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Ng TJ, Ling J, Robbins LB, Kao TSA. Stress Management Interventions Among U.S. High School Adolescents: A Meta-Analysis. J Am Psychiatr Nurses Assoc 2024; 30:252-278. [PMID: 36971329 DOI: 10.1177/10783903231161608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Adolescent ineffective stress management has been associated with negative health outcomes, such as anxiety and depression. Comprehensively evaluating the effects of stress management interventions is needed. AIMS The aim of this study was to quantitatively evaluate the effects of stress management interventions on mental health outcomes (stress, anxiety, depression, and positive and negative affect) and perform moderation analysis to identify moderators of intervention effects on stress, anxiety, and depression among U.S. high school adolescents. METHODS Four databases (CINAHL, ERIC, PubMed, and PsycINFO) were searched. After literature screening, 24 articles describing 25 studies were retained. Hedge's g was calculated using random-effects models. Exploratory moderation analyses were performed to identify moderators. RESULTS The pooled effects on reducing stress were -0.36. The interventions had small effects on decreasing anxiety (g = -0.31) and depression (g = -0.23). Long-term follow-up effects were -0.77 on perceived stress, -0.08 on anxiety, and -0.19 on depression. Mind-body and cognitive-behavioral interventions had moderate effects on reducing anxiety (g = -0.51). Interventions with longer duration (>8 weeks) were more effective in reducing anxiety (-0.39 vs. -0.26) and depression (-0.36 vs. -0.17). CONCLUSIONS These findings support the short-term effectiveness of stress management interventions in improving mental health among high school adolescents in the United States. Subsequent research efforts should focus on sustaining long-term effects.
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Affiliation(s)
- Teresa J Ng
- Teresa J. Ng, PhD Student, BSN, RN, Michigan State University College of Nursing, East Lansing, MI, USA
| | - Jiying Ling
- Jiying Ling, PhD, RN, FAAN, Michigan State University College of Nursing, East Lansing, MI, USA
| | - Lorraine B Robbins
- Lorraine B. Robbins, PhD, RN, FNP-BC, FAAN, Michigan State University College of Nursing, East Lansing, MI, USA
| | - Tsui-Sui A Kao
- Tsui-sui "Annie" Kao, PhD, RN, FNP-BC, FAANP, Michigan State University College of Nursing, East Lansing, MI, USA
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Stepanova E, Thompson A, Yu G, Fu Y. Changes in mental health services in response to the COVID-19 pandemic in high-income countries: a rapid review. BMC Psychiatry 2024; 24:103. [PMID: 38321403 PMCID: PMC10845680 DOI: 10.1186/s12888-024-05497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Severe deterioration in mental health and disrupted care provision during the COVID-19 increased unmet needs for mental health. This review aimed to identify changes in mental health services for patients in response to the pandemic and understand the impact of the changes on patients and providers. METHODS Following the Cochrane guidance for rapid reviews, Cochrane CENTRAL, MEDLINE, Embase and PsycInfo were searched for empirical studies that investigated models of care, services, initiatives or programmes developed/evolved for patients receiving mental health care during COVID-19, published in English and undertaken in high-income countries. Thematic analysis was conducted to describe the changes and an effect direction plot was used to show impact on outcomes. RESULTS 33 of 6969 records identified were included reporting on patients' experiences (n = 24), care providers' experiences (n = 7) and mixed of both (n = 2). Changes reported included technology-based care delivery, accessibility, flexibility, remote diagnostics and evaluation, privacy, safety and operating hours of service provision. These changes had impacts on: (1) care access; (2) satisfaction with telehealth; (3) comparability of telehealth with face-to-face care; (4) treatment effectiveness; (5) continuity of care; (6) relationships between patients and care providers; (7) remote detection and diagnostics in patients; (8) privacy; (9) treatment length and (10) work-life balance. CONCLUSIONS A shift to telecommunication technologies had a significant impact on patients and care providers' experiences of mental health care. Improvements to care access, flexibility, remote forms of care delivery and lengths of operating service hours emerged as crucial changes, which supported accessibility to mental health services, increased attendance and reduced dropouts from care. The relationships between patients and care providers were influenced by service changes and were vastly depending on technological literacy and context of patients and availability and care access ranging from regular contact to a loss of in-person contact. The review also identified an increase in care inequality and a feeling of being disconnected among marginalised groups including homeless people, veterans and ethic minority groups. Telehealth in mental care could be a viable alternative to face-to-face service delivery with effective treatment outcomes. Further research is needed to better understand the impact of the changes identified particularly on underserved populations.
