Collaborative practice competencies needed for telehealth delivery by health and social care professionals: a scoping review

In the context of the COVID-19 pandemic, many healthcare and social services professionals have had to provide services through virtual care. In the workplace, such professionals often need to be sufficiently resourced to collaborate and address collaborative care barriers in telehealth. We performed a scoping review to identify the competencies required to support interprofessional collaboration among clinicians in telehealth. We followed Arksey and O'Malley's and the Joanna Briggs Institute's methodological guidelines, including quantitative and qualitative peer-reviewed articles published between 2010 and 2021. We expanded our data sources by searching for any organization or experts in the field via Google. The analysis of the resulting thirty-one studies and sixteen documents highlighted that health and social services professionals are generally unaware of the competencies they need to develop or maintain interprofessional collaboration in telehealth. In an era of digital innovations, we believe this gap may jeopardize the quality of the services offered to patients and needs to be addressed. Of the six competency domains in the National Interprofessional Competency Framework, it was observed that interprofessional conflict resolution was the competency that emerged least as an essential competency to be developed, while interprofessional communication and patient/client/family/community-centered care were identified as the two most reported essential competencies.

Demand management processes to improve access to cognitive-behavioral therapies for anxiety disorders: a grounded theory study

Introduction

Anxiety disorders are impactful mental health conditions for which evidence-based treatments are available, notably cognitive-behavioral therapies (CBTs). Even when CBTs are available, demand-side factors limit their access, and actors in a position to perform demand management activities lack a framework to identify context-appropriate actions.

Methods

We conducted a constructivist grounded theory study in Quebec, Canada, to model demand management targets to improve access to CBTs for anxiety disorders. We recruited key informants with diverse experiences using purposeful, then theoretical sampling. We analyzed data from 18 semi-directed interviews and 20 documents through an iterative coding process centered around constant comparison.

Results

The resulting model illustrates how actors can target clinical-administrative processes fulfilling the demand management functions of detection, evaluation, preparation, and referral to help patients progress on the path of access to CBTs.

Discussion

Modeling clinical-administrative processes is a promising approach to facilitate leveraging the competency of actors involved in demand management at the local level to benefit public mental health.

Understanding the impacts of the COVID-19 pandemic on the care experiences of people with mental-physical multimorbidity: protocol for a mixed methods study

BACKGROUND

Primary care and other health services have been disrupted during the COVID-19 pandemic, yet the consequences of these service disruptions on patients' care experiences remain largely unstudied. People with mental-physical multimorbidity are vulnerable to the effects of the pandemic, and to sudden service disruptions. It is thus essential to better understand how their care experiences have been impacted by the current pandemic. This study aims to improve understanding of the care experiences of people with mental-physical multimorbidity during the pandemic and identify strategies to enhance these experiences.

METHODS

We will conduct a mixed-methods study with multi-phase approach involving four distinct phases. Phase 1 will be a qualitative descriptive study in which we interview individuals with mental-physical multimorbidity and health professionals in order to explore the impacts of the pandemic on care experiences, as well as their perspectives on how care can be improved. The results of this phase will inform the design of study phases 2 and 3. Phase 2 will involve journey mapping exercises with a sub-group of participants with mental-physical multimorbidity to visually map out their care interactions and experiences over time and the critical moments that shaped their experiences. Phase 3 will involve an online, cross-sectional survey of care experiences administered to a larger group of people with mental disorders and/or chronic physical conditions. In phase 4, deliberative dialogues will be held with key partners to discuss and plan strategies for improving the delivery of care to people with mental-physical multimorbidity. Pre-dialogue workshops will enable us to synthesize an prepare the results from the previous three study phases.

DISCUSSION

Our study results will generate much needed evidence of the positive and negative impacts of the COVID-19 pandemic on the care experiences of people with mental-physical multimorbidity and shed light on strategies that could improve care quality and experiences.

