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Sweileh WM. Analysis and mapping the research landscape on patient-centred care in the context of chronic disease management. J Eval Clin Pract 2024; 30:638-650. [PMID: 38567707 DOI: 10.1111/jep.13988] [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: 06/17/2023] [Revised: 02/07/2024] [Accepted: 03/18/2024] [Indexed: 05/25/2024]
Abstract
RATIONALE Patient-centred care has emerged as a transformative approach in managing chronic diseases, aiming to actively involve patients in their healthcare decisions. AIMS AND OBJECTIVES This study was conducted to analyse and map the research landscape on patient-centred care in the context of chronic disease management. METHODS This study used Scopus to retrieve the relevant articles. The analysis focused on the growth pattern, highly cited articles, randomised clinical trials, patients and providers perspectives, facilitators and barriers, frequent author keywords, emerging topics, and prolific countries and journals in the field. RESULTS In total, 926 research articles met the inclusion criteria. There was a notable increase in the number of publications over time. Cancer had the highest number of articles (n = 379, 40.9%), followed by diabetes mellitus, and mental health and psychiatric conditions. Studies on patient-centred care in diabetic patients received the highest number of citations. The results identified 52 randomised controlled trials that covered four major themes: patient-centred care for diabetes management, shared decision-making in mental health and primary care, shared decision-making in cancer care, and economic evaluation and cost-effectiveness. The study identified 51 studies that examined the impact of tools such as computer-based systems, decision aids, smartphone apps, and online tools to improve patient-centred outcomes. A map of author keywords showed that renal dialysis, HIV, and atrial fibrillation were the most recent topics in the field. Researchers from the United States contributed to more than half of the retrieved publications. The top active journals included "Patient Education and Counselling" and "Health Expectations". CONCLUSION This study provides valuable insights into the research landscape of patient-centred care within the context of chronic diseases. The current study provided a comprehensive overview of the research landscape on patient-centred care, which can empower patients by raising their awareness about clinical experiences and outcomes.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology and Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Hiefner AR, Raman S, Woods SB. Family Support and Type 2 Diabetes Self-management Behaviors in Underserved Latino/a/x Patients. Ann Behav Med 2024:kaae023. [PMID: 38795386 DOI: 10.1093/abm/kaae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2024] Open
Abstract
BACKGROUND Latino/a/x families experience persistent Type 2 diabetes mellitus (T2DM) disparities, including higher rates of diagnosis and mortality due to disease complications than their non-Hispanic White counterparts. Though greater social support is associated with improved disease outcomes for Latino/a/x patients with diabetes, research has yet to identify the specific pathways through which social support, and specifically family support, influences self-management. PURPOSE This study tested a theoretical model highlighting the mechanisms and pathways linking social support and physical health. Specifically, self-efficacy and depression were tested as psychological pathways connecting family support to diabetes self-management behaviors and diabetes morbidity in Latino/a/x patients with T2DM. METHODS Data from 177 patients were analyzed using structural equation modeling. Measures included diabetes-specific family support needed and received, depressive symptoms, self-efficacy in diabetes management, diabetes self-management behaviors, health appraisal, and hemoglobin A1c. RESULTS Greater diabetes-specific family support was significantly associated with more frequent engagement in diabetes self-management behaviors, both directly (p < .001) and through diabetes self-efficacy's partial mediation of this relationship (p = .013). Depression was not significantly associated with either family support (support received, p = .281; support needed, p = .428) or self-management behaviors (p = .349). CONCLUSIONS Family support and diabetes self-efficacy may be important modifiable psychosocial factors to target via integrated care interventions aimed at supporting Latino/a/x patients with T2DM. Future research is needed to test empirically based, culturally adapted interventions to reduce T2DM-related health disparities in this population.
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Affiliation(s)
- Angela R Hiefner
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shivani Raman
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah B Woods
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Yapi SM, Boudrias M, Tremblay A, Belanger G, Sourial N, Boivin A, Sasseville M, Côté A, Gartner JB, Taleb N, Lavoie ME, Trépanier E, Vachon B, Labelle M, Layani G. Intersectoral health interventions to improve the well-being of people living with type 2 diabetes: a scoping review protocol. BMJ Open 2024; 14:e080659. [PMID: 38772897 PMCID: PMC11110582 DOI: 10.1136/bmjopen-2023-080659] [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: 10/06/2023] [Accepted: 05/07/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION Intersectoral collaboration is a collaborative approach between the health sectors and other sectors to address the interdependent nature of the social determinants of health associated with chronic diseases such as diabetes. This scoping review aims to identify intersectoral health interventions implemented in primary care and community settings to improve the well-being and health of people living with type 2 diabetes. METHODS AND ANALYSIS This protocol is developed by the Arksey and O'Malley (2005) framework for scoping reviews and the Levac et al methodological enhancement. MEDLINE, Embase, CINAHL, grey literature and the reference list of key studies will be searched to identify any study, published between 2000 and 2023, related to the concepts of intersectorality, diabetes and primary/community care. Two reviewers will independently screen all titles/abstracts, full-text studies and grey literature for inclusion and extract data. Eligible interventions will be classified by sector of action proposed by the Social Determinants of Health Map and the conceptual framework for people-centred and integrated health services and further sorted according to the actors involved. This work started in September 2023 and will take approximately 10 months to be completed. ETHICS AND DISSEMINATION This review does not require ethical approval. The results will be disseminated through a peer-reviewed publication and presentations to stakeholders.
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Affiliation(s)
- Sopie Marielle Yapi
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Marguerite Boudrias
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Alexandre Tremblay
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Gabrielle Belanger
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Nadia Sourial
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
- Department of Health Management, Evaluation & Policy, Université de Montréal, Montreal, Quebec, Canada
| | - Antoine Boivin
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Maxime Sasseville
- Université Laval, Quebec, Quebec, Canada
- VITAM Centre de Recherche en Santé Durable, Quebec, Quebec, Canada
| | - André Côté
- VITAM Centre de Recherche en Santé Durable, Quebec, Quebec, Canada
- Département de management, Université Laval, Quebec, Quebec, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Quebec, Quebec, Canada
| | - Jean-Baptiste Gartner
- VITAM Centre de Recherche en Santé Durable, Quebec, Quebec, Canada
- Département de management, Université Laval, Quebec, Quebec, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Quebec City, Quebec, Canada
| | - Nadine Taleb
- Institut de recherches cliniques de Montreal, Montreal, Quebec, Canada
- Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
- Universite de Montreal, Montreal, Quebec, Canada
| | - Marie-Eve Lavoie
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Emmanuelle Trépanier
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | | | - Marcel Labelle
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Géraldine Layani
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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Reilly S, Hobson-Merrett C, Gibbons B, Jones B, Richards D, Plappert H, Gibson J, Green M, Gask L, Huxley PJ, Druss BG, Planner CL. Collaborative care approaches for people with severe mental illness. Cochrane Database Syst Rev 2024; 5:CD009531. [PMID: 38712709 PMCID: PMC11075124 DOI: 10.1002/14651858.cd009531.pub3] [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: 05/08/2024]
Abstract
BACKGROUND Collaborative care for severe mental illness (SMI) is a community-based intervention that promotes interdisciplinary working across primary and secondary care. Collaborative care interventions aim to improve the physical and/or mental health care of individuals with SMI. This is an update of a 2013 Cochrane review, based on new searches of the literature, which includes an additional seven studies. OBJECTIVES To assess the effectiveness of collaborative care approaches in comparison with standard care (or other non-collaborative care interventions) for people with diagnoses of SMI who are living in the community. SEARCH METHODS We searched the Cochrane Schizophrenia Study-Based Register of Trials (10 February 2021). We searched the Cochrane Common Mental Disorders (CCMD) controlled trials register (all available years to 6 June 2016). Subsequent searches on Ovid MEDLINE, Embase and PsycINFO together with the Cochrane Central Register of Controlled Trials (with an overlap) were run on 17 December 2021. SELECTION CRITERIA Randomised controlled trials (RCTs) where interventions described as 'collaborative care' were compared with 'standard care' for adults (18+ years) living in the community with a diagnosis of SMI. SMI was defined as schizophrenia, other types of schizophrenia-like psychosis or bipolar affective disorder. The primary outcomes of interest were: quality of life, mental state and psychiatric admissions at 12 months follow-up. DATA COLLECTION AND ANALYSIS Pairs of authors independently extracted data. We assessed the quality and certainty of the evidence using RoB 2 (for the primary outcomes) and GRADE. We compared treatment effects between collaborative care and standard care. We divided outcomes into short-term (up to six months), medium-term (seven to 12 months) and long-term (over 12 months). For dichotomous data we calculated the risk ratio (RR) and for continuous data we calculated the standardised mean difference (SMD), with 95% confidence intervals (CIs). We used random-effects meta-analyses due to substantial levels of heterogeneity across trials. We created a summary of findings table using GRADEpro. MAIN RESULTS Eight RCTs (1165 participants) are included in this review. Two met the criteria for type A collaborative care (intervention comprised of the four core components). The remaining six met the criteria for type B (described as collaborative care by the trialists, but not comprised of the four core components). The composition and purpose of the interventions varied across studies. For most outcomes there was low- or very low-certainty evidence. We found three studies that assessed the quality of life of participants at 12 months. Quality of life was measured using the SF-12 and the WHOQOL-BREF and the mean endpoint mental health component scores were reported at 12 months. Very low-certainty evidence did not show a difference in quality of life (mental health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.03, 95% CI -0.26 to 0.32; 3 RCTs, 227 participants). Very low-certainty evidence did not show a difference in quality of life (physical health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.08, 95% CI -0.18 to 0.33; 3 RCTs, 237 participants). Furthermore, in the medium term (at 12 months) low-certainty evidence did not show a difference between collaborative care and standard care in mental state (binary) (RR 0.99, 95% CI 0.77 to 1.28; 1 RCT, 253 participants) or in the risk of being admitted to a psychiatric hospital at 12 months (RR 5.15, 95% CI 0.67 to 39.57; 1 RCT, 253 participants). One study indicated an improvement in disability (proxy for social functioning) at 12 months in the collaborative care arm compared to usual care (RR 1.38, 95% CI 0.97 to 1.95; 1 RCT, 253 participants); we deemed this low-certainty evidence. Personal recovery and satisfaction/experience of care outcomes were not reported in any of the included studies. The data from one study indicated that the collaborative care treatment was more expensive than standard care (mean difference (MD) international dollars (Int$) 493.00, 95% CI 345.41 to 640.59) in the short term. Another study found the collaborative care intervention to be slightly less expensive at three years. AUTHORS' CONCLUSIONS This review does not provide evidence to indicate that collaborative care is more effective than standard care in the medium term (at 12 months) in relation to our primary outcomes (quality of life, mental state and psychiatric admissions). The evidence would be improved by better reporting, higher-quality RCTs and the assessment of underlying mechanisms of collaborative care. We advise caution in utilising the information in this review to assess the effectiveness of collaborative care.
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Affiliation(s)
- Siobhan Reilly
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Charley Hobson-Merrett
- Primary Care Plymouth, University of Plymouth, Plymouth, UK
- National Institute for Health Research Applied Research Collaboration South West Peninsula, Plymouth, UK
| | | | - Ben Jones
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Debra Richards
- Primary Care Plymouth, University of Plymouth, Plymouth, UK
| | - Humera Plappert
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | | | - Maria Green
- Pennine Health Care NHS Foundation Trust, Bury, UK
| | - Linda Gask
- Health Sciences Research Group, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter J Huxley
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Benjamin G Druss
- Department of Health Policy and Management, Emory University, Atlanta, USA
| | - Claire L Planner
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
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Chae WR, Kohring C, Rohde C, Köhler-Forsberg O, Otte C, Holstiege J. Eight-year nationwide study of the bidirectional association between type 2 diabetes and depression in nearly 8 million German outpatients. BMJ Open Diabetes Res Care 2024; 12:e003903. [PMID: 38719506 PMCID: PMC11085903 DOI: 10.1136/bmjdrc-2023-003903] [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: 11/09/2023] [Accepted: 03/23/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Research linking type 2 diabetes and depression mostly relied on hospital-based diagnoses or prescription data, overlooking many outpatient diagnoses. We aimed to quantify the risks of depression in individuals newly diagnosed with type 2 diabetes, and type 2 diabetes in those newly diagnosed with depression, while exploring potential risk differences depending on age, sex, and follow-up time. RESEARCH DESIGN AND METHODS We conducted a matched cohort study using German nationwide outpatient claims data from 2012 to 2022. Participants were individuals newly diagnosed with type 2 diabetes (N=294 642) or depression (N=1 271 537) in 2015, matched in a 1:4 ratio to controls without these conditions by age, sex, and region. The bidirectional risk was evaluated over an 8-year period using mixed-effects Cox proportional hazards models, adjusting for the Charlson Comorbidity Index, urbanicity, and area-level deprivation. RESULTS New type 2 diabetes diagnosis was associated with higher depression risk over 8 years (N=54 561 with depression, HR=1.23, 99% CI=1.21 to 1.24). Similarly, depression diagnosis was linked to an increased type 2 diabetes risk (N=71 848 with type 2 diabetes, HR=1.15, 99% CI=1.14 to 1.17). The association between depression and type 2 diabetes was stronger in younger age groups, especially under 34 years. Findings held across sex-stratified analyses. Time stratification showed a more pronounced association between type 2 diabetes and depression risk during the earlier follow-up quarters, whereas the risk of developing type 2 diabetes after depression diagnosis remained constant throughout the follow-up period. CONCLUSIONS Our findings confirm a bidirectional link between type 2 diabetes and depression, particularly in younger individuals. As type 2 diabetes and depression are frequent, future research needs to study whether preventive approaches can reduce the risk of developing this comorbidity.
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Affiliation(s)
- Woo Ri Chae
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Berlin, Germany
- DZPG, German Center for Mental Health, partner site Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
| | - Claudia Kohring
- Central Research Institute of Ambulatory Health Care in Germany (Zi), Department of Epidemiology and Health Care Atlas, Berlin, Germany
| | - Christopher Rohde
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Christian Otte
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Berlin, Germany
- DZPG, German Center for Mental Health, partner site Berlin, Germany
| | - Jakob Holstiege
- Central Research Institute of Ambulatory Health Care in Germany (Zi), Department of Epidemiology and Health Care Atlas, Berlin, Germany
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Kalyani RR, Allende-Vigo MZ, Antinori-Lent KJ, Close KL, Das SR, Deroze P, Edelman SV, El Sayed NA, Kerr D, Neumiller JJ, Norton A. Prioritizing Patient Experiences in the Management of Diabetes and Its Complications: An Endocrine Society Position Statement. J Clin Endocrinol Metab 2024; 109:1155-1178. [PMID: 38381587 DOI: 10.1210/clinem/dgad745] [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: 12/11/2023] [Indexed: 02/23/2024]
Abstract
Diabetes can be an arduous journey both for people with diabetes (PWD) and their caregivers. While the journey of every person with diabetes is unique, common themes emerge in managing this disease. To date, the experiences of PWD have not been fully considered to successfully implement the recommended standards of diabetes care in practice. It is critical for health-care providers (HCPs) to recognize perspectives of PWD to achieve optimal health outcomes. Further, existing tools are available to facilitate patient-centered care but are often underused. This statement summarizes findings from multistakeholder expert roundtable discussions hosted by the Endocrine Society that aimed to identify existing gaps in the management of diabetes and its complications and to identify tools needed to empower HCPs and PWD to address their many challenges. The roundtables included delegates from professional societies, governmental organizations, patient advocacy organizations, and social enterprises committed to making life better for PWD. Each section begins with a clinical scenario that serves as a framework to achieve desired health outcomes and includes a discussion of resources for HCPs to deliver patient-centered care in clinical practice. As diabetes management evolves, achieving this goal will also require the development of new tools to help guide HCPs in supporting PWD, as well as concrete strategies for the efficient uptake of these tools in clinical practice to minimize provider burden. Importantly, coordination among various stakeholders including PWD, HCPs, caregivers, policymakers, and payers is critical at all stages of the patient journey.