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Affiliation(s)
- Evgenia Stepanova
- Population Health Sciences Institute, Newcastle University, Newcastle, UK.
| | - Alex Thompson
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Ge Yu
- Health Services and Population Research Department, Institute of Psychiatry, King's Health Economics, King's College London, Psychology & Neuroscience, London, UK
| | - Yu Fu
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
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Flowers D, Goodspeed E, Daly M. Telehealth as an Effective Care Delivery Method During the COVID-19 Pandemic for the Rhode Island Behavioral Health Population. Community Ment Health J 2024; 60:108-114. [PMID: 37737526 DOI: 10.1007/s10597-023-01187-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
In response to the COVID-19 pandemic, Rhode Island implemented a telehealth waiver allowing telehealth parity. This study investigated (1) if telehealth allowed for patients who seek mental health services to maintain visit frequency and (2) if subpopulations were less likely to utilize telehealth. We used descriptive statistics to analyze the change in total number of visits, in-person visits from pre-waiver to post-waiver, and a multivariate linear regression to identify relationships between demographics and telehealth utilization. Participants were able to maintain the frequency of visits during the COVID-19 pandemic. Race/ethnicity, age, gender, employment status, and housing status were all statistically significant predictors of telehealth utilization. Telehealth aids in the continuing of care when in-person visits are not a viable option. Access to telehealth is crucial during public health emergencies and aids in maintaining visit frequency. Further research should be done to evaluate subgroups who are less likely to utilize telehealth.
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Affiliation(s)
- Demetria Flowers
- Department of Behavioral Health, Developmental Disabilities and Hospitals, State of Rhode Island, Cranston, RI, 02904, USA.
| | - Emily Goodspeed
- Department of Behavioral Health, Developmental Disabilities and Hospitals, State of Rhode Island, Cranston, RI, 02904, USA
| | - Mackenzie Daly
- Department of Behavioral Health, Developmental Disabilities and Hospitals, State of Rhode Island, Cranston, RI, 02904, USA
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O’Neill JC, O’Callaghan ET, Sullivan S, Winsberg M. Novel Telehealth Adaptations for Evidence-Based Outpatient Suicide Treatment: Feasibility and Effectiveness of the Crisis Care Program. Healthcare (Basel) 2023; 11:3158. [PMID: 38132048 PMCID: PMC10743225 DOI: 10.3390/healthcare11243158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
Background: Suicide rates in the United States have escalated dramatically over the past 20 years and remain a leading cause of death. Access to evidenced-based care is limited, and telehealth is well-positioned to offer novel care solutions. The Crisis Care program is a suicide-specific treatment program delivered within a national outpatient telehealth setting using a digitally adapted version of the Collaborative Assessment and Management of Suicidality (CAMS) as the framework of care. This study investigates the feasibility and preliminary effectiveness of Crisis Care as scalable suicide-specific treatment model. Methods: Patient engagement, symptom reduction, and care outcomes were examined among a cohort of patients (n = 130) over 16 weeks. The feasibility of implementation was assessed through patient engagement. Clinical outcomes were measured with PHQ-9, GAD-7, and the CAMS SSF-4 rating scales. Results: Over 85% of enrolled patients were approved for Crisis Care at intake, and 83% went on to complete at least four sessions (the minimum required to graduate). All patient subgroups experienced declines in depressive symptoms, anxiety symptoms, suicidal ideation frequency, and suicide-specific risk factors. Conclusions: Results support the feasibility and preliminary effectiveness of Crisis Care as a suicide-specific care solution that can be delivered within a stepped-care model in an outpatient telehealth setting.
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Affiliation(s)
- J. Conor O’Neill
- Brightside Health, 2471a Peralta Street, Oakland, CA 94607, USA (M.W.)