The Psychological Health and Work-Family Balance of Ambulatory Care Nurses in the COVID-19 era: A Cross-Sectional Survey

Introduction: The COVID-19 pandemic impacted nurses’ psychological health and work-family balance, including in ambulatory care settings. The results presented in this article are part of a study aiming to describe and contextualize the psychological health and changes in nurses’ follow-up practices in Quebec (Canada) during the COVID-19 pandemic. Objective: Explore and describe factors that influenced ambulatory care nurses’ psychological health and work-family balance during the first wave of the COVID-19 pandemic. Methods: Exploratory mixed data cross-sectional study using the SurveyMonkey platform. We collected data from July 2020 to September 2020. The target population comprised all practicing nurses in Quebec whose clinical activities included the follow-up of ambulatory patients, 200 of whom completed the survey.  Results: Multiple linear regression models indicated that anxiety (GAD-7 scores) and depressive symptoms (PHQ-9 scores) were associated with younger age, living alone, worries about transmitting COVID-19, and feeling that one’s work was not coherent with one’s values. Work-family balance was considered more difficult than before the pandemic by 54.5 % of participants. Factors perceived as influencing work-family balance were either related to work conditions (e.g., schedule and time at work, access to work from home, redeployment to another work setting), to family-related responsibilities/tasks or were specific to the pandemic. Discussion and conclusion: Apart from age, the feeling that one’s work was not coherent with their values was the only variable correlated with both GAD-7 and PHQ-9 in multivariate models. Further research should investigate the relationships between sense of coherence, psychological health, and work conditions like schedule flexibility and access to work from home.

Strategies to improve access to cognitive behavioral therapies for anxiety disorders: A scoping review

Background

Strategies to improve access to evidence-based psychological treatments (EBPTs) include but are not limited to implementation strategies. No currently available framework accounts for the full scope of strategies available to allow stakeholders to improve access to EBPTs. Anxiety disorders are common and impactful mental conditions for which EBPTs, especially cognitive-behavioral therapies (CBT), are well-established yet often hard to access.

Objective

Describe and classify the various strategies reported to improve access to CBT for anxiety disorders.

Methods

Scoping review with a keyword search of several databases + additional grey literature documents reporting on strategies to improve access to CBT for anxiety disorders. A thematic and inductive analysis of data based on grounded theory principles was conducted using NVivo.

Results

We propose to classify strategies to improve access to CBT for anxiety disorders as either "Contributing to the evidence base," "Identifying CBT delivery modalities to adopt in practice," "Building capacity for CBT delivery," "Attuning the process of access to local needs," "Engaging potential service users," or "Improving programs and policies." Each of these strategies is defined, and critical information for their operationalization is provided, including the actors that could be involved in their implementation.

Implications

This scoping review highlights gaps in implementation research regarding improving access to EBPTs that should be accounted for in future studies.

Social isolation and suicide risk: Literature review and perspectives

Background

Suicide is a major public health problem and a cause of premature mortality. With a view to prevention, a great deal of research has been devoted to the determinants of suicide, focusing mostly on individual risk factors, particularly depression. In addition to causes intrinsic to the individual, the social environment has also been widely studied, particularly social isolation. This paper examines the social dimension of suicide etiology through a review of the literature on the relationship between suicide and social isolation.

Methods

Medline searches via PubMed and PsycINFO were conducted. The keywords were “suicid*” AND “isolation.”

Results

Of the 2,684 articles initially retrieved, 46 were included in the review.

Conclusions

Supported by proven theoretical foundations, mainly those developed by E. Durkheim and T. Joiner, a large majority of the articles included endorse the idea of a causal relationship between social isolation and suicide, and conversely, a protective effect of social support against suicide. Moreover, the association between suicide and social isolation is subject to variations related to age, gender, psychopathology, and specific circumstances. The social etiology of suicide has implications for intervention and future research.