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Affiliation(s)
- Rita R Kalyani
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | | | | | | | - Sandeep R Das
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Phyllisa Deroze
- dQ&A, The Diabetes Research Company, San Francisco, CA 94117, USA
| | - Steven V Edelman
- Division of Endocrinology, Diabetes & Metabolism at the University of California at San Diego, San Diego, CA 92103, USA
| | - Nuha A El Sayed
- American Diabetes Association, Harvard Medical School, Boston, MA 02215, USA
| | - David Kerr
- Director of Digital Health, Diabetes Technology Society, Santa Barbara, CA 94010, USA
| | - Joshua J Neumiller
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA
| | - Anna Norton
- DiabetesSisters, #180, 1112 W Boughton Road, Bolingbrook, IL 60440, USA
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Derendorf L, Stock S, Simic D, Shukri A, Zelenak C, Nagel J, Friede T, Herbeck Belnap B, Herrmann-Lingen C, Pedersen SS, Sørensen J, Müller And On Behalf Of The Escape Consortium D. Health economic evaluation of blended collaborative care for older multimorbid heart failure patients: study protocol. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:29. [PMID: 38615050 PMCID: PMC11015692 DOI: 10.1186/s12962-024-00535-2] [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: 11/10/2023] [Accepted: 03/21/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Integrated care, in particular the 'Blended Collaborative Care (BCC)' strategy, may have the potential to improve health-related quality of life (HRQoL) in multimorbid patients with heart failure (HF) and psychosocial burden at no or low additional cost. The ESCAPE trial is a randomised controlled trial for the evaluation of a BCC approach in five European countries. For the economic evaluation of alongside this trial, the four main objectives were: (i) to document the costs of delivering the intervention, (ii) to assess the running costs across study sites, (iii) to evaluate short-term cost-effectiveness and cost-utility compared to providers' usual care, and (iv) to examine the budgetary implications. METHODS The trial-based economic analyses will include cross-country cost-effectiveness and cost-utility assessments from a payer perspective. The cost-utility analysis will calculate quality-adjusted life years (QALYs) using the EQ-5D-5L and national value sets. Cost-effectiveness will include the cost per hospital admission avoided and the cost per depression-free days (DFD). Resource use will be measured from different sources, including electronic medical health records, standardised questionnaires, patient receipts and a care manager survey. Uncertainty will be addressed using bootstrapping. DISCUSSION The various methods and approaches used for data acquisition should provide insights into the potential benefits and cost-effectiveness of a BCC intervention. Providing the economic evaluation of ESCAPE will contribute to a country-based structural and organisational planning of BCC (e.g., the number of patients that may benefit, how many care managers are needed). Improved care is expected to enhance health-related quality of life at little or no extra cost. TRIAL REGISTRATION The study follows CHEERS2022 and is registered at the German Clinical Trials Register (DRKS00025120).
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Affiliation(s)
- Lisa Derendorf
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany.
| | - Stephanie Stock
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Dusan Simic
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Arim Shukri
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Christine Zelenak
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Jonas Nagel
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Tim Friede
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - Birgit Herbeck Belnap
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
- Center for Behavioral Health, Media, and Technology, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jan Sørensen
- Healthcare Outcomes Research Centre, Dublin, Ireland
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Steel JL, George CJ, Terhorst L, Yabes JG, Reyes V, Zandberg DP, Nilsen M, Kiefer G, Johnson J, Marsh C, Bierenbaum J, Tageja N, Krauze M, VanderWeele R, Goel G, Ramineni G, Antoni M, Vodovotz Y, Walker J, Tohme S, Billiar T, Geller DA. Patient, family caregiver, and economic outcomes of an integrated screening and novel stepped collaborative care intervention in the oncology setting in the USA (CARES): a randomised, parallel, phase 3 trial. Lancet 2024; 403:1351-1361. [PMID: 38490230 DOI: 10.1016/s0140-6736(24)00015-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/06/2023] [Accepted: 01/03/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The current standard of care of screening and referring patients for treatment for symptoms, such as depression, pain, and fatigue, is not effective. This trial aimed to test the efficacy of an integrated screening and novel stepped collaborative care intervention versus standard of care for patients with cancer and at least one of the following symptoms: depression, pain, or fatigue. METHODS This randomised, parallel, phase 3 trial was conducted in 29 oncology outpatient clinics associated with the UPMC Hillman Cancer Center in the USA. Patients (aged ≥21 years) with any cancer type and clinical levels of depression, pain, or fatigue (or all of these) were eligible. Eligible family caregivers were aged 21 years or older and providing care to a patient diagnosed with cancer who consented for this study. Patients were randomly assigned (1:1) to stepped collaborative care or standard of care using a central, permuted block design (sizes of 2, 4, and 6) stratified by sex and prognostic status. The biostatistician, oncologists, and outcome assessors were masked to treatment assignment. Stepped collaborative care was once-weekly cognitive behavioural therapy for 50-60 min from a care coordinator via telemedicine (eg, telephone or videoconferencing). Pharmacotherapy for symptoms might be initiated or changed if recommended by the treatment team or preferred by the patient. Standard of care was screening and referral to a health-care provider for treatment of symptoms. The primary outcome was health-related quality of life in patients at 6 months. Maintenance of the treatment benefits was assessed at 12 months. Participants included in the primary analysis were per intention to treat, which included patients missing one or both follow-up assessments. This trial was registered with ClinicalTrials.gov (NCT02939755). FINDINGS Between Dec 5, 2016, and April 8, 2021, 459 patients and 190 family caregivers were enrolled. 222 patients were assigned to standard of care and 237 to stepped collaborative care. Of 459 patients, 201 (44%) were male and 258 (56%) were female. Patients in the stepped collaborative care group had a greater 0-6-month improvement in health-related quality of life than patients in the standard-of-care group (p=0·013, effect size 0·09). Health-related quality of life was maintained for the stepped collaborative care group (p=0·74, effect size 0·01). Patients in the stepped collaborative care group had greater 0-6-month improvements than the standard-of-care group in emotional (p=0·012), functional (p=0·042), and physical (p=0·033) wellbeing. No adverse events were reported by patients in either group and deaths were considered unrelated to the study. INTERPRETATION An integrated screening and novel stepped collaborative care intervention, compared with the current standard of care, is recommended to improve health-related quality of life. The findings of this study will advance the implementation of guideline concordant care (screening and treatment) and has the potential to shift the practice of screening and treatment paradigm nationwide, improving outcomes for patients diagnosed with cancer. FUNDING US National Cancer Institute.
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Affiliation(s)
- Jennifer L Steel
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychology, Dietrich School of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Charles J George
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren Terhorst
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan G Yabes
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Dan P Zandberg
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marci Nilsen
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jonas Johnson
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | | | | | - Gaurav Goel
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | | | - Michael Antoni
- Department of Psychology, Sylvester Cancer Center, University of Miami, FL, USA
| | - Yoram Vodovotz
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Immunology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Computational and Systems Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon Walker
- School of Information Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Samer Tohme
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Timothy Billiar
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - David A Geller
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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McKinnon K, Lentz C, Boccher-Lattimore D, Cournos F, Pather A, Sukumaran S, Remien RH, Mellins CA. Interventions for Integrating Behavioral Health into HIV Settings for US Adults: A Narrative Review of Systematic Reviews and Meta-analyses, 2010-2020. AIDS Behav 2024:10.1007/s10461-024-04324-z. [PMID: 38578597 DOI: 10.1007/s10461-024-04324-z] [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] [Accepted: 03/14/2024] [Indexed: 04/06/2024]
Abstract
Mental health and substance use disorders can negatively affect physical health, illness management, care access, and quality of life. These behavioral health conditions are prevalent and undertreated among people with HIV and may worsen outcomes along the entire HIV Care Continuum. This narrative review of tested interventions for integrating care for HIV and behavioral health disorders summarizes and contextualizes findings from systematic reviews and meta-analyses conducted in the past decade. We sought to identify gaps in research that hinder implementing evidence-based integrated care approaches. Using terms from the Substance Abuse and Mental Health Services Administration-Health Resources & Services Administration standard framework for integrated health care, we searched PubMed and PsycInfo to identify peer-reviewed systematic reviews or meta-analyses of intervention studies to integrate behavioral health and HIV published between 2010 and 2020. Among 23 studies identified, only reviews and meta-analyses that described interventions from the United States designed to integrate BH services into HIV settings for adults were retained, leaving six studies for narrative review by the study team. Demonstrated benefits from the relatively small literature on integrated care interventions include improved patient- and service-level outcomes, particularly for in-person case management and outreach interventions. Needed are systems-level integration interventions with assessments of long-term outcomes on behavioral health symptoms, HIV viral suppression, HIV transmission rates, and mortality. HIV, primary care, and other providers must include behavioral health as a part of overall healthcare and must play a central role in behavioral health care delivery. Research is needed to guide their way.
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Affiliation(s)
- Karen McKinnon
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 112, New York, 10032, USA.
- Northeast/Caribbean AIDS Education and Training Center, Department of Psychiatry, Columbia University, 601 West 168 Street, New York, 10032, USA.
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 112, New York, 10032, USA
| | - Daria Boccher-Lattimore
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 112, New York, 10032, USA
- Northeast/Caribbean AIDS Education and Training Center, Department of Psychiatry, Columbia University, 601 West 168 Street, New York, 10032, USA
| | - Francine Cournos
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 112, New York, 10032, USA
- Northeast/Caribbean AIDS Education and Training Center, Department of Psychiatry, Columbia University, 601 West 168 Street, New York, 10032, USA
- Mailman School of Public Health, Department of Epidemiology, Columbia University, 722 West 168th St, New York, 10032, USA
| | - Ariana Pather
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 112, New York, 10032, USA
| | - Stephen Sukumaran
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 112, New York, 10032, USA
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 112, New York, 10032, USA
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 112, New York, 10032, USA
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10
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Ski CF, Taylor RS, McGuigan K, Long L, Lambert JD, Richards SH, Thompson DR. Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation. Cochrane Database Syst Rev 2024; 4:CD013508. [PMID: 38577875 PMCID: PMC10996021 DOI: 10.1002/14651858.cd013508.pub3] [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: 04/06/2024]
Abstract
BACKGROUND Depression and anxiety occur frequently (with reported prevalence rates of around 40%) in individuals with coronary heart disease (CHD), heart failure (HF) or atrial fibrillation (AF) and are associated with a poor prognosis, such as decreased health-related quality of life (HRQoL), and increased morbidity and mortality. Psychological interventions are developed and delivered by psychologists or specifically trained healthcare workers and commonly include cognitive behavioural therapies and mindfulness-based stress reduction. They have been shown to reduce depression and anxiety in the general population, though the exact mechanism of action is not well understood. Further, their effects on psychological and clinical outcomes in patients with CHD, HF or AF are unclear. OBJECTIVES To assess the effects of psychological interventions (alone, or with cardiac rehabilitation or pharmacotherapy, or both) in adults who have a diagnosis of CHD, HF or AF, compared to no psychological intervention, on psychological and clinical outcomes. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL databases from 2009 to July 2022. We also searched three clinical trials registers in September 2020, and checked the reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing psychological interventions with no psychological intervention for a minimum of six months follow-up in adults aged over 18 years with a clinical diagnosis of CHD, HF or AF, with or without depression or anxiety. Studies had to report on either depression or anxiety or both. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were depression and anxiety, and our secondary outcomes of interest were HRQoL mental and physical components, all-cause mortality and major adverse cardiovascular events (MACE). We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS Twenty-one studies (2591 participants) met our inclusion criteria. Sixteen studies included people with CHD, five with HF and none with AF. Study sample sizes ranged from 29 to 430. Twenty and 17 studies reported the primary outcomes of depression and anxiety, respectively. Despite the high heterogeneity and variation, we decided to pool the studies using a random-effects model, recognising that the model does not eliminate heterogeneity and findings should be interpreted cautiously. We found that psychological interventions probably have a moderate effect on reducing depression (standardised mean difference (SMD) -0.36, 95% confidence interval (CI) -0.65 to -0.06; 20 studies, 2531 participants; moderate-certainty evidence) and anxiety (SMD -0.57, 95% CI -0.96 to -0.18; 17 studies, 2235 participants; moderate-certainty evidence), compared to no psychological intervention. Psychological interventions may have little to no effect on HRQoL physical component summary scores (PCS) (SMD 0.48, 95% CI -0.02 to 0.98; 12 studies, 1454 participants; low-certainty evidence), but may have a moderate effect on improving HRQoL mental component summary scores (MCS) (SMD 0.63, 95% CI 0.01 to 1.26; 12 studies, 1454 participants; low-certainty evidence), compared to no psychological intervention. Psychological interventions probably have little to no effect on all-cause mortality (risk ratio (RR) 0.81, 95% CI 0.39 to 1.69; 3 studies, 615 participants; moderate-certainty evidence) and may have little to no effect on MACE (RR 1.22, 95% CI 0.77 to 1.92; 4 studies, 450 participants; low-certainty evidence), compared to no psychological intervention. AUTHORS' CONCLUSIONS Current evidence suggests that psychological interventions for depression and anxiety probably result in a moderate reduction in depression and anxiety and may result in a moderate improvement in HRQoL MCS, compared to no intervention. However, they may have little to no effect on HRQoL PCS and MACE, and probably do not reduce mortality (all-cause) in adults who have a diagnosis of CHD or HF, compared with no psychological intervention. There was moderate to substantial heterogeneity identified across studies. Thus, evidence of treatment effects on these outcomes warrants careful interpretation. As there were no studies of psychological interventions for patients with AF included in our review, this is a gap that needs to be addressed in future studies, particularly in view of the rapid growth of research on management of AF. Studies investigating cost-effectiveness, return to work and cardiovascular morbidity (revascularisation) are also needed to better understand the benefits of psychological interventions in populations with heart disease.
