native individuals. It also reinforces telepsychiatry's promise in serving other communities facing a high burden of addiction and mental illness yet facing barriers to high-quality, culturally competent services.
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Affiliation(s)
- Rupinder K Legha
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Center for Health Services and Society, University of California Los Angeles, Los Angeles, California, USA
| | - Laurie Moore
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rebecca Ling
- Cook Inlet Tribal Council, Inc., Anchorage, Alaska, USA
| | - Douglas Novins
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jay Shore
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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12
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Mendoza NS, Moreno FA, Hishaw GA, Gaw AC, Fortuna LR, Skubel A, Porche MV, Roessel MH, Shore J, Gallegos A. Affirmative Care Across Cultures: Broadening Application. Focus (Am Psychiatr Publ) 2020; 18:31-39. [PMID: 32047395 DOI: 10.1176/appi.focus.20190030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Affirmative practice is an approach to health and behavioral health care that validates and supports the identities stated or expressed by those served. Affirmative care requires the practitioner to actively honor and celebrate identity while at the same time validating the oppression felt by individuals seeking services. Validation and empathy fundamentally result from increased understanding of individuals' history, cultural context, and lived experiences. Origins of the approach honored the experience of those in LGBTQ+ communities; however, affirmative care should be valued across cultures, systems, and settings in which health and behavioral health care are offered. Affirmative care principles should be applied across cultures and communities while recognizing the worth of the individual and avoiding stereotyping. Along with delineating historical and demographic contexts, the authors offer recommendations for affirmative care in practice with African American, Asian, Indigenous, and Latinx individuals, as well as those living in rural communities.
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Affiliation(s)
- Natasha S Mendoza
- Center for Applied Behavioral Health Policy, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix (Mendoza, Gallegos); College of Medicine, University of Arizona Health Sciences, Tucson and Phoenix (Moreno); College of Medicine, University of Arizona Health Sciences Center, Tucson (Hishaw); University of California, San Francisco, Medical School, San Francisco (Gaw); Boston Medical Center, School of Medicine (Fortuna), and Wheelock College of Education and Human Development (Skubel, Porche), all at Boston University, Boston; Caucus of American Indian, Alaska Native and Native Hawaiian Psychiatrists, American Psychiatric Association, Washington, DC (Roessel); Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora (Shore)
| | - Francisco A Moreno
- Center for Applied Behavioral Health Policy, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix (Mendoza, Gallegos); College of Medicine, University of Arizona Health Sciences, Tucson and Phoenix (Moreno); College of Medicine, University of Arizona Health Sciences Center, Tucson (Hishaw); University of California, San Francisco, Medical School, San Francisco (Gaw); Boston Medical Center, School of Medicine (Fortuna), and Wheelock College of Education and Human Development (Skubel, Porche), all at Boston University, Boston; Caucus of American Indian, Alaska Native and Native Hawaiian Psychiatrists, American Psychiatric Association, Washington, DC (Roessel); Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora (Shore)
| | - G Alexander Hishaw
- Center for Applied Behavioral Health Policy, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix (Mendoza, Gallegos); College of Medicine, University of Arizona Health Sciences, Tucson and Phoenix (Moreno); College of Medicine, University of Arizona Health Sciences Center, Tucson (Hishaw); University of California, San Francisco, Medical School, San Francisco (Gaw); Boston Medical Center, School of Medicine (Fortuna), and Wheelock College of Education and Human Development (Skubel, Porche), all at Boston University, Boston; Caucus of American Indian, Alaska Native and Native Hawaiian Psychiatrists, American Psychiatric Association, Washington, DC (Roessel); Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora (Shore)
| | - Albert C Gaw
- Center for Applied Behavioral Health Policy, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix (Mendoza, Gallegos); College of Medicine, University of Arizona Health Sciences, Tucson and Phoenix (Moreno); College of Medicine, University of Arizona Health Sciences Center, Tucson (Hishaw); University of California, San Francisco, Medical School, San Francisco (Gaw); Boston Medical Center, School of Medicine (Fortuna), and Wheelock College of Education and Human Development (Skubel, Porche), all at Boston University, Boston; Caucus of American Indian, Alaska Native and Native Hawaiian Psychiatrists, American Psychiatric Association, Washington, DC (Roessel); Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora (Shore)
| | - Lisa R Fortuna
- Center for Applied Behavioral Health Policy, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix (Mendoza, Gallegos); College of Medicine, University of Arizona Health Sciences, Tucson and Phoenix (Moreno); College of Medicine, University of Arizona Health Sciences Center, Tucson (Hishaw); University of California, San Francisco, Medical School, San Francisco (Gaw); Boston Medical Center, School of Medicine (Fortuna), and Wheelock College of Education and Human Development (Skubel, Porche), all at Boston University, Boston; Caucus of American Indian, Alaska Native and Native Hawaiian Psychiatrists, American Psychiatric Association, Washington, DC (Roessel); Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora (Shore)
| | - Anna Skubel
- Center for Applied Behavioral Health Policy, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix (Mendoza, Gallegos); College of Medicine, University of Arizona Health Sciences, Tucson and Phoenix (Moreno); College of Medicine, University of Arizona Health Sciences Center, Tucson (Hishaw); University of California, San Francisco, Medical School, San Francisco (Gaw); Boston Medical Center, School of Medicine (Fortuna), and Wheelock College of Education and Human Development (Skubel, Porche), all at Boston University, Boston; Caucus of American Indian, Alaska Native and Native Hawaiian Psychiatrists, American Psychiatric Association, Washington, DC (Roessel); Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora (Shore)
| | - Michelle V Porche
- Center for Applied Behavioral Health Policy, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix (Mendoza, Gallegos); College of Medicine, University of Arizona Health Sciences, Tucson and Phoenix (Moreno); College of Medicine, University of Arizona Health Sciences Center, Tucson (Hishaw); University of California, San Francisco, Medical School, San Francisco (Gaw); Boston Medical Center, School of Medicine (Fortuna), and Wheelock College of Education and Human Development (Skubel, Porche), all at Boston University, Boston; Caucus of American Indian, Alaska Native and Native Hawaiian Psychiatrists, American Psychiatric Association, Washington, DC (Roessel); Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora (Shore)
| | - Mary Hasbah Roessel
- Center for Applied Behavioral Health Policy, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix (Mendoza, Gallegos); College of Medicine, University of Arizona Health Sciences, Tucson and Phoenix (Moreno); College of Medicine, University of Arizona Health Sciences Center, Tucson (Hishaw); University of California, San Francisco, Medical School, San Francisco (Gaw); Boston Medical Center, School of Medicine (Fortuna), and Wheelock College of Education and Human Development (Skubel, Porche), all at Boston University, Boston; Caucus of American Indian, Alaska Native and Native Hawaiian Psychiatrists, American Psychiatric Association, Washington, DC (Roessel); Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora (Shore)