Challenges of adopting the role of care manager when implementing the collaborative care model for people with common mental illnesses: A scoping review

This review aimed to identify the main factors influencing the adoption of the role of care manager (CM) by nurses when implementing the collaborative care model (CCM) for common mental illnesses in primary care settings. A total of 19 studies met the inclusion criteria, reporting on 14 distinct interventions implemented between 2000 and 2017 in five countries. Two categories of factors were identified and described as follows: (i) strategies for the CCM implementation (e.g. initial care management training and supervision by a mental health specialist) and (ii) context-specific factors (e.g. organizational factors, collaboration with team members, nurses' care management competency). Identified implementation strategies were mainly aimed towards improving the nurse's care management competency, but their efficacy in developing the set of competencies needed to fulfil a CM role was not well demonstrated. There is a need to better understand the relationship between the nurses' competencies, the care management activities, the strategies used to implement the CCM and the context-specific factors. Strategies to optimize the adoption of the CM role should not be solely oriented towards the individual's competency in care management, but also consider other context-specific factors. The CM also needs a favourable context in order to perform his or her activities with competency.

Treatment adequacy for social anxiety disorder in primary care patients

OBJECTIVES

There is a gap between clinical practice guidelines for social anxiety disorder and clinical practice that needs to be addressed to ensure the delivery of evidence-based treatments. The objectives of this study were: 1) to describe mental health service utilization in a cohort of primary care patients with social anxiety disorder; 2) to examine treatment adequacy for pharmacotherapy and psychotherapy according to indicators based on clinical practice guidelines; and 3) to explore correlates of treatment adequacy.

METHOD

The "Dialogue" project (Quebec, Canada) is a large study conducted in 67 primary care clinics. After a mental health screening in primary care (n = 14 833), participants with anxiety or depressive symptoms took part in a telephone/web structured interview on mental health symptoms and service utilization (n = 1956). This study included 289 participants meeting DSM-IV criteria for social anxiety disorder.

RESULTS

Overall, 86.2% of participants reported consulting for mental health reasons over the past 12 months. Only 23.6% of our sample reported the detection of social anxiety disorder by a healthcare professional in the past 12 months. Approximately 2 in 5 respondents with social anxiety disorder reported receiving pharmacotherapy or psychotherapy meeting our treatment adequacy indicators. Antidepressant medication was the most common treatment. Logistic regression models showed that the detection of major depression (OR = 4.651; 95% CI: 2.559-8.453) or other anxiety disorder(s) (OR = 2.957; 95% CI: 1.555-5.625) were associated with receiving any adequate treatment, but the detection of social anxiety disorder itself was not (OR = 1.420; 95% CI: 0.696-2.899).

CONCLUSION

Low rates of detection and treatment adequacy based on our indicators demonstrate that efforts must be made to ensure the quality of care for individuals with social anxiety disorder in primary care.

Patterns of benzodiazepines use in primary care adults with anxiety disorders

BACKGROUND

Benzodiazepines are among the most commonly prescribed drugs for anxiety disorders. While they are indicated as adjunctive treatment for short-term use according to clinical practice guidelines, previous studies have shown patterns of long-term use of benzodiazepines, which is problematic due to side effects, dependence and potential of abuse. The aims of this study were to examine among a large sample of primary care adults suffering from anxiety disorders: 1) benzodiazepine use patterns; and 2) correlates of long-term benzodiazepine use.

METHODS

Data were drawn from the "Dialogue" project, a large primary care study conducted in 64 primary care clinics in the province of Quebec, Canada. Following a mental health screening in waiting rooms, patients at risk of anxiety or depression completed the Composite International Diagnostic Interview-Simplified (CIDIS). A sample of 740 adults meeting DSM-IV criteria for Generalized Anxiety Disorder, Panic Disorder or Social Anxiety Disorder in the past 12 months took part in this study.

RESULTS

Benzodiazepines were used by 22.6% of participants with anxiety disorders in our primary care sample. A large majority of benzodiazepine users (88.4%) met our indicator of long-term use, as defined by utilization for more than 12 weeks including regular and as-needed use. Based on a logistic regression model, individual correlates associated with long-term benzodiazepine use included: being 30 years or older, having a comorbid physical illness, meeting criteria for comorbid agoraphobia, reporting the use of sleep-aids, and concurrent SSRI utilization.

LIMITATION

Data collection with self-reported questionnaires may be subject to information bias.