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Affiliation(s)
- Chantal F Ski
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
- Australian Centre for Heart Health, Deakin University, Melbourne, Australia
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Karen McGuigan
- Queen's Communities and Place, Queen's University Belfast, Belfast, UK
| | - Linda Long
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | | | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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Prince EJ, Carroll CP, Pecker LH. Psychiatry referral and appointment attendance in a clinic for young adults with sickle cell disease. Pediatr Blood Cancer 2024; 71:e30860. [PMID: 38197728 PMCID: PMC10956472 DOI: 10.1002/pbc.30860] [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: 09/08/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/11/2024]
Abstract
Mental illness is a common sickle cell disease (SCD) comorbidity. This observational study evaluated psychiatry appointment attendance among 137 young adults with SCD. In their first year of adult SCD care, 43% of subjects were referred to psychiatry. Referral was associated with chronic transfusion therapy. Twenty-four percent of subjects attended a psychiatry appointment; attendance was associated with the appointment being scheduled within 6 weeks of referral and no subject characteristics. Ninety-one percent of subjects attending psychiatry appointments had a psychiatric disorder. Among young adults with SCD, psychiatric morbidity is high. Psychiatric services are, therefore, essential for this patient population.
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Affiliation(s)
- Elizabeth J Prince
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lydia H Pecker
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Yeung YL, Lee KL, Lau ESH, Yung TF, Yang A, Wu H, Wong KTC, Kong APS, Chow EYK, Ma RCW, Yeung T, Loo KM, Ozaki R, Luk AOY, Lui JNM, Chan JCN. Associations of comorbid depression with cardiovascular-renal events and all-cause mortality accounting for patient reported outcomes in individuals with type 2 diabetes: a 6-year prospective analysis of the Hong Kong Diabetes Register. Front Endocrinol (Lausanne) 2024; 15:1284799. [PMID: 38586459 PMCID: PMC10999250 DOI: 10.3389/fendo.2024.1284799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/29/2024] [Indexed: 04/09/2024] Open
Abstract
Background Psychosocial status and patient reported outcomes (PRO) [depression and health-related quality-of-life (HRQoL)] are major health determinants. We investigated the association between depression and clinical outcomes in Chinese patients with type 2 diabetes (T2D), adjusted for PRO. Methods Using prospective data from Hong Kong Diabetes Register (2013-2019), we estimated the hazard-ratio (HR, 95%CI) of depression (validated Patient Health Questionnaire 9 (PHQ-9) score≥7) with incident cardiovascular disease (CVD), ischemic heart disease (IHD), chronic kidney disease (CKD: eGFR<60 ml/min/1.73m2) and all-cause mortality in 4525 Chinese patients with T2D adjusted for patient characteristics, renal function, medications, self-care and HRQoL domains (mobility, self-care, usual activities, pain/discomfort, anxiety/depression measured by EQ-5D-3L) in linear-regression models. Results In this cohort without prior events [mean ± SD age:55.7 ± 10.6, 43.7% women, median (IQR) disease duration of 7.0 (2.0-13.0) years, HbA1c, 7.2% (6.6%-8.20%), 26.4% insulin-treated], 537(11.9%) patients had depressive symptoms and 1923 (42.5%) patients had some problems with HRQoL at baseline. After 5.6(IQR: 4.4-6.2) years, 141 patients (3.1%) died, 533(11.8%) developed CKD and 164(3.6%) developed CVD. In a fully-adjusted model (model 4) including self-care and HRQoL, the aHR of depression was 1.99 (95% confidence interval CI):1.25-3.18) for CVD, 2.29 (1.25-4.21) for IHD. Depression was associated with all-cause mortality in models 1-3 adjusted for demographics, clinical characteristics and self-care, but was attenuated after adjusting for HRQoL (model 4- 1.54; 95%CI: 0.91-2.60), though HR still indicated same direction with important magnitude. Patients who reported having regular exercise (3-4 times per week) had reduced aHR of CKD [0.61 (0.41-0.89)]. Item 4 of PHQ-9 (feeling tired, little energy) was independently associated with all-cause mortality with aHR of 1.66 (1.30-2.12). Conclusion Depression exhibits significant association with CVD, IHD, and all-cause mortality in patients with diabetes, adjusting for their HRQoL and health behaviors. Despite the association between depression and all-cause mortality attenuated after adjusting for HRQoL, the effect size remains substantial. The feeling of tiredness or having little energy, as assessed by item Q4 of the PHQ-9 questionnaire, was found to be significantly associated with an increased risk of all-cause mortality after covariate adjustments. Our findings emphasize the importance of incorporating psychiatric evaluations into holistic diabetes management.
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Affiliation(s)
- Yiu-Lam Yeung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Ka-Long Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Eric SH. Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Tsun-Fung Yung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Hongjiang Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Kelly TC. Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Alice PS. Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Elaine YK. Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Ronald CW. Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Theresa Yeung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Kit-man Loo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Risa Ozaki
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Andrea OY. Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Juliana NM. Lui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Juliana CN. Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
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Farrand P, Hamilton A, Strickland S. Development of a competency framework for the Assistant Wellbeing Practitioner (Renal) role. J Ren Care 2024; 50:63-75. [PMID: 36461879 DOI: 10.1111/jorc.12449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/12/2022] [Accepted: 11/09/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Many people with kidney disease experience comorbid mental health difficulties that result in worse physical health outcomes alongside greater personal, treatment and societal costs. PROBLEM Workforce expansion to treat comorbid mental health difficulties has focussed on psychological practitioners. This fails to capitalise on benefits arising from embedding roles to address biopsychosocial outcomes directly within the renal specialty. A competency framework to inform development and training for such a role has not been developed. METHODS Five-phase process to develop a competency framework for an Assistant Wellbeing Practitioner (Renal) role. Following identification of competency frameworks for roles in psychological practice, health and social care, relevant competencies were synthesised to create a draft competency framework. This framework was revised through consultation events with professionals associated with the renal specialty and Kidney Patient Involvement Network with the framework informing a competency map. RESULTS The competency map comprised three categories-Knowledge, Values and Principles, Core Skills and Meta-Competencies with specific competencies for an assistant practitioner role to work within the renal specialty identified. Core knowledge and skills included awareness of kidney treatments and common psychosocial difficulties, collaborative care and supporting evidence-based prevention approaches. CONCLUSIONS Competencies associated with the Assistant Wellbeing Practitioner (Renal) role have the potential to promote mental wellbeing, better physical health and generate social and economic benefits. The competency map can inform training and role evaluation, although addressing implementation issues associated with commissioning physical and mental healthcare is required.
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Affiliation(s)
- Paul Farrand
- Clinical Education, Development and Research (CEDAR); Psychology, University of Exeter, Exeter, UK
| | - Alexander Hamilton
- Exeter Kidney Unit, Royal Devon and Exeter NHS Foundation Trust, University of Exeter Medical School, Exeter, UK
| | - Sam Strickland
- Clinical Education, Development and Research (CEDAR); Psychology, University of Exeter, Exeter, UK
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Santos J, Camplain C, Pollitt AM, Baldwin JA. A formative assessment of client characteristics associated with missed appointments in integrated primary care services in rural Arizona. J Eval Clin Pract 2024; 30:243-250. [PMID: 37933799 DOI: 10.1111/jep.13939] [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: 05/06/2023] [Revised: 09/29/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Integrating primary care services in mental healthcare facilities is an uncommon model of care in the United States that could bring several benefits (e.g., improved access to physical healthcare) for vulnerable populations experiencing mental health conditions, especially those living in underserved regions like rural Arizona. AIM This formative assessment aimed to understand the sociodemographic and clinical characteristics of clients accessing integrated primary care (IPC) services implemented in 2021 at a community mental healthcare facility in rural Arizona and to explore the proportion of missed appointments. Additionally, we analysed the association between client characteristics and IPC missed appointments. METHODS The authors collaborated with a community mental health facility in rural Arizona, which provided deidentified data from 280 clients who accessed IPC services from June 2021 to February 2022. RESULTS Most clients were White and of vulnerable socioeconomic status, with a substantial proportion of Native Americans (23.58%). The majority of clients (55.75%) had a mental health disorder (MHD), 23.74% had a substance use disorder (SUD), and 15.10% had comorbid MHD and SUD. Linear regression revealed that experiencing comorbid MHD and SUD was significantly associated with missed appointments. Compared with White clients, Native Americans missed fewer appointments. CONCLUSION Future studies conducted from a culturally-centred perspective are crucial to guide strategies to reduce missed appointments in rural IPC services.
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Affiliation(s)
- Jeffersson Santos
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Carolyn Camplain
- Department of Community and Population Health, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Amanda Marie Pollitt
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Julie Ann Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
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15
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Vickery KD, Gelberg L, Hyson AR, Strother E, Carter J, Oranday Perez O, Franco M, Kavistan S, Gust S, Adair E, Anderson-Campbell A, Brito L, Butler A, Robinson T, Connett J, Evans MD, Emmons KM, Comulada WS, Busch AM. Pilot trial results of D-HOMES: a behavioral-activation based intervention for diabetes medication adherence and psychological wellness among people who have been homeless. Front Psychiatry 2024; 15:1329138. [PMID: 38487573 PMCID: PMC10937567 DOI: 10.3389/fpsyt.2024.1329138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction People living with type 2 diabetes who experience homelessness face a myriad of barriers to engaging in diabetes self-care behaviors that lead to premature complications and death. This is exacerbated by high rates of comorbid mental illness, substance use disorder, and other physical health problems. Despite strong evidence to support lay health coach and behavioral activation, little research has effectively engaged people living with type 2 diabetes who had experienced homelessness (DH). Methods We used community engaged research and incremental behavioral treatment development to design the Diabetes HOmeless MEdication Support (D-HOMES) program, a one-on-one, 3 month, coaching intervention to improve medication adherence and psychological wellness for DH. We present results of our pilot randomized trial (with baseline, 3 mo., 6 mo. assessments) comparing D-HOMES to enhanced usual care (EUC; brief diabetes education session and routine care; NCT05258630). Participants were English-speaking adults with type 2 diabetes, current/recent (<24 mo.) homelessness, and an HbA1c‗7.5%. We focused on feasibility (recruitment, retention, engagement) and acceptability (Client Satisfaction Questionnaire, CSQ-8). Our primary clinical outcome was glycemic control (HbA1c) and primary behavioral outcome was medication adherence. Secondary outcomes included psychological wellness and diabetes self-care. Results Thirty-six eligible participants enrolled, 18 in each arm. Most participants identified as Black males, had high rates of co-morbidities, and lived in subsidized housing. We retained 100% of participants at 3-months, and 94% at 6-months. Participants reported high satisfaction (mean CSQ-8 scores=28.64 [SD 3.94] of 32). HbA1c reduced to clinically significant levels in both groups, but we found no between group differences. Mean blood pressure improved more in D-HOMES than EUC between baseline and 6 mo. with between group mean differences of systolic -19.5 mmHg (p=0.030) and diastolic blood pressure -11.1 mmHg (p=0.049). We found no significant between group differences in other secondary outcomes. Conclusion We effectively recruited and retained DH over 6 months. Data support that the D-HOMES intervention was acceptable and feasible. We observe preliminary blood pressure improvement favoring D-HOMES that were statistically and clinically significant. D-HOMES warrants testing in a fully powered trial which could inform future high quality behavioral trials to promote health equity. Clinical trial registration https://clinicaltrials.gov/study/NCT05258630?term=D-HOMES&rank=1, identifier NCT05258630.
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Affiliation(s)
- Katherine Diaz Vickery
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Lillian Gelberg
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Audrey Rose Hyson
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Ella Strother
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Jill Carter
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Oscar Oranday Perez
- The Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
| | - Moncies Franco
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Silvio Kavistan
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Susan Gust
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Edward Adair
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | | | - Lelis Brito
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Annette Butler
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Tahiti Robinson
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - John Connett
- School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Michael D. Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, United States
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - W. Scott Comulada
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Andrew M. Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
- The Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
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16
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Chen T, Cao Z, Ferland F, Farand L, Fleury MJ. Profiles of Emergency Department Users with Psychiatric Disorders Related to Barriers to Outpatient Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:234. [PMID: 38397723 PMCID: PMC10888102 DOI: 10.3390/ijerph21020234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
Emergency department (ED) overcrowding is a growing problem worldwide. High ED users have been historically targeted to reduce ED overcrowding and associated high costs. Patients with psychiatric disorders, including substance-related disorders (SRDs), are among the largest contributors to high ED use. Since EDs are meant for urgent cases, they are not an appropriate setting for treating recurrent patients or replacing outpatient care. Identifying ED user profiles in terms of perceived barriers to care, service use, and sociodemographic and clinical characteristics is crucial to reduce ED use and unmet needs. Data were extracted from medical records and a survey was conducted among 299 ED patients from 2021 to 2022 in large Quebec networks. Cluster algorithms and comparison tests identified three profiles. Profile 1 had the most patients without barriers to care, with case managers, and received the best primary care. Profile 2 reported moderate barriers to care and low primary care use, best quality of life, and more serious psychiatric disorders. Profile 3 had the most barriers to care, high ED users, and lower service satisfaction and perceived mental/health conditions. Our findings and recommendations inform decision-makers on evidence-based strategies to address the unmet needs of these vulnerable populations.
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Affiliation(s)
- Tiffany Chen
- Department of Psychiatry, McGill University, Montreal, QC H3A 1A1, Canada;
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC H4H 1R3, Canada;
| | - Francine Ferland
- School of Social Work, Addiction Rehabilitation Centre, Laval University, National Capital University Integrated Health and Social Services Centre, Quebec City, QC G1V 0A6, Canada;
| | - Lambert Farand
- Department of Health Administration, Policy, and Evaluation, School of Public Health, University of Montreal, Montreal, QC H3N 1X9, Canada;
| | - Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, QC H3A 1A1, Canada;
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC H4H 1R3, Canada;
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17
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Stephens KA, van Eeghen C, Zheng Z, Anastas T, Ma KPK, Prado MG, Clifton J, Rose G, Mullin D, Chan KCG, Kessler R. Effects of intervention stage completion in an integrated behavioral health and primary care randomized pragmatic intervention trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.07.24302481. [PMID: 38370852 PMCID: PMC10871364 DOI: 10.1101/2024.02.07.24302481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Purpose A pragmatic, cluster-randomized controlled trial of a comprehensive practice-level, multi-staged practice transformation intervention aimed to increase behavioral health integration in primary care practices and improve patient outcomes. We examined association between the completion of intervention stages and patient outcomes across a heterogenous national sample of primary care practices. Methods Forty-two primary care practices across the U.S. with co-located behavioral health and 2,426 patients with multiple chronic medical and behavioral health conditions completed surveys at baseline, midpoint and two year follow-up. Effects of the intervention on patient health and primary care integration outcomes were examined using multilevel mixed-effects models, while controlling for baseline outcome measurements. Results No differences were found associated with the number of intervention stages completed in patient health outcomes were found for depression, anxiety, fatigue, sleep disturbance, pain, pain interference, social function, patient satisfaction with care or medication adherence. The completion of each intervention stage was associated with increases in Practice Integration Profile (PIP) domain scores and were confirmed with modeling using multiple imputation for: Workflow 3.5 (95% CI: 0.9-6.1), Integration Methods 4.6 (95% CI: 1.5-7.6), Patient Identification 2.9 (95% CI: 0.9-5.0), and Total Integration 2.7 (95% CI: 0.7-4.7). Conclusion A practice-centric flexible practice transformation intervention improved integration of behavioral health in primary care across heterogenous primary care practices treating patients with multiple chronic conditions. Interventions that allow practices to flexibly improve care have potential to help complex patient populations. Future research is needed to determine how to best target patient health outcomes at a population level.