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Pro G, Fairman B, Baloh J, Willis D, Montgomery BEE. Temporal Trends in Telehealth Availability in Mental Health Treatment Settings: Differences in Growth by State Rurality, 2015-2020. J Urban Health 2023; 100:1149-1158. [PMID: 38012502 PMCID: PMC10728410 DOI: 10.1007/s11524-023-00795-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 11/29/2023]
Abstract
We sought to investigate temporal trends in telehealth availability among outpatient mental health treatment facilities and differences in the pace of telehealth growth by state urbanicity and rurality. We used the National Mental Health Services Survey (2015-2020) to identify outpatient mental health treatment facilities in the US (N = 28,989 facilities; 2015 n = 5,018; 2020 n = 4,889). We used logistic regression to model telehealth, predicted by time, state rurality (1 to 10% rural, 10 to < 20%, 20 to < 30%, or [Formula: see text] 30%), and their interaction, and adjusted for relevant covariates. We estimated the predicted probability of telehealth based on our model. We estimated effects with and without data from 2020 to assess whether the rapid and widespread adoption of telehealth during the COVID-19 pandemic changed the rural/urban trajectories of telehealth availability. We found that telehealth grew fastest in more urban states (year*rurality interaction p < 0.0001). Between 2015 and 2020, the predicted probability of telehealth in more urban states increased by 51 percentage points (from 9 to 61%), whereas telehealth in more rural states increased by 38 percentage points (from 23 to 61%). Predicted telehealth also varied widely by state, ranging from more than 75% of facilities (RI, OR) to below 20% (VT, KY). Health systems and new technological innovations must consider the unique challenges faced by urban populations and how best practices may be adapted to meet the growing urban demand. We framed our findings around the need for policies that minimize barriers to telehealth.
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Affiliation(s)
- George Pro
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
- Fay W. Boozman College of Public Health, Southern Public Health and Criminal Justice Research Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Brian Fairman
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jure Baloh
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Don Willis
- Department of Internal Medicine, College of Medicine, Community Health and Research, University of Arkansas for Medical Sciences, Fayetteville, AR, USA
| | - Broome E E Montgomery
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Fay W. Boozman College of Public Health, Southern Public Health and Criminal Justice Research Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Bajgain B, Rabi S, Ahmed S, Kiryanova V, Fairie P, Santana MJ. Patient-reported experiences and outcomes of virtual care during COVID-19: a systematic review. J Patient Rep Outcomes 2023; 7:126. [PMID: 38038800 PMCID: PMC10692047 DOI: 10.1186/s41687-023-00659-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 11/15/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION The onset of COVID-19 has caused an international upheaval of traditional in-person approaches to care delivery. Rapid system-level transitions to virtual care provision restrict the ability of healthcare professionals to evaluate care quality from the patient's perspective. This poses challenges to ensuring that patient-centered care is upheld within virtual environments. To address this, the study's objective was to review how virtual care has impacted patient experiences and outcomes during COVID-19, through the use of patient-reported experience and outcome measures (PREMs and PROMs), respectively. METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to evaluate patient responsiveness to virtual care during COVID-19. Using an exhaustive search strategy, relevant peer-reviewed articles published between January 2020 and 2022 were pulled from MEDLINE, CINAHL, EMBASE, and PsychInfo databases. Study quality was independently assessed by two reviewers using the Mixed Methods Appraisal Tool. A patient partner was consulted throughout the study to provide feedback and co-conduct the review. RESULTS After removing duplicates, 6048 articles underwent title and abstract review, from which 644 studies were included in the full-text review stage. Following this, 102 articles were included in the study. Studies were published in 20 different countries, were predominantly cross-sectional, and reported on the delivery of virtual care in specialized adult outpatient settings. This review identified 29 validated PREMs and 43 PROMs. Several advantages to virtual care were identified, with patients citing greater convenience, (such as saving travel time and cost, less waiting experienced to see care providers) and increased protection from viral spread. Some studies also reported challenges patients and caregivers faced with virtual care, including feeling rushed during the virtual care appointment, lack of physical contact or examination presenting barriers, difficulty with communicating symptoms, and technology issues. CONCLUSION This review provides supportive evidence of virtual care experiences during the COVID-19 pandemic from patient and caregiver perspectives. This research provides a comprehensive overview of what patient-reported measures can be used to record virtual care quality amid and following the pandemic. Further research into healthcare professionals' perspectives would offer a supportive lens toward a strong person-centered healthcare system.
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Affiliation(s)
- Bishnu Bajgain
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Sarah Rabi
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Sadia Ahmed
- Alberta SPOR SUPPORT Unit, Patient Engagement Team, Calgary, AB, Canada.
| | - Veronika Kiryanova
- Patient and Community Engagement Research, University of Calgary, Calgary, AB, Canada
| | - Paul Fairie
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Alberta SPOR SUPPORT Unit, Patient Engagement Team, Calgary, AB, Canada
| | - Maria J Santana
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Alberta SPOR SUPPORT Unit, Patient Engagement Team, Calgary, AB, Canada
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7
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Plakun EM. Psychotherapy and Artificial Intelligence. J Psychiatr Pract 2023; 29:476-479. [PMID: 37948172 DOI: 10.1097/pra.0000000000000748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
This column explores the challenges involved in providing psychotherapy through artificial intelligence. It reviews artificial intelligence's capacity across schools of therapy to address relevant issues related to privacy, the use of technical interventions, and the therapeutic relationship.