CONCLUSIONS

Despite knowledge of the risks of long-term use of benzodiazepines, this remains a pervasive problem. Clinicians need to be mindful of patterns and risk factors leading to long-term use of benzodiazepines in patients with anxiety disorders. Results of this study should raise awareness regarding appropriate prescription practices for benzodiazepines, including decision-making in initiation, duration of prescription, and use of strategies for discontinuation in current long-term benzodiazepine users.

Letter to the Editor: RE: Costa et al. (''Nutritional Risk is Associated with Chronic Musculoskeletal Pain in Community-Dwelling Older Persons: The PAINEL Study'')

We read Costa and colleagues' report¹ in 2016 in the Journal of Nutrition in Gerontology and Geriatrics with great interest. In this article, the authors reported a statistically significant association between chronic musculoskeletal pain and nutritional risk after controlling for age, gender, body mass index (BMI), depression (GDS, geriatric depression scale), and diabetes in a Brazilian community-dwelling older adult's population (the PAINEL study, see Table 2 in Costa et al. ¹ . However, in their study, Costa and colleagues used the DETERMINE ² Questionnaire, a questionnaire in which 3 out of the 10 questions are directly or indirectly related to pain (i.e., presence of an illness, tooth or mouth problems, and physical disability). The purpose of this letter is to discuss the potential drawbacks of including pain-related questions in nutrition risk screening tool when these tools are used to investigate the relationship between pain and nutritional risk.

Amorcer un traitement antipsychotique en schizophrénie : la situation au Québec de 1998 à 2006

Contexte Cet article vise à décrire les facteurs associés à la prescription d’antipsychotiques par un psychiatre plutôt qu’un omnipraticien, la prescription d’un antipsychotique de seconde plutôt que de première génération, la prescription d’une multithérapie d’antipsychotiques et le non-renouvellement de la prescription initiale.

Méthodologie Il s’agit d’une étude pharmacoépidémiologique observationnelle avec analyses secondaires d’une banque de données médicoadministratives (RAMQ). Les données disponibles portaient sur un échantillon exhaustif des personnes adultes ayant reçu un diagnostic de schizophrénie et ayant obtenu un antipsychotique couvert par le régime public d’assurance médicaments de 1998 à 2006. Les résultats de régression logistique multiple sont rapportés.

Résultats Parmi les 16 225 personnes éligibles, 46,2 % étaient des femmes et 70 % étaient bénéficiaires d’une aide financière. La clientèle des psychiatres était plus jeune et plus atteinte au niveau de la santé mentale. La multithérapie était associée aux hospitalisations pour psychose, au faible statut socio-économique et à un âge entre 35 et 64 ans. Les antipsychotiques de seconde génération ont pris une place importante au cours de la période à l’étude. Le non-renouvellement était associé à l’abus de substances et était moins fréquent suite à une hospitalisation pour trouble mental.

Conclusions Malgré les limites liées à l’utilisation de données administratives, l’utilisation d’une banque de données exhaustive provenant autant de médecine générale que de spécialité permet à cette étude de brosser un portrait populationnel pertinent pour connaître la situation réelle du traitement incident de la schizophrénie au Québec de 1998 à 2006, une période caractérisée par l’introduction des antipsychotiques de seconde génération.

[Initiating an antipsychotic drug treatment for schizophrenia: the situation in Quebec, Canada, from 1998 to 2006]