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Affiliation(s)
- Kari A Stephens
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | | | - Zihan Zheng
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Tracy Anastas
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Kris Pui Kwan Ma
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Maria G Prado
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
| | - Jessica Clifton
- Department of Medicine, University of Vermont, Burlington, VT 05405, USA
- Parhelia Wellness, Santa Rosa, CA 95409, USA
| | - Gail Rose
- Department of Psychiatry, University of Vermont, Burlington, VT 05405, USA
| | - Daniel Mullin
- Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA 01655, USA
| | - Kwun C G Chan
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Rodger Kessler
- Department of Family Medicine, University of Colorado, Denver, CO 80217, USA
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18
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Chaukos D, Genus S, Wiesenfeld L, Maunder R, Mylopoulos M. Improving patient-centered care for HIV and mental illness: exploring hospital and community integration through education. AIDS Care 2024; 36:181-187. [PMID: 37856839 DOI: 10.1080/09540121.2023.2269408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023]
Abstract
Current models of care delivery are failing patients with complexity, like those living with HIV, mental illness and other psychosocial challenges. These patients often require resource-intensive personalized care across hospital and community settings, but available supports can be fragmented and challenging to access and navigate. To improve this, the authors created a program to enhance integrated, trauma-informed care through an innovative educational role for a HIV community caseworker embedded in an academic HIV Psychiatry clinic, called the Mental Health Clinical Fellowship. Through qualitative interviews with 21 participants (patients, physicians, clinicians and Mental Health Clinical Fellows) from October 2020-March 2023, the authors explore how implementation of this program affects patient experiences and satisfaction with care. Patients described their care experiences as less stigmatizing, more accessible, holistic and coordinated. They often attributed this to the integration between fellow and psychiatrist, and specifically the accessible stance of community organizations embedded within a hospital, which helped build trust. Interchangeable and integrated support by caseworker and psychiatrist improved patient engagement in psychiatric management and patient satisfaction with their care. Cross-context and cross-disciplinary care provision that includes providers from community and hospital working directly together to deliver care can improve care for patients with significant complexity.
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Affiliation(s)
- Deanna Chaukos
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Psychiatry, Sinai Health System, Toronto, Canada
| | - Sandalia Genus
- Department of Psychiatry, Sinai Health System, Toronto, Canada
- Department of Anthropology, University of Toronto, Toronto, Canada
| | - Lesley Wiesenfeld
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Psychiatry, Sinai Health System, Toronto, Canada
| | - Robert Maunder
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Psychiatry, Sinai Health System, Toronto, Canada
| | - Maria Mylopoulos
- Department of Pediatrics, University of Toronto, Temerty Faculty of Medicine, Toronto, Canada
- The Wilson Centre, University of Toronto, Toronto, Canada
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19
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Santos J, Acevedo-Morales A, Jones L, Bautista T, Camplain C, Keene CN, Baldwin J. Client perspectives on primary care integration in a rural-serving behavioral health center. JOURNAL OF INTEGRATED CARE 2024; 32:31-44. [PMID: 38516678 PMCID: PMC10954248 DOI: 10.1108/jica-08-2023-0061] [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] [Indexed: 03/23/2024]
Abstract
Purpose Advancing behavioral health and primary care integration is a priority for helping clients overcome the complex health challenges impacting healthcare deserts like those in Arizona, United States of America (USA). This study aimed to explore the perspectives of people with a substance use disorder (SUD) on accessing integrated primary care (IPC) services in a rural-serving behavioral healthcare organization in Arizona. Design/methodology/approach Clients from a behavioral health facility in Arizona (n = 10) diagnosed with SUDs who also accessed IPC participated in a 45-min semi-structured interview. Findings The authors identified six overarching themes: (1) importance of IPC for clients being treated for SUDs, (2) client low level of awareness of IPC availability at the facility, (3) strategies to increase awareness of IPC availability at the behavioral health facility, (4) cultural practices providers should consider in care integration, (5) attitudes and perceptions about the experience of accessing IPC and (6) challenges to attending IPC appointments. The authors also identified subthemes for most of the main themes. Originality/value This is the first study in rural Arizona to identify valuable insights into the experiences of people with SUDs accessing IPC, providing a foundation for future research in the region on care integration.
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Affiliation(s)
- Jeffersson Santos
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ
| | | | - Lillian Jones
- Department of Clinical Psychology, Northern Arizona University, Flagstaff, AZ
| | | | - Carolyn Camplain
- Department of Community and Population Health, Lehigh University, Bethlehem, PA
| | | | - Julie Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ
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20
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Iturralde E, Fazzolari L, Slama NE, Alexeeff SE, Sterling SA, Awsare S, Koshy MT, Shia M. Telehealth Collaborative Care Led by Clinical Pharmacists for People With Psychosis or Bipolar Disorder: A Propensity Weighted Comparison With Usual Psychiatric Care. J Clin Psychiatry 2024; 85:23m14917. [PMID: 38301189 PMCID: PMC10868914 DOI: 10.4088/jcp.23m14917] [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] [Indexed: 02/03/2024]
Abstract
Objective: People with psychosis or bipolar disorder (severe and persistent mental illness [SPMI]) are at high risk for poor psychiatric and chronic illness outcomes, which could be ameliorated through improved health care quality. This study assessed whether a telehealth, collaborative care program managed by psychiatric clinical pharmacists (SPMI Population Care) was associated with improved health care quality for adults with SPMI in a large California health system. Methods: This retrospective cohort study used electronic health record data to compare 968 program enrollees at 6 demonstration sites (Population Care) to 8,339 contemporaneous patients with SPMI at 6 non-program sites (Usual Care). SPMI diagnoses were based on ICD-10-CM diagnostic codes. Primary outcomes were optimal psychotropic medication adherence, guideline-recommended glycemic screening, annual psychiatrist visit, and emergency department use. Difference-in-difference analyses assessed change in outcomes from 12 months pre- to 12 months post-enrollment using overlap weighting with high dimensional propensity scores to balance participant characteristics across groups. Participant data were collected from January 1, 2020, to June 30, 2022. Results: From pre- to post-enrollment, Population Care was associated with greater achievement of psychotropic medication adherence and glycemic screening (+6 and +9 percentage points), but unexpectedly with a decrease in annual psychiatrist visits (-6 percentage points) and no significant change in emergency department use, relative to Usual Care. More than 75% of Population Care participants attended an intake and ≥ 1 follow-up visits. Participants with psychosis (26% of sample) had similar results as those with bipolar disorder. Conclusions: Clinical pharmacist-led telehealth collaborative care has potential to improve psychopharmacologic treatment adherence and recommended disease preventive screening for people with psychosis or bipolar disorder.
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Affiliation(s)
- Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, Oakland
- Drs Iturralde and Fazzolari are co-first authors
- Corresponding Author: Esti Iturralde, PhD, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612
| | - Lisa Fazzolari
- Permanente Medical Group, Kaiser Permanente Northern California, Oakland
- Drs Iturralde and Fazzolari are co-first authors
| | - Natalie E Slama
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Sameer Awsare
- Permanente Medical Group, Kaiser Permanente Northern California, Oakland
| | - Maria T Koshy
- Permanente Medical Group, Kaiser Permanente Northern California, Oakland
| | - Macy Shia
- Permanente Medical Group, Kaiser Permanente Northern California, Oakland
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21
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Schwabenbauer AK, Merladet J, Metzner N, Salib B, Siffert K. Adapting Measurement-Based Care to VA Home-Based Primary Care Mental Health Treatment: A Quality Improvement Project. Clin Gerontol 2024:1-10. [PMID: 38226906 DOI: 10.1080/07317115.2024.2304889] [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: 01/17/2024]
Abstract
OBJECTIVES This quality improvement project sought to develop guidance for Home-Based Primary Care (HPBC) Mental Health (MH) clinicians on integrating Measurement-Based Care (MBC) into their practice and gain participating psychologists' feedback on their experience using MBC for treating mental health concerns with HBPC Veterans. METHODS Based on feedback from the HBPC MH community and in consultation with national leadership, a workgroup of HBPC psychologists developed a guide tailoring MBC to HBPC Veterans. Eight HBPC psychologists piloted the adapted MBC approach with 53 Veterans. Participating psychologists provided feedback on measure administration, Veterans' responses to MBC, and perceived benefits and challenges. RESULTS Pilot participants' feedback suggested that MBC can be a highly useful tool for delivering mental health services in HBPC, although feedback varied about specific MBC measures. Qualitative feedback was primarily positive, but participants noted challenges based on the nature of the presenting problem and Veteran-specific characteristics. CONCLUSIONS Findings indicate that MBC can be utilized with appropriate HBPC Veterans and has the potential to benefit care. Further research is needed to clarify factors that enhance or reduce MBC's utility within HBPC. CLINICAL IMPLICATIONS HBPC MH providers identified MBC as a useful tool particularly when adapted to meet the needs of HBPC Veterans.
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Affiliation(s)
| | - John Merladet
- Behavioral Health, Orlando VA Medical Center, Orlando, Florida, USA
| | - Neil Metzner
- Behavioral Health, White River Junction VA Medical Center, White River Junction, Vermont, USA
| | - Brea Salib
- Behavioral Health, Durham VA Health Care System, Durham, North Carolina, USA
| | - Kevin Siffert
- Behavioral Health, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
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22
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Huyen NTT, Tsakitzidis G, Tam NM, Valcke M, Chuong HV, Wens J. Perceptions and experiences of primary healthcare providers toward interprofessional collaboration in chronic disease management in Hue, Vietnam. J Interprof Care 2024; 38:52-61. [PMID: 37366565 DOI: 10.1080/13561820.2023.2227650] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/19/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023]
Abstract
In Vietnam, each primary care community health center (CHC) consists of a multi-professional team with six disciplines, including a physician, assistant physician, nurse, pharmacist, midwife, and Vietnamese traditional physician, who are able to meet the majority of patient's needs at the primary care level. How they collaborate, especially in chronic disease management (CDM), is still limited described in the literature. This study aims to gain insight into the perceptions and the experiences of primary health care providers (PHCPs) toward interprofessional collaboration (IPC) in CDM in CHCs in (Hue) Vietnam. A qualitative study of descriptive phenomenology was performed using two focus groups and 15 semi-structured interviews with PHCPs from six professions relevant to CDM in CHCs. The data were analyzed using NVivo 12.0 with a thematic analysis method by a multiprofessional research team. From the analysis, the data were classified into three main themes: "lack of collaborative practice," "knowledge," and "facilitators and barriers to IPC." This study provided evidence of the awareness that actual collaboration in daily care is fragmentarily organized and that PHCPs try to finish their tasks within their profession. PHCPs work multiprofessionally and lack shared decision-making in patient-centered care. There is a need to develop an interprofessional education program and training to address these deficiencies in the Vietnamese context to improve interprofessional collaboration in health care.
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Affiliation(s)
- Nguyen Thi Thanh Huyen
- Department of Family Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
| | - Giannoula Tsakitzidis
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
| | - Nguyen Minh Tam
- Department of Family Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Martin Valcke
- Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Huynh Van Chuong
- The Education Quality Management Agency, Ministry of Education and Training, Vietnam
| | - Johan Wens
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
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23
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Pao M, Mooneyham GC, Raza H. Pediatric Consultation-Liaison (C-L) Psychiatry Training Pathways. J Acad Consult Liaison Psychiatry 2024; 65:106-112. [PMID: 37995942 PMCID: PMC10922888 DOI: 10.1016/j.jaclp.2023.11.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/29/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
This perspective piece reviews the current training pathways for pediatric consultation-liaison psychiatry. Significant workforce shortages of child and adolescent psychiatry over the past 3 decades have led to the creation of new training pathways between pediatrics and child and adolescent psychiatry training programs to care for children whose medical and psychiatric management has become increasingly complex. There are now several options available to receive excellent training in pediatric consultation-liaison. Efforts to foster continued interactions and shared education between adult and pediatric consultation-liaison providers are likely to be beneficial to both disciplines given the astonishing advances in technology over the years that have allowed many patients with complex childhood medical disorders to survive into adulthood today.
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Affiliation(s)
- Maryland Pao
- Office of the Clinical Director, National Institute of Mental Health, NIH, Bethesda, MD.
| | - GenaLynne C Mooneyham
- Office of the Clinical Director, National Institute of Mental Health, NIH, Bethesda, MD
| | - Haniya Raza
- Office of the Clinical Director, National Institute of Mental Health, NIH, Bethesda, MD
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24
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Knutzen T, Bulger E, Iles-Shih M, Hernandez A, Engstrom A, Whiteside L, Birk N, Abu K, Shoyer J, Conde C, Ryan P, Wang J, Russo J, Heagerty P, Palinkas L, Zatzick D. Stepped collaborative care versus American College of Surgeons Committee on Trauma required screening and referral for posttraumatic stress disorder: Clinical trial protocol. Contemp Clin Trials 2024; 136:107380. [PMID: 37952714 PMCID: PMC11025340 DOI: 10.1016/j.cct.2023.107380] [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: 08/10/2023] [Revised: 10/13/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Each year in the US, approximately 1.5-2.5 million individuals are so severely injured that they require inpatient hospital admissions. The American College of Surgeons Committee on Trauma (College) now requires that trauma centers have in place protocols to identify and refer hospitalized patients at risk injury psychological sequelae. Literature review revealed no investigations that have identified optimal screening, intervention, and referral procedures in the wake of the College requirement. METHODS The single-site pragmatic trial investigation will individually randomize 424 patients (212 intervention and 212 control) to a brief stepped care intervention versus College required mental health screening and referral control conditions. Blinded follow-up interviews at 1-, 3-, 6-, and 12-months post-injury will assess the symptoms of PTSD and related comorbidity for all patients. The emergency department information exchange (EDIE) will be used to capture population-level automated emergency department and inpatient utilization data for the intent-to-treat sample. The investigation aims to test the primary hypotheses that intervention patients will demonstrate significant reductions in PTSD symptoms and emergency department/inpatient utilization when compared to control patients. The study incorporates a Rapid Assessment Procedure-Informed Clinical Ethnography (RAPICE) implementation process assessment. CONCLUSIONS The overarching goal of the investigation is to advance the sustainable delivery of high-quality trauma center mental health screening, intervention, and referral procedures for diverse injury survivors. An end-of-study policy summit will harness pragmatic trial data to inform the capacity for US trauma centers to implement high-quality acute care mental health screening, intervention and referral services for diverse injured patient populations. TRIAL REGISTRATION Clinicaltrials.govNCT05632770.