| | - Jay Shore
- Center for Applied Behavioral Health Policy, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix (Mendoza, Gallegos); College of Medicine, University of Arizona Health Sciences, Tucson and Phoenix (Moreno); College of Medicine, University of Arizona Health Sciences Center, Tucson (Hishaw); University of California, San Francisco, Medical School, San Francisco (Gaw); Boston Medical Center, School of Medicine (Fortuna), and Wheelock College of Education and Human Development (Skubel, Porche), all at Boston University, Boston; Caucus of American Indian, Alaska Native and Native Hawaiian Psychiatrists, American Psychiatric Association, Washington, DC (Roessel); Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora (Shore)
| | - Anthony Gallegos
- Center for Applied Behavioral Health Policy, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix (Mendoza, Gallegos); College of Medicine, University of Arizona Health Sciences, Tucson and Phoenix (Moreno); College of Medicine, University of Arizona Health Sciences Center, Tucson (Hishaw); University of California, San Francisco, Medical School, San Francisco (Gaw); Boston Medical Center, School of Medicine (Fortuna), and Wheelock College of Education and Human Development (Skubel, Porche), all at Boston University, Boston; Caucus of American Indian, Alaska Native and Native Hawaiian Psychiatrists, American Psychiatric Association, Washington, DC (Roessel); Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora (Shore)
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13
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Khanna AD, Duca LM, Kay JD, Shore J, Kelly SL, Crume T. Prevalence of Mental Illness in Adolescents and Adults With Congenital Heart Disease from the Colorado Congenital Heart Defect Surveillance System. Am J Cardiol 2019; 124:618-626. [PMID: 31303246 DOI: 10.1016/j.amjcard.2019.05.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/29/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
Abstract
The aim of this study was to estimate the prevalence of the full spectrum of mental illness in adolescents (aged 11 to 17) and adults (aged 18 to 64) with congenital heart defects (CHDs) in the population-level Colorado Congenital Heart Disease Surveillance System. Further we sought to investigate whether severity of the defect, frequency of recent cardiac procedures or underlying genetic disorders influence these estimates. The cohort included patients in clinical care for CHDs between January 1, 2011 and December 31, 2013, identified across multiple healthcare systems and insurance claims. Of 2,192 adolescents with CHDs, 20% were diagnosed with a mental illness with the most prevalent categories being developmental disorders (8%), anxiety disorders (6%), attention, conduct, behavior, impulse control disorders (6%), and mood disorders (5%). Of 6,924 adults with CHDs, 33% were diagnosed with a mental illness with the most prevalent categories being mood disorders (13%), anxiety disorders (13%), and substance-related disorders (6%). Greater lesion complexity was associated with a higher likelihood of anxiety and developmental disorders in both adolescents and adults. Adolescents and adults who had ≥2 cardiac procedures in the 3-year surveillance period had a 3- and 4.5-fold higher likelihood of a mental illness diagnosis, respectively, compared with those who had fewer than 2 cardiac procedures. Finally, patients with a genetic syndrome were more likely to have a mental illness diagnosis. In conclusion, mental illness is a prevalent co-morbidity in the adolescent and adult population with CHDs, thus comprehensive care should include mental health care.
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Affiliation(s)
- Amber D Khanna
- Departments of Internal Medicine and Pediatrics, Divisions of Cardiology, University of Colorado | Anschutz Medical Campus, Aurora, Colorado.
| | - Lindsey M Duca
- Department of Epidemiology, Colorado School of Public Health, University of Colorado | Anschutz Medical Campus, Aurora, Colorado
| | - Joseph D Kay
- Departments of Internal Medicine and Pediatrics, Divisions of Cardiology, University of Colorado | Anschutz Medical Campus, Aurora, Colorado
| | - Jay Shore
- Department of Psychiatry and Family Medicine, University of Colorado | Anschutz Medical Campus, Aurora, Colorado
| | - Sarah L Kelly
- Departments of Pediatrics and Psychiatry, University of Colorado | Anschutz Medical Campus, Aurora, Colorado
| | - Tessa Crume
- Department of Epidemiology, Colorado School of Public Health, University of Colorado | Anschutz Medical Campus, Aurora, Colorado
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Marshall C, Shore J, Arber M, Cikalo M, Oladapo T, Peel A, McCool R, Jenks M. Mepilex Border Sacrum and Heel Dressings for the Prevention of Pressure Ulcers: A NICE Medical Technology Guidance. Appl Health Econ Health Policy 2019; 17:453-465. [PMID: 30820871 PMCID: PMC6647510 DOI: 10.1007/s40258-019-00465-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Mepilex Border Sacrum and Heel dressings are self-adherent, multilayer foam dressings designed for use on the heel and sacrum aiming to prevent pressure ulcers. The dressings are used in addition to standard care protocols for pressure ulcer prevention. The National Institute for Health and Care Excellence (NICE) selected Mepilex Border Sacrum and Heel dressings for evaluation. The External Assessment Centre (EAC) critiqued the company's submission. Thirteen studies (four randomised controlled trials and nine nonrandomised comparative studies) were included. The majority of studies compared Mepilex Border Sacrum dressings (plus standard care) with standard care alone. Comparative evidence for Mepilex Border Heel dressings was limited. A meta-analysis indicated a non-statistically significant difference in favour of Mepilex Border Sacrum dressings for pressure ulcer incidence [RR 0.51 (95% CI 0.22-1.18)]. The company produced a de novo cost model, which was critiqued by the EAC. After the EAC updated input parameters, cost savings of £19 per patient compared with standard care alone for pressure ulcer prevention were estimated with Mepilex Border dressings predicted to be cost saving in 57% of iterations. The Medical Technologies Advisory Committee reviewed the evidence and judged that, although Mepilex Border Heel and Sacrum dressings have potential to prevent pressure ulcers in people who are considered to be at risk in acute care settings, further evidence is required to address uncertainties around the claimed benefits of the dressings and the incidence of pressure ulcers in an NHS acute-care setting. After a public consultation, NICE published this as Medical Technology Guidance 40.
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Affiliation(s)
- C Marshall
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, Heslington, York, YO10 5NQ, UK
| | - J Shore
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, Heslington, York, YO10 5NQ, UK
| | - M Arber
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, Heslington, York, YO10 5NQ, UK
| | - M Cikalo
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, Heslington, York, YO10 5NQ, UK
| | - T Oladapo
- National Institute for Health and Care Excellence, Level 1A, City Tower, Piccadilly Plaza, Manchester, M1 4BT, UK
| | - A Peel
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, Heslington, York, YO10 5NQ, UK
| | - R McCool
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, Heslington, York, YO10 5NQ, UK
| | - Michelle Jenks
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, Heslington, York, YO10 5NQ, UK.