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Affiliation(s)
- Eric M Plakun
- PLAKUN: Medical Director/CEO, The Austen Riggs Center, Stockbridge, MA; and Founder, American Psychiatric Association Psychotherapy Caucus, Washington, DC
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Johnson EE, Kruis R, Verdin R, Wells E, Ford DW, Sterba KR. Development of an Implementation Science Telehealth Toolkit to Promote Research Capacity in Evaluation of Telehealth Programs. TELEMEDICINE REPORTS 2023; 4:286-291. [PMID: 37817872 PMCID: PMC10561742 DOI: 10.1089/tmr.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 10/12/2023]
Abstract
Background The field of telehealth is rapidly growing and expanding access to quality health care, although there have been varied implementation outcomes in telehealth modalities. Dissemination and implementation (D&I) research can provide a systematic approach to identifying barriers and facilitators to telehealth implementation processes and outcomes. Methods An interdisciplinary research and clinical team developed an implementation science telehealth toolkit to guide D&I evaluations of new and existing telehealth innovations. Results The toolkit includes a separate section to correspond to each step in the D&I evaluation process. Each section includes resources to guide evaluation steps, telehealth specific considerations, and case study examples based on three completed telehealth evaluations. Discussion The field of telehealth is forecasted to continue to expand, with potential to increase health care access to populations in need. This toolkit can help guide health care stakeholders to develop and carry out evaluations to improve understanding of telehealth processes and outcomes to maximize implementation and sustainability of these valuable innovations.
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Affiliation(s)
- Emily E. Johnson
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ryan Kruis
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rebecca Verdin
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elana Wells
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dee W. Ford
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katherine R. Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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French A, Jones KA, Bettger JP, Maslow GR, Cholera R, Giri A, Swietek K, Tchuisseu YP, Repka S, Freed S, Whitaker R. Telehealth Utilization Among Adult Medicaid Beneficiaries in North Carolina with Behavioral Health Conditions During the COVID-19 Pandemic. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01730-2. [PMID: 37584807 PMCID: PMC11006092 DOI: 10.1007/s40615-023-01730-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE We examined factors associated with telehealth utilization during COVID-19 among adult Medicaid beneficiaries with behavioral health conditions. DATA SOURCES AND STUDY SETTING NC Medicaid 2019-2021 beneficiary and claims data. STUDY DESIGN This retrospective cohort study examined and compared behavioral health service use pre-COVID-19 (03/01/2019 to 02/28/2020) and during COVID-19 (04/01/2020 to 03/31/2021). Telehealth users included those with at least one behavioral health visit via telehealth during COVID-19. Descriptive statistics were calculated for overall sample and by telehealth status. Multilevel modified Poisson generalized estimating equation examined associations between telehealth use and patient- and area-level characteristics. DATA COLLECTION/EXTRACTION METHODS We identified individuals ages ≥ 21-64, diagnosed with a behavioral health condition, and had at least one behavioral-health specific visit before COVID-19. PRINCIPAL FINDINGS Almost two-thirds of the cohort received behavioral health services during COVID-19, with half of these beneficiaries using telehealth. Non-telehealth users had steeper declines in service use from pre- to during COVID-19 compared to telehealth users. Beneficiaries identifying as Black, multiracial or other were significantly less likely to use telehealth (ARR = 0.86; 95% CI: (0.83, 0.89)); (ARR = 0.92; 95% CI: (0.87, 0.96)) compared to White beneficiaries. Those eligible for Medicaid through the blind/disabled programs and who qualified for a state-specific specialized behavioral health plan were more likely to use telehealth (17% and 20%, respectively). CONCLUSIONS During the pandemic, telehealth facilitated continuity of care for beneficiaries with behavioral health conditions. Future research should aim to investigate how to reduce the digital divide and ensure equitable access to telehealth.
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Affiliation(s)
- Alexis French
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Dr., Suite 300, Durham, NC, 27705, USA.