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Affiliation(s)
- Tanya Knutzen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, USA.
| | - Matt Iles-Shih
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Alexandra Hernandez
- Department of Surgery, University of Washington School of Medicine, Seattle, USA.
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
| | - Navneet Birk
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Khadija Abu
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Jake Shoyer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Cristina Conde
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Paige Ryan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington School of Public Health, Seattle, USA.
| | - Larry Palinkas
- Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, USA.
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
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25
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 1. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S11-S19. [PMID: 38078573 PMCID: PMC10725798 DOI: 10.2337/dc24-s001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at https://professional.diabetes.org/SOC.
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26
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Morelli V. Social Determinants of Health: An Overview for the Primary Care Provider. Prim Care 2023; 50:507-525. [PMID: 37866828 DOI: 10.1016/j.pop.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Social determinants of health (SDoH) are reflected in how people live (access to health care, economic stability, built environment, food security, climate), learn (the educational environment), work (occupational environment), and play/socialize (social context and digital domain). All of these day-to-day conditions play a vital role in a patient's overall health, and a primary care provider should be prepared to understand their role to screen, assess, and address SDoH in clinical practice.
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Affiliation(s)
- Vincent Morelli
- Department of Family & Community Medicine, Meharry Medical College, 3rd Floor, Old Hospital Building, 1005 Dr. D. B. Todd, Jr., Boulevard, Nashville, TN 37208-3599, USA.
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27
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Shroff H, Gallagher H. Multidisciplinary Care of Alcohol-related Liver Disease and Alcohol Use Disorder: A Narrative Review for Hepatology and Addiction Clinicians. Clin Ther 2023; 45:1177-1188. [PMID: 37813775 DOI: 10.1016/j.clinthera.2023.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Models of integrated, multidisciplinary care are optimal in the setting of complex, chronic diseases and in the overlap of medical and mental health disease, both of which apply to alcohol-related liver disease (ALD). Alcohol use disorder (AUD) drives nearly all cases of ALD, and coexisting mental health disease is common. ALD is a complex condition with severe clinical manifestations and high mortality that can occasionally lead to liver transplantation. As a result, integrated care for ALD is an attractive proposition. The aim of this narrative review was to: (1) review the overlapping and concerning trends in the epidemiology of AUD and ALD; (2) use a theoretical framework for integrated care known as the "five-component model" as a basis to highlight the need for integrated care and the overlapping clinical manifestations and management of the 2 conditions; and (3) review the existing applications of integrated care in this area. METHODS We performed a narrative review of epidemiology, clinical manifestations, and management strategies in AUD and ALD, with a particular focus on areas of overlap that are pertinent to clinicians who manage each disease. Previously published models were reviewed for integrating care in AUD and ALD, both in the general ALD population and in the setting of liver transplantation. FINDINGS The incidences of AUD and ALD are rising, with a pronounced acceleration driven by the Coronavirus Disease 2019 pandemic. Hepatologists are underprepared to diagnose and treat AUD despite its high prevalence in patients with liver disease. A patient who presents with overlapping clinical manifestations of both AUD and ALD may not fit neatly into typical treatment paradigms for each individual disease but rather will require new management strategies that are appropriately adapted. As a result, the dimensions of integrated care, including collective ownership of shared goals, interdependence among providers, flexibility of roles, and newly created professional activities, are highly pertinent to the holistic management of both diseases. IMPLICATIONS Integrated care models have proliferated as recognition grows of the dual pathology of AUD and ALD. Ongoing coordination across disciplines and research in the fields of hepatology and addiction medicine are needed to further elucidate optimal mechanisms for collaboration and improved quality of care.
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Affiliation(s)
- Hersh Shroff
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
| | - Heather Gallagher
- Substance Treatment and Recovery Program, University of North Carolina Hospital, Chapel Hill, North Carolina, USA
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Paulus AB, Wendte JM, Vinson B. Integrating Care Coordination and Mental Health Research Into Dialysis Practice: Stakeholder Perspectives, Methods, and Outcomes. Kidney Med 2023; 5:100732. [PMID: 38034511 PMCID: PMC10684385 DOI: 10.1016/j.xkme.2023.100732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Rationale & Objective Despite many studies suggesting beneficial innovations for patients, few make it into clinical practice. This study aims to enhance patient care by facilitating effective dissemination of patient-centered outcomes research to health care workers in outpatient dialysis facilities, aided by the Patient-Centered Outcomes Research Institute's (PCORI) dissemination and implementation framework. Study Design Dissemination and implementation project. Setting & Population Outpatient hemodialysis facilities in the United States. Methods We brought together panels of key stakeholders, which included researchers, patient subject matter experts, and dialysis personnel. Their role was to provide guidance on the content and methods for disseminating research findings. With a focus on 2 critical patient safety areas-care coordination or care transitions and mental or behavioral health-we developed virtual education modules. These modules were then made available to outpatient dialysis facilities by the national 5-Diamond Patient Safety Program. Results In 2022, the training was used by more than 2,500 dialysis facilities and approximately 40,000 dialysis staff in the care coordination module, and by more than 300 dialysis facilities and 5,000 staff for the mental health module. Cumulatively, the modules affected more than 179,000 patients. Evidence of efficacy was the significant increase in trainee knowledge of research findings and implementation considerations (P ≤ 0.05). Limitations Potential selection bias because dialysis facilities that did not participate in the program may differ significantly from those that did, which may affect generalizability. In addition, variable timing in release of the different modules may have influenced uptake by facilities. Conclusions By using key stakeholder guidance and accessible virtual education modules, the implementation framework shows promise in effectively disseminating research findings within outpatient dialysis settings. This method potentially carries implications for broader health care settings as well. Plain-Language Summary Our study addresses a common health care challenge-many promising ideas for improving patient care never actually reach the patients. We aimed to bridge the dissemination gap by sharing research with health care workers in outpatient dialysis, promoting evidence-based practice. We collaborated with experts, patients, and dialysis personnel to develop easy-to-understand educational materials focused on 2 critical topics: care coordination and mental health. In 2022, our training benefited more than 2,500 facilities and 40,000 staff for care coordination, and 300 facilities with 5,000 staff for mental health, positively affecting more than 179,000 patients. We found that the training significantly increased knowledge among staff. Our approach shows promise for sharing research effectively in dialysis centers and potentially in other health care settings.
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Affiliation(s)
- Amber B. Paulus
- School of Nursing; Virginia Commonwealth University; Richmond, VA
| | - Jered M. Wendte
- School of Nursing; Virginia Commonwealth University; Richmond, VA
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Mikkonen U, Voutilainen A, Mikola T, Roponen J, Rajapolvi S, Lehto SM, Ruusunen A, Mäntyselkä P. The effects of motivational self-care promotion on depressive symptoms among adults with type 2 diabetes: A systematic review and meta-analysis. Prev Med Rep 2023; 36:102431. [PMID: 37771374 PMCID: PMC10523005 DOI: 10.1016/j.pmedr.2023.102431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
In individuals with type 2 diabetes (T2D), comorbid depression leads to increased health care costs and unsatisfactory treatment outcomes. Supporting healthy behaviors and self-efficacy might provide means to prevent depressive symptoms. We assessed the effects of motivational interviewing (MI) - based self-care promotion that specifically targets health behaviors, on depressive symptoms in adults with T2D. We followed PRISMA guidelines and searched Pubmed, Scopus, PsycINFO, Cinahl, and Cochrane Library to find randomized controlled trials (RCTs) published up to February 2023. Eligible RCTs had to target the T2D adult population, examine MI-based interventions that focus on multiple health behaviors, and measure depressive symptoms on a validated scale. Standardized mean differences (SMD) with 95% confidence intervals were calculated using a random-effects model. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of the evidence. After the screening, eleven studies with 2,682 individuals were eligible for the narrative synthesis. A meta-analysis of nine studies favored interventions with a pooled SMD of -0.19 (95% Cl = -0.34 to -0.05, p = 0.008, I2 = 52%). Due to the indirectness and imprecision of the evidence, we assessed the certainty of evidence based on GRADE as low. MI-based self-care promotion with a focus on health behaviors and implemented by a well MI-trained person had a preventive effect on depressive symptoms among adults with T2D. However, the certainty of evidence remained low. In future trials, the effect of MI-based self-care promotion on depression should be studied in clinically depressed populations.
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Affiliation(s)
- Ulla Mikkonen
- Institute Of Public Health and Clinical Nutrition, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
- Primary Health Care Center, Wellbeing Services County of North Savo, P.O. Box 1711, FI-70211 Kuopio, Finland
| | - Ari Voutilainen
- Institute Of Public Health and Clinical Nutrition, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Tuomas Mikola
- Institute Of Clinical Medicine, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Johanna Roponen
- Institute Of Public Health and Clinical Nutrition, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Sanna Rajapolvi
- Institute Of Public Health and Clinical Nutrition, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Soili M. Lehto
- Institute Of Clinical Medicine, University Of Oslo, P.O. Box 1171 - Blindern, 0318 Oslo, Norway
- R&D Department, Division Of Mental Health Services, Akershus University Hospital, 1478 Lørenskog, Norway
- Department Of Psychiatry, University Of Helsinki, P.O. Box 22, FI-00014 University Of Helsinki, Finland
| | - Anu Ruusunen
- Institute Of Public Health and Clinical Nutrition, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
- Department Of Psychiatry, Kuopio University Hospital, Wellbeing Services County of North Savo, P.O. Box 1711, FI-70211 Kuopio, Finland
- Deakin University, Institute For Mental And Physical Health And Clinical Translation (IMPACT), Food & Mood Centre, School Of Medicine, Barwon Health, P.O. Box 281 Geelong, Victoria 3220, Australia
| | - Pekka Mäntyselkä
- Institute Of Public Health and Clinical Nutrition, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
- Clinical Research And Trials Centre, Kuopio University Hospital, Wellbeing Services County Of North Savo, P.O. Box 1711, FI-70211 Kuopio, Finland
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Hodgkin D, Horgan CM, Jordan Brown S, Bart G, Stewart MT. Financial Sustainability of Novel Delivery Models in Behavioral Health Treatment. THE JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS 2023; 26:149-158. [PMID: 38113385 PMCID: PMC10752219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/26/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND In the US, much of the research into new intervention and delivery models for behavioral health care is funded by research institutes and foundations, typically through grants to develop and test the new interventions. The original grant funding is typically time-limited. This implies that eventually communities, clinicians, and others must find resources to replace the grant funding -otherwise the innovation will not be adopted. Diffusion is challenged by the continued dominance in the US of fee-for-service reimbursement, especially for behavioral health care. AIMS To understand the financial challenges to disseminating innovative behavioral health delivery models posed by fee-for-service reimbursement, and to explore alternative payment models that promise to accelerate adoption by better addressing need for flexibility and sustainability. METHODS We review US experience with three specific novel delivery models that emerged in recent years. The models are: collaborative care model for depression (CoCM), outpatient based opioid treatment (OBOT), and the certified community behavioral health clinic (CCBHC) model. These examples were selected as illustrating some common themes and some different issues affecting diffusion. For each model, we discuss its core components; evidence on its effectiveness and cost-effectiveness; how its dissemination was funded; how providers are paid; and what has been the uptake so far. RESULTS The collaborative care model has existed for longest, but has been slow to disseminate, due in part to a lack of billing codes for key components until recently. The OBOT model faced that problem, and also (until recently) a regulatory requirement requiring physicians to obtain federal waivers in order to prescribe buprenorphine. Similarly, the CCBHC model includes previously nonbillable services, but it appears to be diffusing more successfully than some other innovations, due in part to the approach taken by funders. DISCUSSION A common challenge for all three models has been their inclusion of services that were not (initially) reimbursable in a fee-for-service system. However, even establishing new procedure codes may not be enough to give providers the flexibility needed to implement these models, unless payers also implement alternative payment models. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE For providers who receive time-limited grant funding to implement these novel delivery models, one key lesson is the need to start early on planning how services will be sustained after the grant ends. IMPLICATIONS FOR HEALTH POLICY For research funders (e.g., federal agencies), it is clearly important to speed up the process of obtaining coverage for each novel delivery model, including the development of new billable service codes, and to plan for this as early as possible. Funders also need to collaborate with providers early in the grant period on sustainability planning for the post-grant environment. For payers, a key lesson is the need to fold novel models into stable existing funding streams such as Medicaid and commercial insurance coverage, rather than leaving them at the mercy of revolving time-limited grants, and to provide pathways for contracting for innovations under new payment models. IMPLICATIONS FOR FURTHER RESEARCH For researchers, a key recommendation would be to pay greater attention to the payment environment when designing new delivery models and interventions.
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Affiliation(s)
- Dominic Hodgkin
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts 02453, United States
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Liebschutz JM, Subramaniam GA, Stone R, Appleton N, Gelberg L, Lovejoy TI, Bunting AM, Cleland CM, Lasser KE, Beers D, Abrams C, McCormack J, Potter GE, Case A, Revoredo L, Jelstrom EM, Kline MM, Wu LT, McNeely J. Subthreshold opioid use disorder prevention (STOP) trial: a cluster randomized clinical trial: study design and methods. Addict Sci Clin Pract 2023; 18:70. [PMID: 37980494 PMCID: PMC10657560 DOI: 10.1186/s13722-023-00424-8] [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: 04/13/2023] [Accepted: 10/30/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Preventing progression to moderate or severe opioid use disorder (OUD) among people who exhibit risky opioid use behavior that does not meet criteria for treatment with opioid agonists or antagonists (subthreshold OUD) is poorly understood. The Subthreshold Opioid Use Disorder Prevention (STOP) Trial is designed to study the efficacy of a collaborative care intervention to reduce risky opioid use and to prevent progression to moderate or severe OUD in adult primary care patients with subthreshold OUD. METHODS The STOP trial is a cluster randomized controlled trial, randomized at the PCP level, conducted in 5 distinct geographic sites. STOP tests the efficacy of the STOP intervention in comparison to enhanced usual care (EUC) in adult primary care patients with risky opioid use that does not meet criteria for moderate-severe OUD. The STOP intervention consists of (1) a practice-embedded nurse care manager (NCM) who provides patient participant education and supports primary care providers (PCPs) in engaging and monitoring patient-participants; (2) brief advice, delivered to patient participants by their PCP and/or prerecorded video message, about health risks of opioid misuse; and (3) up to 6 sessions of telephone health coaching to motivate and support behavior change. EUC consists of primary care treatment as usual, plus printed overdose prevention educational materials and an educational video on cancer screening. The primary outcome measure is self-reported number of days of risky (illicit or nonmedical) opioid use over 180 days, assessed monthly via text message using items from the Addiction Severity Index and the Current Opioid Misuse Measure. Secondary outcomes assess other substance use, mental health, quality of life, and healthcare utilization as well as PCP prescribing and monitoring behaviors. A mixed effects negative binomial model with a log link will be fit to estimate the difference in means between treatment and control groups using an intent-to-treat population. DISCUSSION Given a growing interest in interventions for the management of patients with risky opioid use, and the need for primary care-based interventions, this study potentially offers a blueprint for a feasible and effective approach to improving outcomes in this population. TRIAL REGISTRATION Clinicaltrials.gov, identifier NCT04218201, January 6, 2020.