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15
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Shore J, Webb G, Boyer W, Sukovaty L. Supplementation of INRA 96 extender with EC-Oxyrase for cold storage of stallion spermatozoa. J Equine Vet Sci 2019. [DOI: 10.1016/j.jevs.2019.03.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Shore J, Webb G, Boyer W, Sukovaty L. Inclusion of pyruvate in stallion semen extenders. J Equine Vet Sci 2019. [DOI: 10.1016/j.jevs.2019.03.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Abstract
The edgewise interactions of anions with phenylalanine (Phe) aromatic rings in proteins, known as anion-quadrupole interactions, have been well studied. However, the anion-quadrupole interactions of the tyrosine (Tyr) and tryptophan (Trp) rings have been less well studied, probably because these have been considered weaker than interactions of anions hydrogen bonded to Trp/Tyr side chains. Distinguishing such hydrogen bonding interactions, we comprehensively surveyed the edgewise interactions of certain anions (aspartate, glutamate, and phosphate) with Trp, Tyr, and Phe rings in high-resolution, nonredundant protein single chains and interfaces (protein-protein, DNA/RNA-protein, and membrane-protein). Trp/Tyr anion-quadrupole interactions are common, with Trp showing the highest propensity and average interaction energy for this type of interaction. The energy of an anion-quadrupole interaction (-15.0 to 0.0 kcal/mol, based on quantum mechanical calculations) depends not only on the interaction geometry but also on the ring atom. The phosphate anions at DNA/RNA-protein interfaces interact with aromatic residues with energies comparable to that of aspartate/glutamate anion-quadrupole interactions. At DNA-protein interfaces, the frequency of aromatic ring participation in anion-quadrupole interactions is comparable to that of positive charge participation in salt bridges, suggesting an underappreciated role for anion-quadrupole interactions at DNA-protein (or membrane-protein) interfaces. Although less frequent than salt bridges in single-chain proteins, we observed highly conserved anion-quadrupole interactions in the structures of remote homologues, and evolutionary covariance-based residue contact score predictions suggest that conserved anion-quadrupole interacting pairs, like salt bridges, contribute to polypeptide folding, stability, and recognition.
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Affiliation(s)
- Suvobrata Chakravarty
- Chemistry & Biochemistry, South Dakota State University, Brookings, SD, USA, 57007
- BioSNTR, Brookings, SD, USA, 57007
| | - Adron R. Ung
- Chemistry & Biochemistry, South Dakota State University, Brookings, SD, USA, 57007
| | - Brian Moore
- University Networking and Research Computing, South Dakota State University, Brookings, SD, USA, 57007
| | - Jay Shore
- Chemistry & Biochemistry, South Dakota State University, Brookings, SD, USA, 57007
| | - Mona Alshamrani
- Chemistry & Biochemistry, South Dakota State University, Brookings, SD, USA, 57007
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18
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Mohatt NV, Boeckmann R, Winkel N, Mohatt DF, Shore J. Military Mental Health First Aid: Development and Preliminary Efficacy of a Community Training for Improving Knowledge, Attitudes, and Helping Behaviors. Mil Med 2018; 182:e1576-e1583. [PMID: 28051976 DOI: 10.7205/milmed-d-16-00033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Persistent stigma, lack of knowledge about mental health, and negative attitudes toward treatment are among the most significant barriers to military service members and veterans seeking behavioral health care. With the high rates of untreated behavioral health needs among service members and veterans, identifying effective programs for reducing barriers to care is a national priority. This study adapted Mental Health First Aid (MHFA), an evidence-based program for increasing mental health knowledge, decreasing stigma, and increasing laypeople's confidence in helping and frequency of referring people in need, for military and veteran populations and pilot tested the adapted training program with 4 Army National Guard armories. MATERIALS AND METHODS A total of 176 community first responders (CFRs) participated in a comparative outcomes study, with 69 receiving the training and 107 participating in the control group. CFRs were individuals in natural positions within the Armory or home communities of Guard members to identify and help service members in mental health crisis. Surveys assessing confidence in helping, attitudes toward help seeking, knowledge of resources, use of MHFA practices, and stigma were completed before the training, immediately post-training, at 4 months post-training, and at 8 months post-training. Analyses included repeated measures analysis of variances on data from CFRs who received the training and mixed between-within subjects analysis of variances comparing the intervention and control group longitudinally at three time points. Institutional review board approval for this study was received from Montana State University and the U.S. Army Medical Department, Medical Research and Materiel Command, Human Research Protection Office. RESULTS Significant and meaningful improvements in confidence (p < 0.05, η2 = 0.49), knowledge (p < 0.05, η2 = 0.39), behaviors (p < 0.05, η2 = 0.27), and stigma (p < 0.05, η2 = 0.16) were observed among trainees. When compared to a control group, statistically meaningful differences in change over time were observed for knowledge (η2 = 0.03), attitudes (η2 = 0.02), confidence (η2 = 0.06), and stigma (η2 = 0.02), with a significant and meaningful difference observed for practice behaviors (p < 0.05, η2 = 0.07). CONCLUSIONS Results from the comparative outcomes pilot study of military and veterans MHFA indicate that the intervention is acceptable and feasible to implement in National Guard Armories and among non-Guard community-based first responders. There was a significant intervention effect detected for the likelihood that a CFR would use appropriate engagement, support, and referral practices when identifying someone in need of mental health support. In addition, there were positive growth trends in the data for improvements in confidence, knowledge of mental health resources, attitudes toward help seeking, and stigma, which indicate that with a larger number of participants and armories we would expect to see significant intervention effects. Study weaknesses included insufficient power and demographic data for more robust analyses of intervention effects. A larger randomized controlled trial is recommended for better establishing efficacy; however, these results indicate that Military and Veterans MHFA is a promising intervention for reducing critical barriers to care.
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Affiliation(s)
- Nathaniel Vincent Mohatt
- Western Interstate Commission for Higher Education, Mental Health Program, 3035 Center Green Drive, Suite 200, Boulder, CO 80301
| | - Robert Boeckmann
- Department of Psychology, University of Alaska Anchorage, 3211 Providence Drive, SSB 352, Anchorage, AK 99508
| | - Nicola Winkel
- Western Interstate Commission for Higher Education, Mental Health Program, 3035 Center Green Drive, Suite 200, Boulder, CO 80301
| | - Dennis F Mohatt
- Western Interstate Commission for Higher Education, Mental Health Program, 3035 Center Green Drive, Suite 200, Boulder, CO 80301
| | - Jay Shore
- University of Colorado Denver School of Medicine, 13001 East 17th Place, Aurora, CO 80045
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Yellowlees P, Burke Parish M, González Á, Chan S, Hilty D, Iosif AM, McCarron R, Odor A, Scher L, Sciolla A, Shore J, Xiong G. Asynchronous Telepsychiatry: A Component of Stepped Integrated Care. Telemed J E Health 2017; 24:375-378. [PMID: 29024612 DOI: 10.1089/tmj.2017.0103] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Integrated behavioral healthcare models typically involve a range of consultation options for mental healthcare. Asynchronous telepsychiatry (ATP) consults may be an additional potential choice, so we are conducting a 5-year clinical trial comparing ATP with synchronous telepsychiatry (STP) consultations. METHODS Patients referred by primary care providers are randomly assigned to one of the two treatment groups, ATP or STP. Clinical outcome, satisfaction, and economic data are being collected from patients for 2 years at 6-month intervals. RESULTS Baseline characteristics for the first 158 patients and case examples of ATP are presented. CONCLUSION Implementing ATP in existing integrated behavioral healthcare models could make mental healthcare more efficient.