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA
| | - Janet Prvu Bettger
- Department of Health and Rehabilitation Sciences, Temple University, 1700 N. Broad Street, Suite 300, Philadelphia, PA, 19121, USA
| | - Gary R Maslow
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Dr., Suite 300, Durham, NC, 27705, USA
- Department of Pediatrics, Duke University School of Medicine, 4020 N Roxboro St, Box 3675, Durham, NC, 27710, USA
| | - Rushina Cholera
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA
- Department of Pediatrics, Duke University School of Medicine, 4020 N Roxboro St, Box 3675, Durham, NC, 27710, USA
- Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
| | - Abhigya Giri
- The George Washington University Biostatistics Center, 6110 Executive Blvd, Rockville, MD, 20852, USA
| | - Karen Swietek
- NORC at the University of Chicago, 1 Broadway, 14Th Floor, Cambridge, MA, 02142, USA
| | - Yolande Pokam Tchuisseu
- Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
| | - Samantha Repka
- Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
| | - Salama Freed
- Health Policy and Management, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, 6th Floor, Washington, DC, 20052, USA
| | - Rebecca Whitaker
- Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
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Abstract
Although the technology for telemedicine existed before the Covid-19 pandemic, the need to provide medical services while minimizing the risk of contagion has encouraged its more widespread use. I argue that, although telemedicine can be useful in certain situations, physicians should not consider it an adequate substitute for the office visit. I first provide a narrative account of the experience of telemedicine. I then draw on philosophical critiques of technology to examine how telemedicine has epistemic and ethical effects that make some of the goods of medicine unavailable. Telemedicine rules out an embodied encounter between physician and patient, in which the sense of touch has special importance. The individualized attention facilitated by the in-person visit may better sustain a caring physician-patient relationship. Physicians should criticize attempts by administrators, insurers, or other parties to incentivize the wholesale replacement of traditional office visits with telemedicine.
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Lin B, Costakis A, John M, Linder H. Decreased inpatient psychiatric admissions with telepsychiatry use during the COVID-19 pandemic. Front Psychiatry 2023; 14:1172019. [PMID: 37351003 PMCID: PMC10284274 DOI: 10.3389/fpsyt.2023.1172019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/17/2023] [Indexed: 06/24/2023] Open
Abstract
Objective This study examines the quality of care provided through telepsychiatry by comparing psychiatric hospitalization rates among patients receiving in-person psychiatric care prior to the COVID-19 pandemic with rates among patients receiving virtual psychiatric care during the COVID-19 pandemic. Methods Mental health-related hospitalization rates among patients enrolled in a large academic hospital's outpatient psychiatry programs between March 1, 2018 and February 28, 2022 were retrospectively analyzed. Four time periods were created, spanning March 1 to February 28 of the following year. Demographic and clinical data were collected from the electronic health record, and descriptive statistics were calculated. Change in hospitalization rate between time periods was evaluated using McNemar's test. Results In the 2018 time period, 7.38% of all enrolled patients were hospitalized, compared to 7.70% hospitalized in the 2019 period, 5.74% in the 2020 period, and 5.38% in the 2021 period. Patients enrolled in both the 2018 and the 2019 periods saw no difference in hospitalization rate between the 2 years (2.93% in 2018, 2.83% in 2019; p = 0.830); patients enrolled in both 2019 and 2020 saw significantly lower hospitalization rates in 2020 (5.47% in 2019, 4.58% in 2020; p = 0.022); and patients enrolled in both 2020 and 2021 saw no difference (3.34% in 2020, 3.23% in 2021; p = 0.777). Conclusion Psychiatric hospitalization rates significantly decreased between the 2019 and the 2020 periods, suggesting a decrease in admissions associated with adoption of telepsychiatry. Future research should differentiate the roles played by telepsychiatry and COVID-19-related factors in reducing hospitalization rates during the pandemic.
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Affiliation(s)
- Brendon Lin
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Anna Costakis
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
| | - Majnu John
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Howard Linder
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
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Sciarrino NA, Myers US. If it's offered, will they come? Practical considerations when offering intensive PTSD treatment in an outpatient Veterans Affairs PTSD clinic. Bull Menninger Clin 2023; 87:46-62. [PMID: 36856477 DOI: 10.1521/bumc.2023.87.1.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) are efficacious; however, treatment dropout remains high. The delivery of intensive EBPs for PTSD (i.e., sessions three times per week or more) and telemental health may address barriers impacting dropout. Current evidence for intensive EBPs comes primarily from programs specifically designed for this level of care. Therefore, the feasibility of delivering intensive EBPs for PTSD in traditional outpatient clinics remains unclear. The aim of this pilot study was to identify veteran level of interest in intensive treatment and explore the feasibility of delivering intensive treatment via telemental health in an outpatient PTSD clinic at a Veterans Affairs (VA) hospital. One provider offered intensive treatment to 14 veterans. Three of the veterans initiated intensive treatment and completed with benefit. Veteranand system-level barriers, as well as veteran preferences for initiating intensive therapy and suggestions for implementing intensive EBPs in a routine outpatient clinic, are discussed.