Objectives To describe factors associated with the following characteristics of the first prescription of an antipsychotic drug treatment (ADT): 1) prescribing physician type (psychiatrist vs. general practitioner); 2) second-generation vs. first-generation antipsychotic drug; 3) in conjunction with at least one additional antipsychotic drug (multitherapy); 4) never renewed by the patient.Methods This is a pharmacoepidemiologic study using administrative data from the Régie de l'assurance maladie du Québec (RAMQ), the public healthcare insurer in Quebec, Canada. Available data sample was exhaustive for adults with a diagnosis of schizophrenia who received an ADT under RAMQ drug coverage from 1998 to 2006. We report multiple logistic regression results.Results Among 16,225 patients who met inclusion criteria 46.2% were women and 70% were beneficiaries of governmental financial assistance. Patients who had their ADT prescribed by psychiatrists tended to be younger and were more burdened by their mental illness. Multitherapy was associated with hospitalization with a psychotic disorder as main diagnosis, lower socioeconomic status, and age between 35 and 64. Second-generation antipsychotic use became progressively more prominent during the period under study. Antipsychotic non renewal was correlated with substance use disorders and was less likely to happen following hospitalization with a psychiatric main diagnosis. Conclusions Although this study is subject to the intrinsic limitations of secondary analysis of administrative data, the database available for study was exhaustive within the Quebec healthcare system and included data from both general practice and specialized care, which allowed us to draw a relevant picture of how ADT were initiated for schizophrenia in Quebec, Canada, from 1998 to 2006. This timeframe is especially relevant since the 1990s were marked by the introduction of second-generation antipsychotics in Canada.

Predicting chronic benzodiazepine use in adults with depressive disorder: Retrospective cohort study using administrative data in Quebec

OBJECTIVE

To identify predictive variables of incident chronic benzodiazepine (BZD) use that could be assessed by prescribing physicians.

DESIGN

Retrospective cohort study using public health and drug insurance administrative data.

SETTING

Quebec.

PARTICIPANTS

New adult BZD users from January 1, 1999, to March 31, 2006, with a diagnosis of depressive disorder in the previous year were included. Chronic BZD use was defined as BZD availability at least 50% of the days between day 181 and day 365 following initiation.

MAIN OUTCOME MEASURES

Potential associations between chronic BZD use and age; sex; drug insurance status; recent hospitalization; comorbidity; presence of chronic pain; use of psychotropic medication; mental health diagnoses; number, type, and duration of BZDs prescribed; and the prescribing physician's specialty.

RESULTS

Selection led to an exhaustive cohort of 13 688 patients aged 18 to 64 years, and 3683 aged 65 and older. For the 18 to 64 age group, the combination of disability insurance and more than 1 BZD increased the proportion of chronic users from 14.4% to 53.4%. For patients 65 and older, the main correlates of chronic BZD use included claiming more than 1 BZD (adjusted odds ratio 2.24, 99% CI 1.65 to 3.06) and recent hospitalization (adjusted odds ratio 1.70, 99% CI 1.38 to 2.10). Recently hospitalized older patients with a prescription duration of less than 8 days were the highest-risk group identified (57.8%).

CONCLUSION

Physicians should be aware that patients are more likely to become chronic BZD users if they receive disability insurance or following a hospitalization. Combination of BZDs is a potentially problematic practice that could be increasing the risk of chronic use.

Respiratory hygiene in emergency departments: compliance, beliefs, and perceptions

Background

Low respiratory hygiene compliance among health care workers of emergency departments has become a major concern in the spread of respiratory infections. Our objective was to determine the compliance with respiratory hygiene of triage nurses at 2 university hospital centers and to identify factors influencing compliance to the respiratory hygiene principles of emergency health care workers.

Methods

A 2-part, cross-sectional, descriptive study was conducted at 2 training centers. An anonymous observation of compliance with respiratory hygiene by triage emergency nurses was performed. A self-administered, voluntary questionnaire on attitudes, perceptions, and knowledge of respiratory hygiene guidelines was distributed to the health care workers at the emergency department of the 2 hospital sites.

Results

Median objective compliance with respiratory hygiene measures of triage nurses was 22% (interquartile range [IQR], 11%-33%). Median perceived compliance of the health care workers was 68% (IQR, 61%-79%). Median actual knowledge score was 75% (IQR, 75%-100%). Overall, 91.9% of respondents believed that the mask was an effective preventive measure. The main obstacles toward mask wearing by the health care worker were “tendency to forget” (37.8%) and “discomfort” (35.1%).

Conclusion

The compliance rate at our institution is very low. We identified a few factors affecting adherence to respiratory hygiene measures that are of potential use in targeting groups and formulating recommendations.