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Affiliation(s)
- Peter Yellowlees
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California
| | - Michelle Burke Parish
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California.,2 The Betty Irene Moore School of Nursing, University of California, Davis , Sacramento, California
| | - Álvaro González
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California
| | - Steven Chan
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California
| | - Don Hilty
- 3 Department of Psychiatry, Keck School of Medicine, University of Southern California , Visalia, California
| | - Ana-Maria Iosif
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California
| | - Robert McCarron
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California
| | - Alberto Odor
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California
| | - Lorin Scher
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California
| | - Andrés Sciolla
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California
| | - Jay Shore
- 4 Department of Psychiatry, University of Colorado Denver , Aurora, Colorado
| | - Glen Xiong
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California
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Myers K, Nelson EL, Rabinowitz T, Hilty D, Baker D, Barnwell SS, Boyce G, Bufka LF, Cain S, Chui L, Comer JS, Cradock C, Goldstein F, Johnston B, Krupinski E, Lo K, Luxton DD, McSwain SD, McWilliams J, North S, Ostrowski J, Pignatiello A, Roth D, Shore J, Turvey C, Varrell JR, Wright S, Bernard J. American Telemedicine Association Practice Guidelines for Telemental Health with Children and Adolescents. Telemed J E Health 2017; 23:779-804. [DOI: 10.1089/tmj.2017.0177] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Kathleen Myers
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Eve-Lynn Nelson
- KU Center for Telemedicine & Telehealth, University of Kansas Medical Center, Kansas City, Kansas
- Department of Pediatrics, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Terry Rabinowitz
- Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, Vermont
- Department of Family Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Donald Hilty
- Psychiatry & Addiction Medicine, Kaweah Delta Medical Center, UC Irvine Affiliate, Visalia, California
- Department of Psychiatry, Keck School of Medicine at University of Southern California, Los Angeles, California
- Research and Health Services, Aligned Telehealth, Calabasas, California
| | - Deborah Baker
- Office of Legal and Regulatory Affairs, Practice Directorate, American Psychological Association, Washington, District of Columbia
| | - Sara Smucker Barnwell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Seattle Psychology PLLC, Seattle, Washington
| | | | - Lynn F. Bufka
- Practice Research and Policy, Practice Directorate, American Psychological Association, Washington, District of Columbia
| | - Sharon Cain
- Child and Adolescent Psychiatry Division, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Lisa Chui
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Jonathan S. Comer
- Center for Children and Families, Florida International University, Miami, Florida
- Mental Health Interventions and Technology (MINT) Program, Florida International University, Miami, Florida
| | | | | | | | - Elizabeth Krupinski
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia
| | - Katherine Lo
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - David D. Luxton
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Office of Forensic Mental Health Services, State of Washington, Olympia, Washington
| | - S. David McSwain
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
- Department of Telehealth Optimization, Medical University of South Carolina, Charleston, South Carolina
| | | | - Steve North
- Center for Rural Health Innovation, Spruce Pine, North Carolina
- Mission Virtual Care, Spruce Pine, North Carolina
| | - Jay Ostrowski
- Behavioral Health Innovation, Charlotte, North Carolina
| | - Antonio Pignatiello
- TeleLink Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Medical Psychiatry Alliance, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - David Roth
- Mind and Body Works, Inc., Honolulu, Hawaii
| | - Jay Shore
- Department of Psychiatry, Center for American Indian and Alaska Native Health, University of Colorado, Denver, Colorado
- Telepsychiatry Committee, American Psychiatric Association, Arlington, Virginia
| | - Carolyn Turvey
- Department of Psychiatry, Carver School of Medicine, University of Iowa, Iowa City, Iowa
| | | | - Shawna Wright
- KU Center for Telemedicine & Telehealth, University of Kansas Medical Center, Kansas City, Kansas
- Wright Psychological Services, Chanute, Kansas
| | - Jordana Bernard
- American Telemedicine Association, Washington, District of Columbia
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Stanton ML, Galen C, Shore J. POPULATION STRUCTURE ALONG A STEEP ENVIRONMENTAL GRADIENT: CONSEQUENCES OF FLOWERING TIME AND HABITAT VARIATION IN THE SNOW BUTTERCUP,
RANUNCULUS ADONEUS. Evolution 2017; 51:79-94. [DOI: 10.1111/j.1558-5646.1997.tb02390.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/1995] [Accepted: 08/26/1996] [Indexed: 11/27/2022]
Affiliation(s)
- M. L. Stanton
- Section of Evolution and Ecology and Center for Population Biology University of California Davis California 95616
| | - C. Galen
- Division of Biological Sciences, 105 Tucker Hall University of Missouri Columbia Missouri 65211
| | - J. Shore
- Department of Biology York University 4700 Keele Street North York Ontario M3J 1P3 Canada
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22
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Shore J. The evolution and history of telepsychiatry and its impact on psychiatric care: Current implications for psychiatrists and psychiatric organizations. Int Rev Psychiatry 2016; 27:469-75. [PMID: 26397182 DOI: 10.3109/09540261.2015.1072086] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We have reached a critical convergence in psychiatry between the changing systems of health care structure and funding, our evolution into a technology-based society, and growth in the science and delivery of psychiatric treatments. Fostered by this convergence is the maturation over the past two decades of telepsychiatry, in the form of live interactive video conferencing, as a critical tool to improve access, increase quality and reduce costs of psychiatric treatment. This article reviews the history and evolution of telepsychiatry including implications for the field in order to provide individual psychiatrists and psychiatric organizations guidance on how to formulate current and strategic directions. This article begins with a broad overview of the history of medicine providing contextualization of the development of the field of telepsychiatry. It concludes with projected trends and recommendations.