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Affiliation(s)
- Nicole A Sciarrino
- The Ralph H. Johnson VA Medical Center, and in the Department of Psychiatry and Behavioral Sciences, Military Sciences Division, Medical University of South Carolina, Charleston, South Carolina. Dr
| | - Ursula S Myers
- The Ralph H. Johnson VA Medical Center, and in the Department of Psychiatry and Behavioral Sciences, Military Sciences Division, Medical University of South Carolina, Charleston, South Carolina. Dr.,The Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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Kister K, Laskowski J, Dybała E, Makarewicz A. Are we ready for Telepsychiatry? Benefits and challenges of digital
psychotherapy. CURRENT PROBLEMS OF PSYCHIATRY 2023. [DOI: 10.12923/2353-8627/2023-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Background: Telemedicine is one of the most modern and fastest-growing branches of medicine. The most common form is video consultation. We distinguish between synchronous and asynchronous telepsychiatry. This study aims to show the benefits of using telepsychiatry services, the challenges it poses to users, and to evaluate its use against traditional therapy.
Materials and methods: A review of literature from 1956-2023 in EMBASE, OpenKnowledge and PubMed databases was conducted. Keywords used were: telepsychiatry, teletherapy, and digital psychiatry. Ninety-eight articles were included.
Discussion: Telepsychiatry is an opportunity for regions affected by medical staff shortages. It bypasses cultural barriers, the problem of traveling and reduces the cost of medical point-of-service. Telepsychiatry is an opportunity for patients who do not use psychiatrists due to discrimination in a conservative society. Groups that may find it challenging include the elderly, the blind, and the deaf. Creating a healthy therapeutic alliance through a screen can be impossible, making it difficult to achieve successful therapy. A barrier to developing telepsychiatry is the need for more guidelines for dealing with medical errors.
Conclusions: Telemedicine can help in accessing specialized care regardless of location. Telepsychiatry provides a safe and anonymous environment for patients reluctant to receive inpatient therapy. The effectiveness of online therapy is primarily debated. Telepsychiatry should be limited to follow-up consultations and well-known patients - it is a form of complementing the diagnosis and treatment process. The authors point to the need for developing specific guidelines for conducting teletherapy with particular attention to the problem of suicide.
Keywords: telepsychiatry, teletherapy, digital psychiatry.
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Affiliation(s)
- Klaudia Kister
- I Departmentof Psychiatry, Psychoterapy and Early Intervention of Medical University in Lublin, Poland - Students Research Group
| | - Jakub Laskowski
- Department of Paediatrician Oncology, Transplantology and Haematology Medical University of Lublin, Poland - Students Research Group
| | | | - Agata Makarewicz
- I Department of Psychiatry, Psychoterapy and Early Intervention, Medical University of Lublin, Poland
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Berry KR, Gliske K, Schmidt C, Ballard J, Killian M, Fenkel C. The Impact of Family Therapy Participation on Youth and Young Adult Engagement and Retention in a Telehealth Intensive Outpatient Program: Quality Improvement Analysis (Preprint). JMIR Form Res 2022; 7:e45305. [PMID: 37079372 PMCID: PMC10160927 DOI: 10.2196/45305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/17/2023] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Early treatment dropout among youths and young adults (28%-75%) puts them at risk for poorer outcomes. Family engagement in treatment is linked to lower dropout and better attendance in outpatient, in-person treatment. However, this has not been studied in intensive or telehealth settings. OBJECTIVE We aimed to examine whether family members' participation in telehealth intensive outpatient (IOP) therapy for mental health disorders in youths and young adults is associated with patient's treatment engagement. A secondary aim was to assess demographic factors associated with family engagement in treatment. METHODS Data were collected from intake surveys, discharge outcome surveys, and administrative data for patients who attended a remote IOP for youths and young adults, nationwide. Data included 1487 patients who completed both intake and discharge surveys and either completed or disengaged from treatment between December 2020 and September 2022. Descriptive statistics were used to characterize the sample's baseline differences in demographics, engagement, and participation in family therapy. Mann-Whitney U and chi-square tests were used to explore differences in engagement and treatment completion between patients with and those without family therapy. Binomial regression was used to explore significant demographic predictors of family therapy participation and treatment completion. RESULTS Patients with family therapy had significantly better engagement and treatment completion outcomes than clients with no family therapy. Youths and young adults with ≥1 family therapy session were significantly more likely to stay in treatment an average of 2 weeks longer (median 11 weeks vs 9 weeks) and to attend a higher percentage of IOP sessions (median 84.38% vs 75.00%). Patients with family therapy were more likely to complete treatment than clients with no family therapy (608/731, 83.2% vs 445/752, 59.2%; P<.001). Different demographic variables were associated with an increased likelihood of participating in family therapy, including younger age (odds ratio 1.3) and identifying as heterosexual (odds ratio 1.4). After controlling for demographic factors, family therapy remained a significant predictor of treatment completion, such that each family therapy session attended was associated with a 1.4-fold increase in the odds of completing treatment (95% CI 1.3-1.4). CONCLUSIONS Youths and young adults whose families participate in any family therapy have lower dropout, greater length of stay, and higher treatment completion than those whose families do not participate in services in a remote IOP program. The findings of this quality improvement analysis are the first to establish a relationship between participation in family therapy and an increased engagement and retention in remote treatment for youths and young patients in IOP programing. Given the established importance of obtaining an adequate dosage of treatment, bolstering family therapy offerings is another tool that could contribute to the provision of care that better meets the needs of youths, young adults, and their families.
