Collaborative Care for Depression and Posttraumatic Stress Disorder: Evaluation of Collaborative Care Fidelity on Symptom Trajectories and Outcomes

The impact of a partnership care model on self-efficacy and self-care in hemodialysis patients: A quasi-experimental study

Introduction and objective

Self-care and self-efficacy are crucial in managing kidney failure requiring hemodialysis. However, traditional education methods have not effectively improved self-care and self-efficacy. Therefore, utilizing more effective models, such as the partnership care model, is essential. This study aimed to determine the impact of the partnership care model on self-care and self-efficacy in hemodialysis patients.

Materials and methods

This quasi-experimental study was conducted with 74 hemodialysis patients at Shahid Beheshti Hospital in Hamadan. Patients were divided into control and intervention groups. The control group received only routine care, while the intervention group received nursing care based on the partnership care model in addition to routine care. This included eight educational sessions over one month, with two sessions per week. Data were collected using self-care and Sherer self-efficacy questionnaires before and two months after the intervention. Data were analyzed using SPSS version 16.

Results

The study demonstrated significant improvements in self-care and self-efficacy among hemodialysis patients following the collaborative care intervention. Post-intervention, the experimental group showed substantial benefits with an effect size of 1.41 for self-care (95 % CI: 0.87-1.95, p < 0.001) and an effect size of 1.55 for self-efficacy (95 % CI: 0.99-2.10, p < 0.001), highlighting the effectiveness of the intervention.

Conclusion

The study demonstrated that the partnership care model, through comprehensive education and social and motivational support, significantly improved self-care and self-efficacy in hemodialysis patients. Therefore, it is recommended that hospitals and nurses adopt this model to enhance the health and quality of life of patients.

Time course and heterogeneity of treatment effect of the collaborative chronic care model on psychiatric hospitalization rates: A survival analysis using routinely collected electronic medical records

BACKGROUND

Health systems are undergoing widespread adoption of the collaborative chronic care model (CCM). Care structured around the CCM may reduce costly psychiatric hospitalizations. Little is known, however, about the time course or heterogeneity of treatment effects (HTE) for CCM on psychiatric hospitalization.

RATIONALE

Assessment of CCM implementation support on psychiatric hospitalization might be more efficient if the timing were informed by an expected time course. Further, understanding HTE could help determine who should be referred for intervention.

OBJECTIVES

(i) Estimate the trajectory of CCM effect on psychiatric hospitalization rates. (ii) Explore HTE for CCM across demographic and clinical characteristics.

METHODS

Data from a stepped wedge CCM implementation trial were reanalyzed using 5 570 patients in CCM treatment and 46 443 patients receiving usual care. Time-to-event data was constructed from routine medical records. Effect trajectory of CCM on psychiatric hospitalization was simulated from an extended Cox model over one year of implementation support. Covariate risk contributions were estimated from subset stratified Cox models without using simulation. Ratios of hazard ratios (RHR) allowed comparison by trial arm for HTE analysis, also without simulation. No standard Cox proportional hazards models were used for either estimating the time-course or heterogeneity of treatment effect.

RESULTS

The effect of CCM implementation support increased most rapidly immediately after implementation start and grew more gradually throughout the rest of the study. On the final study day, psychiatric hospitalization rates in the treatment arm were 17% to 49% times lower than controls, with adjustment for all model covariates (HR 0.66; 95% CI 0.51-0.83). Our analysis of HTE favored usual care for those with a history of prior psychiatric hospitalization (RHR 4.92; 95% CI 3.15-7.7) but favored CCM for those with depression (RHR 0.61; 95% CI: 0.41-0.91). Having a single medical diagnosis, compared to having none, favored CCM (RHR 0.52; 95% CI 0.31-0.86).

CONCLUSION

Reduction of psychiatric hospitalization is evident immediately after start of CCM implementation support, but assessments may be better timed once the effect size begins to stabilize, which may be as early as six months. HTE findings for CCM can guide future research on utility of CCM in specific populations.

Evaluation of an Adapted Collaborative Care Model for Older Adult Depression Severity Reduction and Quality of Life Improvement

PURPOSE

The purpose of this clinical study was to evaluate the efficacy of a collaborative care model in the reduction of depression severity and the improvement of quality of life (QOL) of older adults.

METHODS

Individual participant encounters were conducted approximately every 2 weeks over 4 months with nineteen participants. Average participant age was 73 years. A pre-experimental single pretest-posttest group was conducted in which the Patient Health Questionnaire 9 (PHQ-9) and Quality of Life Assessment (QOLA) scores respectively measured depression severity and QOL of participants.

RESULTS

The average PHQ-9 score (0-27; higher indicates worse depression) decreased from 14 pre-intervention to 8.3 post-intervention (p < .001), while the average QOLA score (0-10; higher indicates better QOL) increased from 5.7 pre-intervention to 6.5 post-intervention (p = .342).

CONCLUSION

The adapted collaborative care model provided an affordable, effective method of older adult depression management within the contexts of this clinical study.