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Affiliation(s)
- Jay Shore
- a University of Colorado Anschutz Medical Campus, Helen and Arthur E. Johnson Depression Center , Aurora, Colorado , USA
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Hubley S, Lynch SB, Schneck C, Thomas M, Shore J. Review of key telepsychiatry outcomes. World J Psychiatry 2016; 6:269-82. [PMID: 27354970 PMCID: PMC4919267 DOI: 10.5498/wjp.v6.i2.269] [Citation(s) in RCA: 287] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/27/2016] [Accepted: 03/14/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To conduct a review of the telepsychiatry literature. METHODS We conducted a systematic search of the literature on telepsychiatry using the search terms, "telepsychiatry", "telemental health", "telecare", "telemedicine", "e-health", and "videoconferencing". To meet criteria for inclusion, studies had to: (1) be published in a peer-reviewed journal after the year 2000; (2) be written in English; (3) use videoconferencing technology for the provision of mental health assessment or treatment services; and (4) use an adequately-powered randomized controlled trial design in the case of treatment outcome studies. Out of 1976 studies identified by searches in PubMed (Medline database), Ovid medline, PsychInfo, Embase, and EBSCO PSYCH, 452 met inclusion criteria. Studies that met all inclusion criteria were organized into one of six categories: (1) satisfaction; (2) reliability; (3) treatment outcomes; (4) implementation outcomes; (5) cost effectiveness; and (6) and legal issues. All disagreements were resolved by reassessing study characteristics and discussion. RESULTS Overall, patients and providers are generally satisfied with telepsychiatry services. Providers, however, tend to express more concerns about the potentially adverse of effects of telepsychiatry on therapeutic rapport. Patients are less likely to endorse such concerns about impaired rapport with their provider. Although few studies appropriately employ non-inferiority designs, the evidence taken together suggests that telepsychiatry is comparable to face-to-face services in terms of reliability of clinical assessments and treatment outcomes. When non-inferiority designs were appropriately used, telepsychiatry performed as well as, if not better than face-to-face delivery of mental health services. Studies using both rudimentary and more sophisticated methods for evaluating cost-effectiveness indicate that telepsychiatry is not more expensive than face-to-face delivery of mental health services and that telepsychiatry is actually more cost-effective in the majority of studies reviewed. Notwithstanding legal concerns about loss of confidentiality and limited capacity to respond to psychiatric emergencies, we uncovered no published reports of these adverse events in the use of telepsychiatry. CONCLUSION A large evidence base supports telepsychiatry as a delivery method for mental health services. Future studies will inform optimal approaches to implementing and sustaining telepsychiatry services.
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Wadsworth HE, Galusha-Glasscock JM, Womack KB, Quiceno M, Weiner MF, Hynan LS, Shore J, Cullum CM. Remote Neuropsychological Assessment in Rural American Indians with and without Cognitive Impairment. Arch Clin Neuropsychol 2016; 31:420-5. [PMID: 27246957 DOI: 10.1093/arclin/acw030] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2016] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To determine the feasibility and reliability of a brief battery of standard neuropsychological tests administered via video teleconference (VTC) to a sample of rural American Indians compared with traditional face-to-face administration. METHODS The sample consisted of 84 participants from the Choctaw Nation in Oklahoma, including 53 females and 31 males [M age = 64.89 (SD = 9.73), M education = 12.58 (SD = 2.35)]. Of these, 29 had a diagnosis of mild cognitive impairment or dementia, and 55 were cognitively normal. Tests included the MMSE, Clock Drawing, Digit Span Forward and Backward, Oral Trails, Hopkins Verbal Learning Test-Revised, Letter and Category Fluency, and a short form Boston Naming Test. Alternative forms of tests were administered in counterbalanced fashion in both face-to-face and VTC conditions. Intraclass correlation coefficients (ICCs) were used to compare test scores between test conditions across the entire sample. RESULTS All ICCs were significant (p< .0001) and ranged from 0.65 (Clock Drawing) to 0.93 (Boston Naming Test), with a mean ICC of 0.82. CONCLUSION Results add to the expanding literature supporting the feasibility and reliability of remote videoconference-based neuropsychological test administration and extend findings to American Indians.
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Affiliation(s)
- Hannah E Wadsworth
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Kyle B Womack
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mary Quiceno
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Myron F Weiner
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Linda S Hynan
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jay Shore
- Department of Psychiatry, University of Colorado Denver, Denver, CO, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Kaufman CE, Kaufman LJ, Shangreau C, Dailey N, Blair B, Shore J. American Indian veterans and VA services in three tribes. Am Indian Alsk Native Ment Health Res 2016; 23:64-83. [PMID: 27115133 DOI: 10.5820/aian.2302.2016.64] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The purpose of this project was to describe experiences of reservation-based American Indian (AI) veterans with the Department of Veterans Affairs (VA), and to identify opportunities for improving care and services. Focus group discussions and individual interviews were conducted with AI veterans, family members, and community members in three diverse tribes. Results showed that many veterans in tribal communities experienced challenges receiving services and benefits from the VA, including lack of culturally competent care, transportation problems, and difficulties navigating the system. Family members, often main caregivers for AI veterans, lacked necessary resources, including sources for information, support services, and financial means to procure adequate care. A number of strengths also were identified, including local leadership and a strong community commitment to improve care for veterans.
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Shore J, Vo A, Yellowlees P, Waugh M, Schneck C, Nagamoto H, Thomas M. Antipsychotic-Induced Movement Disorder: Screening via Telemental Health. Telemed J E Health 2015; 21:1027-9. [PMID: 26125084 DOI: 10.1089/tmj.2014.0242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The purpose of this brief report is to make clinical and research recommendations to advance current knowledge and practices related to the assessment of antipsychotic drug-induced movement disorders (DIMDs) via live interactive videoconferencing. MATERIALS AND METHODS The authors provide an overview of the frequent neurological side effects of antipsychotic drugs and review relevant telemedicine research. DIMD prevention is critical, but these disorders remain underdetected and under-reported. Although there are not yet formal recommendations for specific screening tools or screening frequency, baseline and annual assessments are generally agreed-upon minimums. As DIMD awareness increases and more specific guidelines are developed to steer assessments, telemental health may aid practitioners in efficiently and regularly monitoring onset and severity. Research shows that videoconferencing can be used for effective psychiatric treatments and assessment, with at least one study validating the use of videoconference assessment for a subset of movement disorders. RESULTS AND CONCLUSIONS Clinical recommendations include developing practice-level protocols and procedures that include regular DIMD assessment (either in-person or via telemedicine) for the full spectrum of possible movement disorders for all patients taking antipsychotic medications. Research and evaluation recommendations include replicating and expanding upon the existing study using videoconferencing to assess movement disorder symptoms, using asynchronous telemental health assessments of DIMDs, and pilot-testing facial and movement recognition software to allow for clinical comparison of patients' movement patterns over time.