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Affiliation(s)
- Jane M Liebschutz
- Division of General Internal Medicine, Center for Research On Health Care, University of Pittsburgh, 200 Lothrop Street, Suite 933W, Pittsburgh, PA, 15213, USA.
| | | | - Rebecca Stone
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Noa Appleton
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Lillian Gelberg
- David Geffen School of Medicine at UCLA, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Travis I Lovejoy
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Amanda M Bunting
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Charles M Cleland
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Karen E Lasser
- Section of General Internal Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- School of Public Health, Boston University, Boston, MA, USA
| | - Donna Beers
- Section of General Internal Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | | | - Gail E Potter
- The Emmes Company, LLC, Rockville, MD, USA
- Biostatistics Research Branch, NIH/NIAID, Rockville, MD, USA
| | | | | | | | | | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer McNeely
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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Petersen I, Kemp CG, Rao D, Wagenaar BH, Bachmann M, Sherr K, Kathree T, Luvuno Z, Van Rensburg A, Gigaba SG, Mthethwa L, Grant M, Selohilwe O, Hongo N, Faris G, Ras CJ, Fairall L, Bucibo S, Bhana A. Strengthening integrated depression services within routine primary health care using the RE-AIM framework in South Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002604. [PMID: 37956110 PMCID: PMC10642780 DOI: 10.1371/journal.pgph.0002604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023]
Abstract
Integration of mental health into routine primary health care (PHC) services in low-and middle-income countries is globally accepted to improve health outcomes of other conditions and narrow the mental health treatment gap. Yet implementation remains a challenge. The aim of this study was to identify implementation strategies that improve implementation outcomes of an evidence-based depression care collaborative implementation model integrated with routine PHC clinic services in South Africa. An iterative, quasi-experimental, observational implementation research design, incorporating the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework, was applied to evaluate implementation outcomes of a strengthened package of implementation strategies (stage two) compared with an initial evaluation of the model (stage one). The first stage package was implemented and evaluated in 10 PHC clinics and the second stage strengthened package in 19 PHC clinics (inclusive of the initial 10 clinics) in one resource-scarce district in the province of KwaZulu-Natal, South Africa. Diagnosed service users were more likely to be referred for counselling treatment in the second stage compared with stage one (OR 23.15, SE = 18.03, z = 4.04, 95%CI [5.03-106.49], p < .001). Training in and use of a validated, mandated mental health screening tool, including on-site educational outreach and technical support visits, was an important promoter of nurse-level diagnosis rates (OR 3.75, 95% CI [1.19, 11.80], p = 0.02). Nurses who perceived the integrated care model as acceptable were also more likely to successfully diagnose patients (OR 2.57, 95% CI [1.03-6.40], p = 0.043). Consistent availability of a clinic counsellor was associated with a greater probability of referral (OR 5.9, 95%CI [1.29-27.75], p = 0.022). Treatment uptake among referred service users remained a concern across both stages, with inconsistent co-located counselling services associated with poor uptake. The importance of implementation research for strengthening implementation strategies along the cascade of care for integrating depression care within routine PHC services is highlighted.
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Affiliation(s)
- Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
| | - Christopher G. Kemp
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Bradley H. Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Max Bachmann
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Tasneem Kathree
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Zamasomi Luvuno
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - André Van Rensburg
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Londiwe Mthethwa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Merridy Grant
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Curtin University, Perth, Australia
| | - One Selohilwe
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Nikiwe Hongo
- Mental Health Directorate, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa
| | - Gillian Faris
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Christy-Joy Ras
- Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Sanah Bucibo
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Arvin Bhana
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- SA Medical Research Council, Health Systems Research Unit, Durban, South Africa
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Maun A, Björkelund C, Arvidsson E. Primary care utilisation, adherence to guideline-based pharmacotherapy and continuity of care in primary care patients with chronic diseases and multimorbidity - a cross-sectional study. BMC PRIMARY CARE 2023; 24:237. [PMID: 37957554 PMCID: PMC10644564 DOI: 10.1186/s12875-023-02191-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND To understand how to improve care for patients with chronic diseases and multimorbidity we wanted to describe the prevalence of different chronic diseases and the pattern of multimorbidity and to analyse the associations between occurrence of diseases and primary care utilization, adherence to guideline-based pharmacotherapy, and continuity of care. METHODS Retrospective cross-sectional study of routine care data of the general population in region Jönköping in Sweden (345 916 inhabitants using primary care services) covering 4.3 years. PARTICIPANTS Patients fulfilling the inclusion criteria of having ≥ 1 of 10 common chronic diseases and ≥ 3 visits to primary care between 2011 and 2015. PRIMARY OUTCOME MEASURES In order to determine diseases and multimorbidity, primary care utilisation, adherence to guideline-based pharmacotherapy, frequencies and percentages, interval and ratio scaled variables were described using means, standard deviations, and various percentiles in the population. Two continuity indices were used (MMCI, COC) to describe continuity. RESULTS Of the general population, 25 829 patients fulfilled the inclusion criteria (7.5% of the population). Number of diseases increased with increasing age, and multimorbidity was much more common than single diseases (mean 2.0 per patient). There was a slight positive correlation (0.29) between number of diseases and visits, but visits did not increase proportionally to the number of diseases. Patients with physical diseases combined with anxiety and/or depression made more visits than others. The number of diseases per patient was negatively associated with the adherence to pharmacotherapy guidelines. There was no association between continuity and healthcare utilisation or adherence to pharmacotherapy guidelines. CONCLUSIONS Multimorbid patients are common in primary care and for many chronic diseases it is more common to have other simultaneous diseases than having only one disease. This can make adherence to pharmacotherapy guidelines a questionable measure for aged multimorbid patients. Existing continuity indices also revealed limitations. Holistic and patient-centred measures should be used for quality assessment of care for multimorbid patients in primary care.
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Affiliation(s)
- Andy Maun
- Institute of General Practice / Primary Care, Faculty of Medicine and Medical Center, University of Freiburg, Elsässer Str 2m, Freiburg, DE-79110, Germany.
| | - Cecilia Björkelund
- Primary Health Care, Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 454, Göteborg, SE-405 30, Sweden
| | - Eva Arvidsson
- Research and Development Unit for Primary Care, Futurum, Hus B4, Länssjukhuset Ryhov, Jönköping, SE-551 85, Sweden
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Smolderen KG, Samaan Z, Decker C, Collins T, Lazar RM, Itoga NK, Mena-Hurtado C. Association Between Mental Health Burden, Clinical Presentation, and Outcomes in Individuals With Symptomatic Peripheral Artery Disease: A Scientific Statement From the American Heart Association. Circulation 2023; 148:1511-1528. [PMID: 37781785 DOI: 10.1161/cir.0000000000001178] [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: 10/03/2023]
Abstract
Along with the rising burden of peripheral artery disease (PAD), mental health concerns are increasingly being recognized as a comorbidity to address in the chronic disease management of symptomatic PAD. Apart from a high prevalence of comorbid mental health conditions, the role of pain and changing health behaviors and the broader impacts of illness and adaptation to living with PAD require specialized behavioral health expertise. This scientific statement builds a case that this expertise should be integrated within the multidisciplinary PAD team. Furthermore, areas such as cognitive dysfunction and palliative care are highlighted as needing psychological interventions. Although much of the evidence of the efficacy of psychological and psychotropic interventions has been extrapolated from other cardiovascular populations, evidence for the role of psychological interventions for behavior change, for example, uptake of exercise regimens, is increasingly being accrued within PAD. Areas for behavioral health needs and interactions with PAD treatment are discussed, including the use of opioids, depression management, anxiety and stress reduction interventions, the use of benzodiazepines and antidepressants, smoking cessation, rehabilitation trajectories after amputation, and the role of cognitive decline for PAD treatment and outcomes. A case summary highlights the stigma around mental health and vascular disease and the fragmentation of care. This scientific statement provides remarks for building a road map for integrated behavioral PAD care and potential solutions to overcome these barriers. Instrumental to reaching these changes are interprofessional advocacy efforts and initiatives that help break down the stigma around mental health and promote evidence-based collaborative, nonhierarchical, and multidisciplinary PAD care.
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Littenberg B, Clifton J, Crocker AM, Baldwin LM, Bonnell LN, Breshears RE, Callas P, Chakravarti P, Clark/Keefe K, Cohen DJ, deGruy FV, Eidt-Pearson L, Elder W, Fox C, Frisbie S, Hekman K, Hitt J, Jewiss J, Kaelber DC, Kelley KS, Kessler R, O'Rourke-Lavoie JB, Leibowitz GS, Macchi CR, Martin MP, McGovern M, Mollis B, Mullin D, Nagykaldi Z, Natkin LW, Pace W, Pinckney RG, Pomeroy D, Reynolds P, Rose GL, Scholle SH, Sieber WJ, Soucie J, Stancin T, Stange KC, Stephens KA, Teng K, Waddell EN, van Eeghen C. A Cluster Randomized Trial of Primary Care Practice Redesign to Integrate Behavioral Health for Those Who Need It Most: Patients With Multiple Chronic Conditions. Ann Fam Med 2023; 21:483-495. [PMID: 38012036 PMCID: PMC10681692 DOI: 10.1370/afm.3027] [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: 12/21/2022] [Revised: 05/05/2023] [Accepted: 05/31/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE Patient outcomes can improve when primary care and behavioral health providers use a collaborative system of care, but integrating these services is difficult. We tested the effectiveness of a practice intervention for improving patient outcomes by enhancing integrated behavioral health (IBH) activities. METHODS We conducted a pragmatic, cluster randomized controlled trial. The intervention combined practice redesign, quality improvement coaching, provider and staff education, and collaborative learning. At baseline and 2 years, staff at 42 primary care practices completed the Practice Integration Profile (PIP) as a measure of IBH. Adult patients with multiple chronic medical and behavioral conditions completed the Patient-Reported Outcomes Measurement Information System (PROMIS-29) survey. Primary outcomes were the change in 8 PROMIS-29 domain scores. Secondary outcomes included change in level of integration. RESULTS Intervention assignment had no effect on change in outcomes reported by 2,426 patients who completed both baseline and 2-year surveys. Practices assigned to the intervention improved PIP workflow scores but not PIP total scores. Baseline PIP total score was significantly associated with patient-reported function, independent of intervention. Active practices that completed intervention workbooks (n = 13) improved patient-reported outcomes and practice integration (P ≤ .05) compared with other active practices (n = 7). CONCLUSION Intervention assignment had no effect on change in patient outcomes; however, we did observe improved patient outcomes among practices that entered the study with greater IBH. We also observed more improvement of integration and patient outcomes among active practices that completed the intervention compared to active practices that did not. Additional research is needed to understand how implementation efforts to enhance IBH can best reach patients.
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Affiliation(s)
- Benjamin Littenberg
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
| | - Jessica Clifton
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
- Parhelia Wellness, Santa Rosa, California (J.C.)
| | - Abigail M Crocker
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Laura-Mae Baldwin
- University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.)
| | - Levi N Bonnell
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - Peter Callas
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - Kelly Clark/Keefe
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Deborah J Cohen
- Oregon Health & Science University, Portland, Oregon (D.J.C., E.N.W.)
| | - Frank V deGruy
- University of Colorado School of Medicine, Aurora, Colorado (F.V.D., R.K.)
| | | | | | - Chester Fox
- University at Buffalo, Buffalo, New York (C.F.)
| | - Sylvie Frisbie
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Katie Hekman
- University of California San Diego, San Diego, California (K.H., W.J.S.)
| | - Juvena Hitt
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Jennifer Jewiss
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - David C Kaelber
- The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.)
- Case Western Reserve University, Cleveland, Ohio (D.C.K., K.C.S.)
| | - Kairn Stetler Kelley
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Rodger Kessler
- University of Colorado School of Medicine, Aurora, Colorado (F.V.D., R.K.)
| | - Jennifer B O'Rourke-Lavoie
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - C R Macchi
- Arizona State University, Tempe, Arizona (C.R.M., M.P.M.)
| | | | - Mark McGovern
- Stanford University School of Medicine, Stanford, California (M.M.)
| | - Brenda Mollis
- University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.)
| | - Daniel Mullin
- UMass Chan Medical School, Worcester, Massachusetts (L.E-P., D.M.)
| | - Zsolt Nagykaldi
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma (Z.N.)
| | - Lisa W Natkin
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - Richard G Pinckney
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Douglas Pomeroy
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Paula Reynolds
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Gail L Rose
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - William J Sieber
- University of California San Diego, San Diego, California (K.H., W.J.S.)
| | - Jeni Soucie
- National Committee for Quality Assurance, Washington, DC (S.H.S., J.S.)
| | - Terry Stancin
- The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.)
| | - Kurt C Stange
- Case Western Reserve University, Cleveland, Ohio (D.C.K., K.C.S.)
| | - Kari A Stephens
- University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.)
| | - Kathryn Teng
- The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.)
| | | | - Constance van Eeghen
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
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Namdeo MK, Verma S, Das Gupta R, Islam R, Nazneen S, Rawal LB. Depression and health-related quality of life of patients with type 2 diabetes attending tertiary level hospitals in Dhaka, Bangladesh. Glob Health Res Policy 2023; 8:43. [PMID: 37845742 PMCID: PMC10577997 DOI: 10.1186/s41256-023-00328-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) and depression are closely linked. People with T2DM are at increased risk of developing depression and vice versa. T2DM and depression comorbid conditions adversely affect Health-Related Quality of Life (HRQOL) and management of T2DM. In this study, we assessed depression and HRQOL among patients with T2DM in Dhaka, Bangladesh. METHODS A cross-sectional study was conducted in two tertiary-level hospitals in Dhaka, Bangladesh. Data were collected from 318 patients with T2DM. A set of standard tools, PHQ-9 (for assessing depression) and EuroQol-5D-5L (for assessing the HRQOL), were used. Statistical analyses, including Chi-square and Fisher's exact tests, Wilcoxon (Mann-Whitney), and Spearman's correlation coefficient tests, were performed using SPSS (v.20). RESULTS The majority of the patients (58%) were females, with a mean age (standard deviation) of 52 ± 10 years, and 74% of patients lived in urban areas. The prevalence of depression was 62% (PHQ-9 score ≥ 5). Over three-quarters (76%) reported problems in the anxiety/ depression dimension of EQ-5D, followed by pain/discomfort (74%), mobility (40%), self-care (36%), and usual activities (33%). The depression and T2DM comorbid condition were associated with all the five dimensions of EQ-5D (χ2 statistics with df = 1 was 52.33, 51.13, 52.67, 21.61, 7.92 for mobility, self-care, usual activities, pain/discomfort, and anxiety/ depression dimensions respectively, p- < 0.01). The mean EQ-5D index (0.53 vs. 0.75) and the mean EQ-5D VAS (65 vs. 76) both showed lower values in T2DM patients with depression compared to T2DM patients without depression (Wilcoxon test, p- < 0.001). CONCLUSIONS We conclude that the majority of the patients with T2DM had comorbid conditions, and the HRQOL was negatively affected by comorbid depression in T2DM patients. This suggests the importance of timely screening, diagnosis, treatment, and follow-up of comorbid depression in T2DM patients to improve overall health and QOL.