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Affiliation(s)
| | - Kate Gliske
- Charlie Health, Inc, Bozeman, MT, United States
| | | | - Jaime Ballard
- University of Minnesota, St. Paul, MN, United States
| | - Michael Killian
- College of Social Work, Florida State University, Tallahassee, FL, United States
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Mulvaney-Day N, Dean D, Miller K, Camacho-Cook J. Trends in Use of Telehealth for Behavioral Health Care During the COVID-19 Pandemic: Considerations for Payers and Employers. Am J Health Promot 2022; 36:1237-1241. [PMID: 36003014 PMCID: PMC9412131 DOI: 10.1177/08901171221112488e] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - David Dean
- National Cancer Institute, Rockville, MD, USA
| | - Kay Miller
- IBM Watson Health, IBM, Santa Barbara, CA, USA
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16
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Henke RM. Knowing Well, Being Well: well-being born of understanding: Supporting Workforce Mental Health During the Pandemic. Am J Health Promot 2022; 36:1213-1244. [PMID: 36003017 PMCID: PMC9523433 DOI: 10.1177/08901171221112488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Benudis A, Re'em Y, Kanellopoulos D, Moreno A, Zonana J. Patient and provider experiences of telemental health during the COVID-19 pandemic in a New York City academic medical center. Psychiatry Res 2022; 311:114496. [PMID: 35306378 PMCID: PMC8898588 DOI: 10.1016/j.psychres.2022.114496] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 02/26/2022] [Accepted: 03/05/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We aimed to evaluate patient and provider experiences with telemental health (TMH) at an academic outpatient psychiatry department in New York City during the first wave of the COVID-19 pandemic. METHODS Patients and providers completed online surveys evaluating their experience with TMH during the first wave of the COVID-19 pandemic. Surveys were distributed to 1,178 patients and 287 providers from July 2020 through October 2020. RESULTS 42.5% of providers and 21% of patients responded to the survey. The majority of patient and provider respondents rated the quality of phone and video visits as "equally good" or "somewhat worse" than in-person visits, while the majority of respondents were "somewhat satisfied" or "very satisfied" with video visits. Patients and providers preferred a hybrid model for future care. Common barriers to TMH included privacy, technical difficulties, and wi-fi access. CONCLUSIONS Patients and providers appeared willing to exchange some degree of quality for satisfaction with TMH. This study did not demonstrate with statistical significance any specific patient populations that would benefit more or less from TMH, suggesting that TMH may be a successful model for diverse patient populations. Our results suggest that providers, payors, and regulators should facilitate hybrid care delivery models that incorporate TMH beyond the pandemic.