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Affiliation(s)
- Jay Shore
- 1 University of Colorado Anschutz Medical Campus, Aurora, Colorado.,2 Colorado Access , Denver, Colorado
| | | | - Peter Yellowlees
- 3 Department of Psychiatry, University of California Davis , Sacramento, California
| | | | | | - Herbert Nagamoto
- 1 University of Colorado Anschutz Medical Campus, Aurora, Colorado.,4 Denver Veterans Affairs Medical Center , Denver, Colorado
| | - Marshall Thomas
- 1 University of Colorado Anschutz Medical Campus, Aurora, Colorado.,2 Colorado Access , Denver, Colorado
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Brooks E, Kaufman C, Nagamoto HT, Dailey NK, Bair BD, Shore J. The impact of demographic differences on native veterans' outpatient service utilization. Psychol Serv 2015; 12:134-40. [PMID: 25961649 DOI: 10.1037/a0038687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many Native veterans--including American Indian/Alaska Native (AIAN) and Native Hawaiian/Pacific Islanders (NHPI)--have served in the United States Armed Forces. Most of these veterans are eligible for medical care from the Department of Veterans Affairs (VA), but research examining the determinants of their service use is needed to inform policy and allocate appropriate resources for these unique groups. In a retrospective cohort study, we examined the impact of Native veterans' personal demographics on their outpatient utilization of VA-based primary care and mental health services. AIAN (n = 37,687) and NHPI (n = 46,582) veterans were compared with a non-Native reference (N = 262,212) using logistic and binomial regression. AIAN and NHPIs were more likely to be female, report military sexual trauma, and utilize the VA for posttraumatic stress disorder, traumatic brain injury, depression, addiction, anxiety, hypertension, and diabetes care. More AIAN and urban NHPI veterans served in Iraq and Afghanistan, and Native women reported more military sexual trauma than their non-Native counterparts. Primary care and mental health services were associated with race, number of diagnoses, and disability ratings. For mental health services, service era, military sexual trauma, and marital status were related to service utilization. Native veterans' medical need was elevated for primary and mental health care. Rural residence was associated with less mental health use. The findings underscore the need for additional specialized services in rural areas, more targeted outreach to Operation Enduring Freedom/Operation Iraqi Freedom Native veterans, and additional care directed toward Native women's health care needs.
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Affiliation(s)
| | | | | | | | - Byron D Bair
- Veterans Rural Health Resource Center - Western Region
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Grosch MC, Weiner MF, Hynan LS, Shore J, Cullum CM. Video teleconference-based neurocognitive screening in geropsychiatry. Psychiatry Res 2015; 225:734-5. [PMID: 25596957 PMCID: PMC4410696 DOI: 10.1016/j.psychres.2014.12.040] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/15/2014] [Accepted: 12/28/2014] [Indexed: 10/24/2022]
Abstract
Validation of remote video teleconference (VTC)-based procedures for geropsychiatry applications is essential to ensure validity and reliability of diagnostic procedures. The current study demonstrates the similarity of scores obtained from several brief neurocognitive screening measures in an outpatient VA geropsychiatry clinic population when participants were tested in-person and via VTC. Results revealed similar mean scores and moderate to good consistency among our mixed geropsychiatric sample on brief measures of global cognition, attention, and visuospatial function.
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Affiliation(s)
- Maria C. Grosch
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Myron F. Weiner
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Linda S. Hynan
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA, Department of Clinical Science, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jay Shore
- Department of Psychiatry, University of Colorado Denver School of Medicine, Denver, CO, USA
| | - C. Munro Cullum
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA, Department of Neurology and Neurotherapeutics, The University of Texas Southwestern Medical Center, Dallas, TX, USA, Correspondence to: Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9044, USA. (C.M. Cullum)
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Vo A, Shore J, Waugh M, Doarn CR, Richardson J, Hathaway O, Bostick E, Lippolis S, Thomas M. Meaningful use: a national framework for integrated telemedicine. Telemed J E Health 2015; 21:355-63. [PMID: 25636151 DOI: 10.1089/tmj.2014.0142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The Centers for Medicare and Medicaid Services has incentivized electronic health records (EHRs) implementation through meaningful use (MU) to improve healthcare quality and efficacy. Telemedicine is a key tool that has shown its ability to facilitate MU through technological innovation with cost savings and has shown promise in the area of integrated behavioral healthcare. The purpose of this article is to propose a model of MU to frame the incentivized implementation of an integrated telemedicine (ITM)-specific model to effect system-level change. MATERIALS AND METHODS We reviewed the background, principles, and a justification for the ITM Model including cost issues, the development and structure of MU in the context of EHRs, the benefits of integrated behavioral healthcare and telemedicine, and the case for their combined implementation in the form of ITM. RESULTS The model proposed, the ITM Incentive Program, parallels the current MU program and is composed of three stages. Stage 1 focuses on incentivizing current and new Medicaid providers to adapt, implement, and upgrade technology needed to conduct virtual meetings with patients and other healthcare professionals. Stage 2 is a tiered incentive system with process-focused and track metrics related to increasing the number of consultations with patients. In Stage 3, providers are encouraged to continue use of ITM by meeting thresholds for several objectives focused on clinical outcomes. Recommendations for implementing this model within a payment waiver system are discussed. CONCLUSIONS The ITM Model offers a needed union of integrated care and telemedicine through the combination of technology, business, and clinical processes. The success of MU as a tiered incentive program for EHRs, as well as the precedent of using waiver opportunities for incentive funding repayments, sets forth a strategic framework to successful implementation of ITM to address cost issues and improve quality and access to care in the healthcare system.
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Whealin JM, Stotzer RL, Pietrzak RH, Vogt D, Shore J, Morland L, Southwick SM. Deployment-related sequelae and treatment utilization in rural and urban war veterans in Hawaii. Psychol Serv 2013; 11:114-123. [PMID: 24099457 DOI: 10.1037/a0032782] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study compared common deployment-related health issues and correlates of mental health service utilization among rural and urban veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) living in Hawaii. Frequency of utilization of a broad range of mental health resources, including clergy/spiritual leaders, videoconference/online programs, and traditional/alternative healers, was also characterized. A random sample of 116 rural and 117 urban ethnoracially diverse veterans completed a mail survey. Rural veterans were more likely than urban veterans to meet screening criteria for posttraumatic stress disorder (PTSD), deployment-related concussion with persistent postconcussive symptoms, and alcohol use problems. Over one third of veterans who desired help for a mental health problem reported no current use of any services. Rural veterans were more likely than urban veterans to have accessed Veteran Readjustment Centers, but they did not differ with respect to utilization of other services. Correlates of mental health service utilization included higher education, PTSD, and lower mental-health-related quality of life. Results of this study underscore the need for dissemination efforts to enable OEF/OIF/OND veterans to access mental health resources.
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Affiliation(s)
- Julia M Whealin
- National Center for Posttraumatic Stress Disorder, Pacific Islands Division, VA Pacific Island Health Care System
| | | | - Robert H Pietrzak
- National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Pacific Island Health Care System
| | - Dawne Vogt
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System
| | - Jay Shore
- Native Domain, Department of Veterans Affairs Office of Rural Veterans Rural Health Resource Center-Western Region
| | - Leslie Morland
- National Center for Posttraumatic Stress Disorder, Pacific Islands Division, VA Pacific Island Health Care System
| | - Steven M Southwick
- National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System
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Brooks E, Dailey N, Bair B, Shore J. Rural women veterans demographic report: defining VA users' health and health care access in rural areas. J Rural Health 2013; 30:146-52. [PMID: 24689540 DOI: 10.1111/jrh.12037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE While many women choose to live in rural areas after retiring from active military duty, a paucity of studies examine rural women veterans' health care needs. This report is the first of its kind to describe the population demographics and health care utilization of rural female veteran patients enrolled in the Department of Veterans Affairs (VA). METHODS Using the National Patient Care Datasets (n = 327,785), we ran adjusted regression analyses to examine service utilization between (1) urban and rural and (2) urban and highly rural women veterans. FINDINGS Rural and highly rural women veterans were older and more likely to be married than their urban counterparts. Diagnostic rates were generally similar between groups for several mental health disorders, hypertension, and diabetes, with the exception of nonposttraumatic stress anxiety that was significantly lower for highly rural women veterans. Rural and highly rural women veterans were less likely to present to the VA for women's specific care than urban women veterans; highly rural women veterans were less likely to present for mental health care compared to urban women veterans. Among the users of primary care, mental health, women's specific, and all outpatient services, patients' annual utilization rates were similar. CONCLUSIONS Improved service options for women's specific care and mental health visits may help rural women veterans access care. Telehealth technologies and increased outreach, perhaps peer-based, should be considered. Other recommendations for VA policy and planning include increasing caregiver support options, providing consistency for mental health services, and revising medical encounter coding procedures.