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Affiliation(s)
- Manish K Namdeo
- Independent Scholar and Alumni, JPGSPH, BRAC University, Bangladesh, Chhindwara, India.
| | - Sarita Verma
- Tata Institute of Social Sciences, Mumbai, India
| | | | - Rubana Islam
- International Initiative for Impact Evaluation (3Ie), Columbia, SC, USA
| | | | - Lal B Rawal
- Central Queensland University, Sydney Campus, Sydney, Australia
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Roy R, Mayer MM, Dzekem BS, Laiteerapong N. Screening for Emotional Distress in Patients with Cardiovascular Disease. Curr Cardiol Rep 2023; 25:1165-1174. [PMID: 37610597 DOI: 10.1007/s11886-023-01936-0] [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] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE OF REVIEW In this article, we discuss the relationship between emotional distress and common cardiovascular disease condition, including coronary artery disease, atrial fibrillation, congestive heart failure, mechanical circulatory support, and heart transplant. We review screening measures that have been studied and used in clinical practice for each condition, as well as priorities for future research. RECENT FINDINGS Studies consistently demonstrate failing to identify and treat emotional distress in patients with cardiovascular disease is associated with adverse outcomes. However, routine emotional distress screening is not formally recommended for all cardiovascular disease conditions and is limited to depression screening in select patient populations. Future research should focus on evaluating the validity and reliability of standardized screening measures across the scope of emotional distress in patients with or at risk for cardiovascular disease. Other areas of future research include implementation of evidence-based pharmaceutical treatments and integrated behavioral health approaches and interventions.
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Affiliation(s)
- Rukmini Roy
- Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA
| | - Michael M Mayer
- Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA
| | - Bonaventure S Dzekem
- Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA
| | - Neda Laiteerapong
- Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA.
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA.
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Heavey SC, Bleasdale J, Rosenfeld EA, Beehler GP. Collaborative Care Models to Improve Pain and Reduce Opioid Use in Primary Care: a Systematic Review. J Gen Intern Med 2023; 38:3021-3040. [PMID: 37580632 PMCID: PMC10593691 DOI: 10.1007/s11606-023-08343-9] [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: 03/06/2023] [Accepted: 07/17/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Collaborative care management (CCM) is an empirically driven model to overcome fractured medical care and improve health outcomes. While CCM has been applied across numerous conditions, it remains underused for chronic pain and opioid use. Our objective was to establish the state of the science for CCM approaches to addressing pain-related outcomes and opioid-related behaviors through a systematic review. METHODS We identified peer-reviewed articles from Cochrane, Embase, PsycINFO, and PubMed databases from January 1, 1995, to October 31, 2022. Abstracts and full-text articles were screened for study inclusion, resulting in 18 studies for the final review. In addition, authors used the Patient-Centered Integrated Behavioral Health Care Principles and Tasks Checklist as a tool for assessing the reported CCM components within and across studies. We conducted this systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. RESULTS Several CCM trials evidenced statistically significant improvements in pain-related outcomes (n = 11), such as pain severity and pain-related activity interference. However, effect sizes varied considerably across studies and some effects were not clinically meaningful. CCM had some success in targeting opioid-related behaviors (n = 4), including reduction in opioid prescription dose. Other opioid-related work focused on CCM to facilitate buprenorphine treatment for opioid use disorder (n = 2), including improved odds of receiving treatment and greater prevalence of abstinence from opioids and alcohol. Uniquely, several interventions used CCM to target mental health as a way to address pain (n = 10). Generally, there was moderate alignment with the CCM model. CONCLUSIONS CCM shows promise for improving pain-related outcomes, as well as facilitating buprenorphine for opioid use disorder. More robust research is needed to determine which aspects of CCM best support improved outcomes and how to maximize the effectiveness of such interventions.
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Affiliation(s)
- Sarah Cercone Heavey
- Department of Community Health & Health Behavior, School of Public Health & Health Professions, State University of New York at Buffalo, Buffalo, NY, 14214, USA.
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY, USA.
| | - Jacob Bleasdale
- Department of Community Health & Health Behavior, School of Public Health & Health Professions, State University of New York at Buffalo, Buffalo, NY, 14214, USA
| | - Eve A Rosenfeld
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, Palo Alto, CA, USA
- Deparment of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Gregory P Beehler
- Department of Community Health & Health Behavior, School of Public Health & Health Professions, State University of New York at Buffalo, Buffalo, NY, 14214, USA
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY, USA
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Gawande R, Smith L, Comeau A, Creedon TB, Wilson CL, Griswold T, Cook BL, Loucks EB, Schuman-Olivier Z. Impact of warm mindfulness on emotion regulation: A randomized controlled effectiveness trial. Health Psychol 2023; 42:699-711. [PMID: 37410421 PMCID: PMC10529078 DOI: 10.1037/hea0001303] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To determine the effects of mindfulness training for primary care (MTPC), an integrated warm mindfulness training program, on emotion regulation and its relationship with health behavior change. Interventions that improve self-regulation, particularly emotion regulation, are needed for the self-management of comorbid chronic physical and mental illnesses. Mindfulness-based interventions (MBIs) may impact self-regulation and facilitate health behavior change. METHOD A randomized controlled comparative effectiveness trial was conducted in a population of adult primary care patients to evaluate the impact of MTPC versus a low-dose mindfulness comparator (LDC) on self-reported difficulties in emotion regulation (DERS) total score and other assays of self-regulation at baseline, Weeks 8 and 24. Self-reported action plan initiation was reported between Weeks 8 and 10. Participants had diagnoses of anxiety, depression, or stress-related disorders. MTPC is an 8-week insurance-reimbursable warm MBI designed to cultivate mindfulness and self-compassion and to catalyze chronic illness self-management related health behavior change. RESULTS Compared to LDC, MTPC participants had statistically significant reductions in DERS total score at 8 weeks (d = -0.59, β = -12.98, 95% CI [-23.3 to -2.6]; p = .01) and 24 weeks (d = -0.61, β = -13.35, [-24.3, -2.4]; p = .02). Compared to 38% for LDC, 63% of MTPC participants successfully initiated their action plan within 3 weeks (OR = 2.87, [1.1, 7.9]; p = .04). CONCLUSIONS This randomized controlled trial demonstrated MTPC enhanced emotion regulation and facilitated initiation of chronic illness self-management and health behavior change among primary care patients with anxiety, depression, and stress-related disorders, replicating previous reports. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Richa Gawande
- Cambridge Health Alliance, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lydia Smith
- Cambridge Health Alliance, Cambridge, MA, USA
| | | | | | | | - Todd Griswold
- Cambridge Health Alliance, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Benjamin L. Cook
- Cambridge Health Alliance, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Zev Schuman-Olivier
- Cambridge Health Alliance, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Guo D, Zhou C, Li H, Su D, Gong G, Chen X, Chen X, Chen Y. Mapping the scientific research on integrated care: a bibliometric and social network analysis. Front Psychol 2023; 14:1095616. [PMID: 37786479 PMCID: PMC10541993 DOI: 10.3389/fpsyg.2023.1095616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 08/25/2023] [Indexed: 10/04/2023] Open
Abstract
Background Integrated care (IC) is the cornerstone of the sustainable development of the medical and health system. A thorough examination of the existing scientific literature on IC is essential for assessing the present state of knowledge on this subject. This review seeks to offer an overview of evidence-based knowledge, pinpoint existing knowledge gaps related to IC, and identify areas requiring further research. Methods Data were retrieved from the Web of Science Core Collection, from 2010 to 2020. Bibliometrics and social network analysis were used to explore and map the knowledge structure, research hotspots, development status, academic groups and future development trends of IC. Results A total of 7,501 articles were obtained. The number of publications on IC was rising in general. Healthcare science services were the most common topics. The United States contributed the highest number of articles. The level of collaboration between countries and between authors was found to be relatively low. The keywords were stratified into four clusters: IC, depression, integrative medicine, and primary health care. In recent years, complementary medicine has become a hotspot and will continue to be a focus. Conclusion The study provides a comprehensive analysis of global research hotspots and trends in IC, and highlights the characteristics, challenges, and potential solutions of IC. To address resource fragmentation, collaboration difficulties, insufficient financial incentives, and poor information sharing, international collaboration needs to be strengthened to promote value co-creation and model innovation in IC. The contribution of this study lies in enhancing people's understanding of the current state of IC research, guiding scholars to discover new research perspectives, and providing valuable references for researchers and policymakers in designing and implementing effective IC strategies.
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Affiliation(s)
- Dandan Guo
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chaofeng Zhou
- Wuhan Library, Chinese Academy of Sciences, Wuhan, China
- Department of Library, Information and Archives Management, School of Economic and Management, UCAS, Beijing, China
| | - Haomiao Li
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
| | - Dai Su
- Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, China
| | - Guangwen Gong
- Guangwen Gong, School of Management, Hubei University of Chinese Medicine, Wuhan, China
| | - Xinlin Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinlan Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingchun Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Centre for Rural Health Service, Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, China
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Lee CT, Harty S, Adegoke A, Palacios J, Gillan CM, Richards D. The Effectiveness of Low-Intensity Psychological Interventions for Comorbid Depression and Anxiety in Patients with Long-Term Conditions: A Real-World Naturalistic Observational Study in IAPT Integrated Care. Int J Behav Med 2023:10.1007/s12529-023-10215-9. [PMID: 37697142 DOI: 10.1007/s12529-023-10215-9] [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] [Accepted: 08/17/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Low-intensity psychological interventions may be a cost-effective, accessible solution for treating depression and anxiety in patients with long-term conditions, but evidence from real-world service settings is lacking. This study examined the effectiveness of low-intensity psychological interventions provided in the Improving Access to Psychological Therapies programme in England for patients with and without long-term conditions. METHODS A retrospective analysis was conducted on patients (total N = 21,051, long-term conditions n = 4024) enrolled in three low-intensity psychological interventions, i.e. Internet-delivered cognitive behavioural therapy (iCBT), guided self-help (GSH), and psychoeducational group therapy (PGT) within a Talking Therapies service from 2016 to 2020. Primary outcomes included pre-post-treatment changes in depression (Patient Health Questionnaire-9) and anxiety (Generalised Anxiety Disorder-7). RESULTS Overall, both cohorts significantly improved on all outcomes post-treatment, with large effect sizes. Patients with long-term conditions experienced a greater reduction in depression while those without experienced a greater reduction in anxiety, but these differences were marginal (< 1 score difference on both measures). No difference between the cohorts was shown when comparing the differential effectiveness across interventions, but those engaging in iCBT showed greater reduction in depression and anxiety than those in GSH and PGT, while those in GSH improved more than PGT. CONCLUSIONS Low-intensity psychological interventions, particularly iCBT, were effective in treating depression and anxiety in patients with long-term conditions in a real-world service setting. Our large-scale study supports the continued and increased implementation of low-intensity psychological interventions for this subpopulation via integrated care.
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Affiliation(s)
- Chi Tak Lee
- School of Psychology, Trinity College Dublin, Dublin, Ireland.
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
| | - Siobhan Harty
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
| | - Adedeji Adegoke
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
| | - Jorge Palacios
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
| | - Claire M Gillan
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Derek Richards
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
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Cross JG, May BR, Mai PQM, Anderson E, Welsh C, Chandran S, Chorath KT, Herr S, Gonzalez D. A systematic review and evaluation of post-stroke depression clinical practice guidelines. J Stroke Cerebrovasc Dis 2023; 32:107292. [PMID: 37572601 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/06/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023] Open
Abstract
OBJECTIVE Post-stroke depression is a depressive mood disorder that follows a cerebrovascular accident and is a burden on stroke patients. Its management is included in clinical practice guidelines focused on stroke, and the recommended treatment is selective serotonin reuptake inhibitors in conjunction with psychotherapy. Clinical practice guidelines are recommendations used to standardize best medical practice, but there is no current evaluation of guidelines containing post stroke depression recommendations. Thus, the objective is to appraise the selected guidelines manner of development and quality. MATERIALS AND METHODS A systematic literature review across three databases and a manual google search was performed to collect guidelines that included recommendations on the management of post-stroke depression. 1236 guidelines were screened, and 27 were considered for inclusion. Considered guidelines were manually reviewed by the authors, and ultimately, 7 met inclusion criteria. The appraisal of guidelines for research and evaluation was used to evaluate these guidelines' recommendations around post-stroke depression. RESULTS Three guidelines met the threshold considered "High", with all of them having five or more quality domains eclipse the cutoff score of 70%. Across all guidelines, the highest scoring domains were "Scope and Purpose", "Clarity of Presentation", and "Editorial Independence" with scores of 76.98%, 73.81%, and 91.36% respectively. The lowest scoring domains were "Applicability", "Rigor of Development", and "Stakeholder Involvement" with respective scores of 58.73%, 54.02%, and 43.90%. CONCLUSIONS The domains "Applicability", "Rigor of Development," and "Stakeholder Involvement" were the lowest scoring domains. These specific domains represent areas in which future guidelines could be more developed.
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Affiliation(s)
| | - Brandon R May
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Peter Q M Mai
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Elizabeth Anderson
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Connor Welsh
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | - Kevin T Chorath
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Shelby Herr
- Creighton University School of Medicine, Phoenix, Arizona, USA
| | - Daniel Gonzalez
- Department of Neurovascular & Stroke Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA.
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Solomons L, Farrar C, Carpenter L. Psychological support for chronic conditions. Curr Opin Support Palliat Care 2023; 17:240-246. [PMID: 37432092 DOI: 10.1097/spc.0000000000000659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
PURPOSE OF REVIEW Haematological conditions are varied, and every condition presents unique psychosocial challenges to patients and their families. There is a growing body of evidence about high levels of psychological distress, negative impact on outcomes and evidence-based treatments, yet service provision is patchy and demand far exceeds supply. RECENT FINDINGS This article focuses on the major subspecialty areas and associated neuropsychiatric comorbidities - haematological malignancies, issues related to stem cell transplants, haemoglobinopathies and haemophilia. The subsequent sections focus on common psychiatric comorbidities, considerations across the life span and models of care. SUMMARY Anxiety disorders and depression have higher prevalence in people with haematological conditions. The stressors faced by the individual can vary based on their condition and their stage of life. Early diagnosis and integrated management of comorbid psychiatric illness can improve quality of life and clinical outcomes. A stepped care model is recommended to ensure that psychological distress is identified and managed appropriately, and evidence for a collaborative care model is provided.