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Affiliation(s)
- Abigail Benudis
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
| | - Yochai Re'em
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Dora Kanellopoulos
- NewYork-Presbyterian Hospital/Westchester Behavioral Health Center, White Plains, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | | | - Jess Zonana
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
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18
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Steenblock C, Schwarz PEH, Perakakis N, Brajshori N, Beqiri P, Bornstein SR. The interface of COVID-19, diabetes, and depression. DISCOVER MENTAL HEALTH 2022; 2:5. [PMID: 35253006 PMCID: PMC8886346 DOI: 10.1007/s44192-022-00007-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/27/2022] [Indexed: 02/07/2023]
Abstract
Comorbid diabetes with depression is a challenging and often under-recognized clinical problem. During the current COVID-19 pandemic, a communicable disease is thriving on the increasing incidences of these non-communicable diseases. These three different health problems are bidirectionally connected forming a vicious cycle. Firstly, depressed individuals show a higher risk of developing diabetes and patients with diabetes have a higher risk of developing symptoms of depression. Secondly, patients with diabetes have a higher risk of developing severe COVID-19 as well as of experiencing breakthrough infections. Thirdly, in both patients with type 2 diabetes and in COVID-19 survivors the prevalence of depression seems to be increased. Fourthly, lockdown and quarantine measurements during the COVID-19 pandemic has led to an increase in depression. Therefore, it is of importance to increase the awareness of this interface between depression, diabetes and COVID-19. Finally, as symptoms of post-COVID, diabetes and depression may be overlapping, there is a need for educating skilled personnel in the management of these comorbidities.
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Affiliation(s)
- Charlotte Steenblock
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Peter E. H. Schwarz
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
- Paul Langerhans Institute Dresden (PLID), Helmholtz Center Munich, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
- German Center for Diabetes Research (DZD E.V.), Neuherberg, Germany
| | - Nikolaos Perakakis
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
- Paul Langerhans Institute Dresden (PLID), Helmholtz Center Munich, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
- German Center for Diabetes Research (DZD E.V.), Neuherberg, Germany
| | - Naime Brajshori
- Research Unit, Heimerer College, Prishtina, Republic of Kosovo
| | - Petrit Beqiri
- Research Unit, Heimerer College, Prishtina, Republic of Kosovo
| | - Stefan R. Bornstein
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
- Paul Langerhans Institute Dresden (PLID), Helmholtz Center Munich, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
- German Center for Diabetes Research (DZD E.V.), Neuherberg, Germany
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
- Department of Diabetes, School of Life Course Science and Medicine, Kings College London, London, UK
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19
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Liberman JN, Bhattacharjee S, Rui P, Ruetsch C, Rothman B, Kulkarni A, Forma F. Impact of the COVID-19 Pandemic on Healthcare Resource Utilization in Individuals with Major Depressive Disorder. Health Serv Res Manag Epidemiol 2022; 9:23333928221111864. [PMID: 35832488 PMCID: PMC9272161 DOI: 10.1177/23333928221111864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To estimate the impact COVID-19 pandemic on healthcare resource utilization (HCRU) among individuals with major depressive disorder (MDD). Method A retrospective cohort study was conducted to compare HCRU in the twelve months prior to and six months following pandemic onset among 1,318,709 individuals with MDD and propensity-score matched controls. Outcomes were monthly rates of all-cause and MDD-specific outpatient, inpatient, and prescription medication HCRU. Piecewise random effects models were used to adjust for patient-level clustering, trends over time, and pre-pandemic factors. Results In the first month following onset, outpatient HCRU declined with primary care visits down 25.1%. Following this initial decline, outpatient HCRU increased, exceeding pre-pandemic rates within three months. By April 2020, three quarters of all psychotherapy sessions were delivered by telehealth, followed by psychiatry (62.3%), and primary care visits (30.1%). The use of telehealth remained highest for psychotherapy and psychiatry (representing 67.6% and 54.2% of visits, respectively, in September 2020). All-cause partial-day hospitalizations declined 50.5% and remained depressed through July 2020 (down 18.3%). Beginning in the first month post-onset, prescription medication HCRU increased for all antidepressant and antipsychotic medication classes: serotonin modulators ( + 11.8%), bupropion ( + 10.4%), SSRIs ( + 9.0%), SNRIs ( + 8.6%), and atypical antipsychotics ( + 7.5%). Conclusions Following pandemic onset, individuals with MDD realized an immediate, but short-lived, reduction in primary care HCRU. Telehealth use remained elevated through the first six months. The most significant and sustained reduction in HCRU was noted for partial-day hospitalizations and all-cause ED visits.
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Affiliation(s)
- Joshua N. Liberman
- Health Analytics, LLC, USA
- Joshua N. Liberman, Health Analytics, LLC, United States.
| | | | | | | | - Brian Rothman
- Otsuka Pharmaceutical Development & Commercialization, Inc, USA
| | - Amit Kulkarni
- Otsuka Pharmaceutical Development & Commercialization, Inc, USA
| | - Felicia Forma
- Former employee of Otsuka Pharmaceutical Development & Commercialization, Inc
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