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Affiliation(s)
- Elizabeth Brooks
- Department of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Kaufman CE, Brooks E, Kaufmann LJ, Noe T, Nagamoto HT, Dailey N, Bair B, Shore J. Rural Native Veterans in the Veterans Health Administration: Characteristics and Service Utilization Patterns. J Rural Health 2013; 29:304-10. [DOI: 10.1111/j.1748-0361.2012.00450.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - L. Jeanne Kaufmann
- Veterans Rural Health Resource Center-Western Region, Office of Rural Health; Veterans Health Administration; Salt Lake City; Utah
| | | | | | - Nancy Dailey
- Veterans Rural Health Resource Center-Western Region, Office of Rural Health; Veterans Health Administration; Salt Lake City; Utah
| | - Byron Bair
- Veterans Rural Health Resource Center-Western Region, Office of Rural Health; Veterans Health Administration; Salt Lake City; Utah
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Doarn CR, Shore J, Ferguson S, Jordan PJ, Saiki S, Poropatich RK. Challenges, Solutions, and Best Practices in Telemental Health Service Delivery Across the Pacific Rim—A Summary. Telemed J E Health 2012; 18:654-60. [DOI: 10.1089/tmj.2012.0123] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charles R. Doarn
- Department of Family and Community Medicine—Research, University of Cincinnati, Cincinnati, Ohio
| | - Jay Shore
- Centers for American Indian and Alaska Native Health, University of Colorado, Denver, Denver, Colorado
- Telemedicine and Advanced Technology Research Center, Ft. Detrick, Maryland
| | | | - Patricia J. Jordan
- Telemedicine and Advanced Technology Research Center, Ft. Detrick, Maryland
- Pacific Telehealth & Technology Hui, Honolulu, Hawai'i
| | - Stanley Saiki
- Telemedicine and Advanced Technology Research Center, Ft. Detrick, Maryland
- Pacific Telehealth & Technology Hui, Honolulu, Hawai'i
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Shore J, Kaufmann LJ, Brooks E, Bair B, Dailey N, Richardson WJB, Floyd J, Lowe J, Nagamoto H, Phares R, Manson S. Review of American Indian veteran telemental health. Telemed J E Health 2012; 18:87-94. [PMID: 22283396 DOI: 10.1089/tmj.2011.0057] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Rural American Indian veterans have unique healthcare needs and face numerous barriers to accessing healthcare services. Over the past decade, the Department of Veterans Affairs in conjunction with the University of Colorado Denver has turned to the promising field of telemental health to develop a series of videoconferencing-based clinics to reach this vulnerable population and improve mental healthcare services. The ongoing development, implementation, and expansion of these clinics have been assessed as part of a program improvement. The outcomes of these assessments have been documented in a series of published articles, controlled studies, program and case reports, and model descriptions. This article summarizes a decade of experience with the American Indian Telemental Health Clinics, the clinic model, and the literature arising from these clinics and presents lessons learned while establishing, maintaining, and evaluating these clinics. The ability to tailor the clinics to individual sites and cultures and to provide various services has been critical to the operation of the clinics. Culturally specific care through culturally knowledgeable providers, onsite tribal outreach workers, and collaboration with community services has proven essential in operating the clinics, as well as building rapport, trust, and engagement with the target patient population. It is hoped that the lessons learned and practices presented here can not only assist others working to improve the care for rural Native veterans but also serve as a model in the use of telemental health services for improving care and access to rural veteran and non-veteran populations.
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Affiliation(s)
- Jay Shore
- Veterans Rural Health Resource Center-Western Region, Office of Rural Health, Department of Veterans Affairs, Salt Lake City, Utah, USA.
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Morland LA, Greene CJ, Rosen CS, Foy D, Reilly P, Shore J, He Q, Frueh BC. Telemedicine for anger management therapy in a rural population of combat veterans with posttraumatic stress disorder: a randomized noninferiority trial. J Clin Psychiatry 2010; 71:855-63. [PMID: 20122374 DOI: 10.4088/jcp.09m05604blu] [Citation(s) in RCA: 158] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 09/28/2009] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To demonstrate the noninferiority of a telemedicine modality, videoteleconferencing, compared to traditional in-person service delivery of a group psychotherapy intervention for rural combat veterans with posttraumatic stress disorder (PTSD). METHOD A randomized controlled noninferiority trial of 125 male veterans with PTSD (according to DSM criteria on the Clinician-Administered PTSD Scale) and anger difficulties was conducted at 3 Veterans Affairs outpatient clinics. Participants were randomly assigned to receive anger management therapy delivered in a group setting with the therapist either in-person (n = 64) or via videoteleconferencing (n = 61). Participants were assessed at baseline, midtreatment (3 weeks), posttreatment (6 weeks), and 3 and 6 months posttreatment. The primary clinical outcome was reduction of anger difficulties, as measured by the anger expression and trait anger subscales of the State-Trait Anger Expression Inventory-2 (STAXI-2) and by the Novaco Anger Scale total score (NAS-T). Data were collected from August 2005 to October 2008. RESULTS Participants in both groups showed significant and clinically meaningful reductions in anger symptoms, with posttreatment and 3 and 6 months posttreatment effect sizes ranging from .12 to .63. Using a noninferiority margin of 2 points for STAXI-2 subscales anger expression and trait anger and 4 points for NAS-T outcomes, participants in the videoteleconferencing condition demonstrated a reduction in anger symptoms similar ("non-inferior") to symptom reductions in the in-person groups. Additionally, no significant between-group differences were found on process variables, including attrition, adherence, satisfaction, and treatment expectancy. Participants in the in-person condition reported significantly higher group therapy alliance. CONCLUSIONS Clinical and process outcomes indicate delivering cognitive-behavioral group treatment for PTSD-related anger problems via videoteleconferencing is an effective and feasible way to increase access to evidence-based care for veterans residing in rural or remote locations.
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Affiliation(s)
- Leslie A Morland
- National Center for PTSD-Pacific Islands Division, Department of Veterans Affairs Pacific Islands Healthcare System, 3375 Koapaka St., Honolulu, HI 96819, USA.