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Affiliation(s)
| | - Catherine Farrar
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Fathima FN, Selvam S, Heylen E, Srinivasan K, Ekstrand M. Effect of collaborative care intervention on productivity losses among people with comorbid common mental disorders and cardiovascular disease in rural Karnataka. J Family Med Prim Care 2023; 12:1917-1922. [PMID: 38024913 PMCID: PMC10657040 DOI: 10.4103/jfmpc.jfmpc_2296_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/13/2023] [Accepted: 04/26/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Common mental disorders (CMD) and cardiovascular diseases (CVD), common health problems among patients seeking primary healthcare, contribute to high economic productivity losses. Collaborative care programs for CMDs and CVDs have shown improvement in clinical outcomes for both conditions; however, data on productivity outcomes are scarce. Objective: Effect of integrated collaborative care on productivity among people with comorbid CMD and CVD in rural Karnataka primary health clinics. Methods Participants were recruited within a randomized trial in rural South India, where patients received either collaborative or enhanced standard care. In this substudy, 303 participants were followed for 3 months and assessed with the iMTA Productivity Cost Questionnaire (iPCQ). Results We found a reduction in the proportion of individuals reporting productivity loss at 3 months (66%) compared to baseline (76%; P = 0.002). Productivity losses decreased from INR 30.3 per person per day at baseline to 17.7 at 3 months. Reductions were similar in the two treatment conditions. Conclusion Medical intervention may foster reduced productivity losses among patients with CMD and CVD. Collaborative care did not translate into higher reductions in productivity losses than "enhanced standard care."
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Affiliation(s)
- Farah Naaz Fathima
- Department of Community Health, St. John’s Medical College, Sarjapur Road, Bengaluru, Karnataka, India
| | - Sumithra Selvam
- Division of Epidemiology, Biostatistics and Population Health, St. John’s Research Institute, Bengaluru, Karnataka, India
| | | | | | - Maria Ekstrand
- Department of Medicine University of California San Francisco, USA
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Ma KPK, Mollis BL, West II, Rolfes J, Clifton J, Kessler R, Baldwin LM, Chakravarti P, Dewane S, Gerrish W, Holmes J, Karlson K, Roberts V, Stephens KA. Integrated Behavioral Health in Primary Care Residency and Nonresidency Practices. Fam Med 2023; 55:530-538. [PMID: 37696022 PMCID: PMC10622053 DOI: 10.22454/fammed.2023.715036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Integrated behavioral health (BH) is becoming a preferred model of care for primary care because it improves patient outcomes and satisfaction. Little is known about whether residency practices are consistently modeling this preferred care model relative to real-world nonresidency practices. The study compared levels of BH integration, patient health outcomes, and satisfaction with care between residency practices and nonresidency practices with colocated BH providers. METHODS Baseline data were collected in 2018-2019 from 44 practices and their adult patients with chronic conditions participating in a cluster-randomized, pragmatic trial to improve BH integration. The sample included 18 (40.9%) residency and 26 (59.1%) nonresidency practices, with 1,817 (45.3%) patients from residency practices and 2,190 (54.7%) patients from nonresidency practices. Outcomes including BH integration levels (the Practice Integration Profile), patient health outcomes (the PROMIS-29), and patient satisfaction with care (the Consultation and Relational Empathy scale) were compared between residency and nonresidency practices using multivariate regression analyses. RESULTS No differences were found between BH integration levels, patient health outcomes, and patient satisfaction with care between residency and nonresidency practices. In a sample of primary care practices with colocated BH providers, residencies had BH integration and patient outcomes similar to real-world practices. CONCLUSIONS Primary care practices with residency programs reported comparable levels of BH integration, patient health outcomes, and patient satisfaction compared to practices without residency programs. Both types of practices require interventions and resources to help them overcome challenges associated with dissemination of high levels of BH integration.
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Affiliation(s)
- Kris Pui Kwan Ma
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | - Brenda L. Mollis
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | - Imara I. West
- Department of Psychiatry & Behavioral Sciences, University of Washington School of MedicineSeattle, WA
| | | | | | - Rodger Kessler
- Department of Family Medicine, University of Colorado Anschutz Medical CampusAurora, CO
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | | | | | - Winslow Gerrish
- Full Circle Health/Family Medicine Residency of IdahoBoise, ID
| | - John Holmes
- Department of Family Medicine, Idaho State UniversityPocatello, ID
| | | | - Verena Roberts
- Department of Family Medicine, Idaho State UniversityPocatello, ID
| | - Kari A. Stephens
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
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Zolaly MA, Alshawi AH, Binsari IA, Alharbi AA, Almutairi YN, Zolaly FM, Al Belowi MA. Psychological Burden Among Patients With Inherited Bleeding Disorders in Madinah Province, Saudi Arabia. Cureus 2023; 15:e45165. [PMID: 37842369 PMCID: PMC10570756 DOI: 10.7759/cureus.45165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Hereditary bleeding disorders, such as hemophilia and von Willebrand disease (VWD), result from specific deficiencies or malformations in the coagulation cascade proteins. These disorders can significantly impact both physical and psychological health. Complications such as depression, anxiety, and stress (DAS) can further exacerbate these impacts. Despite their significance, detailed prevalence data remain limited, especially for regions such as Madinah province in Saudi Arabia. This study aimed to determine the prevalence of DAS and their associated risk factors among patients with hereditary bleeding disorders in Madinah province, Saudi Arabia. Methods We conducted a cross-sectional study using telephonic interviews involving patients diagnosed with severe hemophilia A or B or VWD attending a hematology clinic in Madinah. Patients over 10 were included, and the study excluded those with central nervous system insults and platelet count concerns. The validated and reliable Depression Anxiety Stress Scale-21-item questionnaire and Statistical Product and Service Solutions (SPSS), version 26.0 (IBM SPSS Statistics for Windows, Armonk, NY), facilitated data collection and analysis, respectively. Results Of the 44 patients studied, 25% exhibited symptoms of depression, 45.5% showed signs of anxiety, and 29.5% had stress symptoms. Regarding symptom severity, 9.1% of patients experienced extremely severe depression, 15.9% had moderate anxiety, and 13.6% reported moderate stress. The prevalence of these psychological issues varied with patients' age and economic status. Notably, a significantly higher rate of depression was observed in patients over 15 years (42.9% vs. 8.7%; p=0.009). Additionally, while not statistically significant, patients with a high economic status reported increased rates of DAS. Conclusions Patients with inherited bleeding disorders, particularly those older than 15, manifest significant psychological distress. There is a pressing need for enhanced awareness, specialized screenings, and tailored counseling services to improve treatment adherence and overall quality of life. Given the findings, a comprehensive national study in Saudi Arabia is highly recommended, alongside the integration of specialized psychological services.
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Affiliation(s)
- Mohammed A Zolaly
- Hematology and Oncology, Taibah University, Al-Madinah al-Munawwarah, SAU
| | - Ali H Alshawi
- Pediatrics, Taibah University, Al-Madinah al-Munawwarah, SAU
| | - Idris A Binsari
- Pediatrics, Taibah University, Al-Madinah al-Munawwarah, SAU
| | | | | | - Fayzah M Zolaly
- Pediatrics, Taibah University, Al-Madinah al-Munawwarah, SAU
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Nasuti L, Andrews B, Li W, Wiltz J, Hohman KH, Patanian M. Using latent class analysis to inform the design of an EHR-based national chronic disease surveillance model. Chronic Illn 2023; 19:675-680. [PMID: 35505590 PMCID: PMC10515457 DOI: 10.1177/17423953221099043] [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: 10/29/2021] [Accepted: 04/10/2022] [Indexed: 11/17/2022]
Abstract
The Multi-state EHR-based Network for Disease Surveillance (MENDS) developed a pilot electronic health record (EHR) surveillance system capable of providing national chronic disease estimates. To strategically engage partner sites, MENDS conducted a latent class analysis (LCA) and grouped states by similarities in socioeconomics, demographics, chronic disease and behavioral risk factor prevalence, health outcomes, and health insurance coverage. Three latent classes of states were identified, which inform the recruitment of additional partner sites in conjunction with additional factors (e.g. partner site capacity and data availability, information technology infrastructure). This methodology can be used to inform other public health surveillance modernization efforts that leverage timely EHR data to address gaps, use existing technology, and advance surveillance.
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Affiliation(s)
- Laura Nasuti
- National Association of Chronic Disease Directors, Decatur, USA
| | - Bonnie Andrews
- National Association of Chronic Disease Directors, Decatur, USA
| | - Wenjun Li
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, USA
| | - Jennifer Wiltz
- Office of the Director, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Miriam Patanian
- National Association of Chronic Disease Directors, Decatur, USA
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Wilson JB, Epstein M, Lopez B, Brown AK, Lutfy K, Friedman TC. The role of Neurochemicals, Stress Hormones and Immune System in the Positive Feedback Loops between Diabetes, Obesity and Depression. Front Endocrinol (Lausanne) 2023; 14:1224612. [PMID: 37664841 PMCID: PMC10470111 DOI: 10.3389/fendo.2023.1224612] [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: 05/17/2023] [Accepted: 07/25/2023] [Indexed: 09/05/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) and depression are significant public health and socioeconomic issues. They commonly co-occur, with T2DM occurring in 11.3% of the US population, while depression has a prevalence of about 9%, with higher rates among youths. Approximately 31% of patients with T2DM suffer from depressive symptoms, with 11.4% having major depressive disorders, which is twice as high as the prevalence of depression in patients without T2DM. Additionally, over 80% of people with T2DM are overweight or obese. This review describes how T2DM and depression can enhance one another, using the same molecular pathways, by synergistically altering the brain's structure and function and reducing the reward obtained from eating. In this article, we reviewed the evidence that eating, especially high-caloric foods, stimulates the limbic system, initiating Reward Deficiency Syndrome. Analogous to other addictive behaviors, neurochemical changes in those with depression and/or T2DM are thought to cause individuals to increase their food intake to obtain the same reward leading to binge eating, weight gain and obesity. Treating the symptoms of T2DM, such as lowering HbA1c, without addressing the underlying pathways has little chance of eliminating the disease. Targeting the immune system, stress circuit, melatonin, and other alterations may be more effective.
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Affiliation(s)
- Julian B. Wilson
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
| | - Ma’ayan Epstein
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
- Psychiatric Emergency Room, Olive View – University of California, Los Angeles (UCLA) Medical Center, Sylmar, CA, United States
| | - Briana Lopez
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
- Friends Research Institute, Cerritos, CA, United States
| | - Amira K. Brown
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
| | - Kabirullah Lutfy
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, United States
| | - Theodore C. Friedman
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
- Friends Research Institute, Cerritos, CA, United States
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Yazgan I, Bartlett V, Romain G, Cleman J, Petersen-Crair P, Spertus JA, Hardt M, Mena-Hurtado C, Smolderen KG. Longitudinal Pathways Between Physical Activity, Depression, and Perceived Stress in Peripheral Artery Disease. Circ Cardiovasc Qual Outcomes 2023; 16:544-553. [PMID: 37470195 PMCID: PMC10561081 DOI: 10.1161/circoutcomes.122.009840] [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: 12/06/2022] [Accepted: 06/14/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND One-fifth of the patients with peripheral artery disease (PAD) experience depression and stress. Depression and stress may impact patients' abilities to be physically active, a key recommendation for supporting overall PAD management to improve symptoms and reduce the risk of cardiovascular events. We aimed to study interrelationships between 1-year longitudinal trajectories of depression, stress, and physical activity following a PAD diagnosis. METHODS Patients with new or worsening PAD symptoms enrolled at 10 US PORTRAIT study (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) vascular specialty clinics (CT, LA, MI, MO, NC, OH, and RI) were assessed at baseline, 3, 6, and 12 months between June 2, 2011 and December 3, 2015. Depressive symptoms were measured with the 8-item Patient Health Questionnaire, perceived stress with the 4-item Perceived Stress Scale and physical activity with items from the INTERHEART study. Path analysis was used to examine the longitudinal relationship between depression and physical activity and perceived stress and physical activity. RESULTS A total of 766 patients were included (mean age of 68.2 [±9.4] years; 57.7% male). Overall, 17.8% reported significant depressive symptoms, 36.0% experienced increased perceived stress, and 44.1% were sedentary upon PAD diagnosis. A decrease in physical activity preceded a rise in subsequent depressive symptoms (β ranges -0.45 [95% CI, -0.80 to -0.09]; -0.81 [95% CI, -1.19 to 0.42]) over the course of 1 year. Low physical activity scores at the initial presentation were followed by high perceived stress at 3 months (β=-0.44 [95% CI, -0.80 to -0.07]). CONCLUSIONS In symptomatic PAD, a decrease in physical activity was followed by an increased risk of depressive symptoms and perceived stress at subsequent intervals over the course of 1 year following PAD diagnosis and treatment. Integrated behavioral health approaches for PAD, addressing physical activity and managing depression or distress, are indicated as collective PAD treatment goals.
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Affiliation(s)
- Idil Yazgan
- Yale School of Medicine, New Haven, CT (I.Y., G.R., J.C., C.M.-H., K.G.S.)
| | | | - Gaëlle Romain
- Yale School of Medicine, New Haven, CT (I.Y., G.R., J.C., C.M.-H., K.G.S.)
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (G.R., J.C., C.M.-H., K.G.S.)
| | - Jacob Cleman
- Yale School of Medicine, New Haven, CT (I.Y., G.R., J.C., C.M.-H., K.G.S.)
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (G.R., J.C., C.M.-H., K.G.S.)
| | - Pamela Petersen-Crair
- Department of Psychiatry, Section of Psychology, Yale School of Medicine, New Haven, CT (P.P.-C., M.A.H., K.G.S.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.)
- Department of Biomedical and Health Informatics, School of Medicine, University of Missouri Kansas City, Kansas City, MO (J.A.S.)
| | - Madeleine Hardt
- Department of Psychiatry, Section of Psychology, Yale School of Medicine, New Haven, CT (P.P.-C., M.A.H., K.G.S.)
| | - Carlos Mena-Hurtado
- Yale School of Medicine, New Haven, CT (I.Y., G.R., J.C., C.M.-H., K.G.S.)
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (G.R., J.C., C.M.-H., K.G.S.)
| | - Kim G Smolderen
- Yale School of Medicine, New Haven, CT (I.Y., G.R., J.C., C.M.-H., K.G.S.)
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (G.R., J.C., C.M.-H., K.G.S.)
- Department of Psychiatry, Section of Psychology, Yale School of Medicine, New Haven, CT (P.P.-C., M.A.H., K.G.S.)
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Chopra A, Luccarelli J, Cohen JN, Mischoulon D, Stern TA. Evaluation, Treatment, and Referral of Treatment-Resistant Depression in Primary Care. Prim Care Companion CNS Disord 2023; 25:22f03438. [PMID: 37506395 PMCID: PMC10564558 DOI: 10.4088/pcc.22f03438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. Prim Care Companion CNS Disord. 2023;25(4):22f03438. Author affiliations are listed at the end of this article.
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Affiliation(s)
- Amit Chopra
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
- Corresponding Author: Amit Chopra, MBBS, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jonah N Cohen
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Theodore A Stern
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
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