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Charles KJ, Shore J, Sellwood J, Laverick M, Hart A, Pedley S. Assessment of the stability of human viruses and coliphage in groundwater by PCR and infectivity methods. J Appl Microbiol 2009; 106:1827-37. [PMID: 19298517 DOI: 10.1111/j.1365-2672.2009.04150.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate the potential health hazard from infectious viruses where coliphages, or viruses by polymerase chain reaction (PCR), have been detected in groundwater. Two aspects were investigated: the relationship between infectivity and detection by PCR and the stability of coliphage compared to human viruses. METHODS AND RESULTS Virus decay (1 year) and detection (2 years) studies were undertaken on groundwater at 12 degrees C. The order of virus stability from most to least stable in groundwater, based on first-order inactivation, was: coliphage PhiX174 (0.5 d(-1)) > adenovirus 2 > coliphage PRD1 > poliovirus 3 > coxsackie virus B1 (0.13 d(-1)). The order for PCR results was: norovirus genotype II > adenovirus > norovirus genotype I > enterovirus. CONCLUSIONS Enterovirus and adenovirus detection by PCR and the duration of infectivity in groundwater followed similar trends over the time period studied. Adenovirus might be a better method for assessing groundwater contamination than using enterovirus; norovirus detection would provide information on a significant human health hazard. Bacteriophage is a good alternative indicator. SIGNIFICANCE AND IMPACT OF THE STUDY PCR is a useful tool for identifying the health hazard from faecal contamination in groundwater where conditions are conducive to the survival of viruses and their nucleic acid.
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Affiliation(s)
- K J Charles
- Robens Centre for Public and Environmental Health, University of Surrey, Guildford, England.
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Affiliation(s)
- J. S. Mason
- Fielding & Johnson Limited Abbey Mill Ross Walk Leicester
| | - J. Park
- Fielding & Johnson Limited Abbey Mill Ross Walk Leicester
| | - T. M. Thompson
- Fielding & Johnson Limited Abbey Mill Ross Walk Leicester
| | - J. Shore
- I. C. I. Organics Division AR. TS Department Hexagon House Blackley Manchester
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Jervis LL, Shore J, Hutt E, Manson SM. Suboptimal Pharmacotherapy in a Tribal Nursing Home. J Am Med Dir Assoc 2007; 8:1-7. [PMID: 17210496 DOI: 10.1016/j.jamda.2006.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 03/23/2006] [Accepted: 03/27/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Suboptimal medication use among nursing home (NH) residents is common. NH residents tend to be older, suffer from multiple conditions, and take numerous medications, increasing their risk of serious complications. This article examines pharmacotherapy in a rural, tribally owned NH. DESIGN Medical records were reviewed and case studies were conducted by a team composed of a medical anthropologist, psychiatrist, and geriatrician. SETTING A rural, American Indian-owned NH in the US northern plains. PARTICIPANTS 40 American Indian and 5 EuroAmerican NH residents. MEASUREMENTS Minimum Data Set assessments, admission records, care plans, social histories, prescription lists, and behavioral consultation reports. RESULTS Potential underuse affected almost 75% of residents; undertreatment of depressive and psychotic/agitated symptoms was especially common. Potential inappropriate use, especially of analgesics, psychotropics, and antihistamines, affected 30% of residents. A smaller, but still substantial, number of residents (21%) experienced potential overuse, much of which involved anticonvulsants, antibiotics, cardiovascular, and psychotropic agents. The prescription of 10 or more medications was significantly associated with potential drug interactions, as well as underuse, inappropriate medication use, and overuse. CONCLUSIONS Psychotropic medications were the most potentially problematic medication category, and were strongly implicated in potential underuse, inappropriate use, and overuse. Fewer medications; the discontinuation of drugs known to be potentially problematic for NH residents; modification of psychotropic medication regimens; use of cognitive-enhancing medications where appropriate; implementation of an electronic medical record system; and greater use of nonpharmacological behavioral interventions may have substantially improved residents' treatment regimens.
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Affiliation(s)
- Lori L Jervis
- American Indian and Alaska Native Programs, Department of Psychiatry, University of Colorado at Denver and Health Sciences Center, Aurora, CO 80045, USA.
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Abstract
The authors examined the rate of and factors associated with alcohol abuse among 754 urban American Indian and Alaska Native primary care patients. Data were collected through a self-administered survey and by abstracting medical records. A total of 423 respondents (56 percent) screened positive for lifetime alcohol abuse, and 202 (27 percent) reported current alcohol abuse. A diagnosis of alcohol abuse was found in the medical records of 68 of the patients who screened positive (16 percent). Logistic regression analysis showed that being male, having been a victim of violence, and feeling depressed were associated with alcohol abuse. Further research is warranted to help clinicians detect and treat alcohol abuse in this special population.
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Affiliation(s)
- Jay Shore
- Department of Psychiatry, University of Colorado Health Sciences Center, Denver 80220, USA.
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Long HW, Gaede HC, Shore J, Reven L, Bowers CR, Kritzenberger J, Pietrass T, Pines A, Tang P, Reimer JA. High-field cross polarization NMR from laser-polarized xenon to a polymer surface. J Am Chem Soc 2002. [DOI: 10.1021/ja00071a086] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
A procedure for concentrating small round-structured viruses (SRSVs) (Norwalk-like viruses) from water and other environmental materials is described. Primers based on the helicase region of the SRSV genome were confirmed as specific by reaction with typed specimens, and used to detect virus in concentrates of unseeded and seeded samples. Virus was detected in estuarine recreational water polluted by untreated sewage, although not in seawater samples taken some distance from outfall discharges. It was also detected in river water downstream of a sewage treatment plant. Virus could be detected in all matrices when they were seeded with a positive stool extract, including sewage seeded with as little as 2 microl stool extract, thus confirming the suitability of the method for environmental monitoring.
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Dilts S, Goldman L, Shore J. Physician Health Research Conference (Estes Park, Colorado--September 15-17, 1996): progress report one year later. Psychiatr Q 1999; 70:93-106. [PMID: 10392406 DOI: 10.1023/a:1022145102107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The 1996 Physician Health Research Conference was the first conference to focus exclusively on research issues and methods for impaired physicians. The conference was initiated by James Shore, M.D., professor and chairman of the Department of Psychiatry in the School of Medicine at the University of Colorado Health Sciences Center and superintendent of the Colorado Psychiatric Hospital, and Stephen Dilts, M.D., Ph.D., medical director of the Colorado Physician Health Program and clinical professor of psychiatry at the University of Colorado Health Sciences Center. Forty participants represented a wide range of national organizations. The conference was supported by contributions from the American Medical Association, American Psychiatric Association, Colorado Physician Health Program, Colorado Physician Insurance Program, and the Department of Psychiatry and Colorado Psychiatric Hospital at the Health Sciences Center. In addition, the conference was cosponsored by the American Academy of Addiction Psychiatry, the American Society of Addiction Medicine, and the Federation of State Physician Health Programs. This paper summarizes the formal presentations of the conference.
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Affiliation(s)
- S Dilts
- Colorado Physician Health Program, Denver 80203, USA
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