Care Management of Comorbid Medical and Psychiatric Illness: A Conceptual Framework for Improving Equity of Care

Psychiatric learning experiences in PGY1 pharmacy residency training: A 5-year analysis

PURPOSE

A growing shortage of mental health providers and the increasing prevalence and severity of mental illness necessitate a qualified pharmacist workforce to increase access and care. Psychiatric learning experiences (PLEs) completed during pharmacy residency training are one way to address this need. The purpose of this study was to characterize PLEs offered by postgraduate year 1 (PGY1) programs and completed by PGY1 residents over a 5-year period.

METHODS

A retrospective review of data from PharmAcademic was conducted. All ASHP-accredited PGY1 programs from the 2016-2017 through 2020-2021 residency years were included in the descriptive analysis. PLE presence was identified using a keyword search of learning experience titles and descriptions. A post hoc analysis was conducted to compare yearly PLE completion rates during the study period and annual completion rates relative to presence or absence of a postgraduate year 2 psychiatric pharmacy residency.

RESULTS

Of 1,461 PGY1 programs, 511 programs (34.9%) offered a PLE. Most PLEs were elective (82%). During the study period, 20.8% of PGY1 residents completed a PLE despite 77% having access.

CONCLUSION

PGY1 residents complete PLEs at low rates. The reasons for this are unclear and need to be further explored. The growing need for qualified pharmacists to care for patients with mental illness calls for strategies to increase mental health training, including greater completion of PLEs by PGY1 residents and an understanding of how PLEs are promoted to PGY1 residents.

Mixed discipline 'Simulation Integrating Mental and Physical health Learning' (SMIPL): A qualitative study of student experience and learning

BACKGROUND/PROBLEMS

Individuals with comorbid physical and mental health conditions face significant threats to their well-being while placing a substantial burden on healthcare systems through increased service costs. Nursing professionals encounter multiple challenges in delivering effective care to this population. These challenges include a lack of integrated care models, communication barriers among providers, the complexity of addressing dual health needs, insufficient training in comorbidity management, resource and time constraints, and pervasive stigma toward mental illness. These factors leave many nurses, in particular, report feeling ill-prepared to provide integrated care for individuals with such complex conditions. Comorbid physical and mental health problems pose significant risks to individuals and incur additional costs to healthcare services. Addressing these barriers calls for enhanced training programs, stronger collaboration among healthcare professionals, and the adoption of integrated care approaches. Simulation-based approaches have emerged as a potential solution to address some of these challenges, offering a way to enhance healthcare providers' knowledge and confidence in managing comorbidities.

AIM/OBJECTIVE

To 1) explore the experiences of students learning together in a mixed specialty high-fidelity simulation developed to increase knowledge and confidence in providing care for people with comorbidities and 2) understand what aspects of the simulation facilitated and hindered their engagement and learning.

METHODOLOGY

This study employed an illuminative evaluation, a qualitative research approach designed to provide a deeper understanding of how learning occurs in specific educational contexts.

METHODS

An exploratory qualitative study was conducted using focus groups to gather data. Eighteen undergraduate students from mental health and adult nursing programs participated in a novel, integrated simulation-based learning experience designed to simulate real-world healthcare challenges. Participants were purposively sampled to ensure diverse perspectives. The focus groups were semi-structured, with sessions lasting approximately 60 min, and discussions were analysed using thematic analysis.

RESULTS

Nursing students from both disciplines reported an increase in knowledge, confidence and assessment skills. Peer learning through observation and discussion, alongside the interdisciplinary working that was encouraged during the simulation session, was highly valued. Students spoke about the key features of the simulation, such as group size and authenticity, that had supported and hindered their engagement.

CONCLUSIONS

Collaborative learning between nursing specialisms about comorbid health conditions effectively aligns student experience and teaching methods with their learning outcomes. Educators might consider the potential of this approach for a range of complex, multi-factor health conditions.

Umbrella Review: Atlas of the Meta-Analytical Evidence of Early-Onset Psychosis

OBJECTIVE

Early-onset psychosis (EOP) refers to the development of psychosis before the age of 18 years. We aimed to summarize, for the first time, the meta-analytical evidence in the field of this vulnerable population and to provide evidence-based recommendations.

METHOD

We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant, pre-registered (PROSPERO: CRD42022350868) systematic review of several databases and registers to identify meta-analyses of studies conducted in EOP individuals to conduct an umbrella review. Literature search, screening, data extraction, and quality assessment were carried out independently. Results were narratively reported, clustered across core domains. Quality assessment was performed with the Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool.

RESULTS

A total of 30 meta-analyses were included (373 individual studies, 25,983 participants, mean age 15.1 years, 38.3% female). Individuals with EOP showed more cognitive impairments compared with controls and individuals with adult/late-onset psychosis. Abnormalities were observed meta-analytically in neuroimaging markers but not in oxidative stress and inflammatory response markers. In all, 60.1% of EOP individuals had a poor prognosis. Clozapine was the antipsychotic with the highest efficacy for overall, positive, and negative symptoms. Tolerance to medication varied among the evaluated antipsychotics. The risk of discontinuation of antipsychotics for any reason or side effects was low or equal compared to placebo.

CONCLUSION

EOP is associated with cognitive impairment, involuntary admissions, and poor prognosis. Antipsychotics can be efficacious in EOP, but tolerability and safety need to be taken into consideration. Clozapine should be considered in EOP individuals who are resistant to 2 non-clozapine antipsychotics. Further meta-analytical research is needed on response to psychological interventions and other prognostic factors.

PLAIN LANGUAGE SUMMARY

This umbrella review summarized the meta-analytical knowledge from 30 meta-analyses on early-onset psychosis. Early-onset psychosis refers to the development of psychosis before the age of 18 years and is associated with cognitive impairment, hospitalization, and poor prognosis. Individuals with early-onset psychosis show more cognitive impairments and abnormalities compared with controls. Clozapine was the antipsychotic with the highest efficacy for positive, negative, and overall symptoms and should be considered in individuals with early-onset psychosis.

STUDY PREREGISTRATION INFORMATION

Early Onset Psychosis: Umbrella Review on Diagnosis, Prognosis and Treatment factors; https://www.crd.york.ac.uk/PROSPERO/; CRD42022350868.

Equity in health service utilisation among middle-aged and elderly people with multiple chronic conditions in China: evidence from longitudinal data of 2011-2018 CHARLS

OBJECTIVES

Equity in health service utilisation is a central objective for health systems. Middle-aged and elderly patients with multiple chronic conditions (MCCs) are particularly vulnerable to healthcare inequity. This study aimed to update the information on the trends in the incidence and equity of outpatient health service utilisation (OHSU) and inpatient health service utilisation (IHSU) for middle-aged and elderly MCCs patients in China, identify socioeconomic determinants that may contribute to inequity, and suggest optimisation strategies to mitigate this disparity.

METHODS

Panel data obtained from four waves of the China Health and Retirement Longitudinal Study (CHARLS) were used to determine the trends in OHSU and IHSU. The inequity in OHSU and IHSU was measured by the Concentration Index (CI) and Horizontal Inequity Index (HI), which is a valid measure of health service utilisation equity. The decomposition model of the CI was set up to explore the contribution of various determinants of overall equity.

RESULTS

The annual rate of OHSU gradually decreased from 29.32% in 2011 to 27.27% in 2018. The HI remained positive and decreased from 0.0803 in 2011 to 0.0662 in 2018, indicating the existence of pro-rich inequity. The annual rate of IHSU gradually increased from 13.31% in 2011 to 19.89% in 2018. The HI remained positive and showed a declining trend from 0.2363 in 2011 to 0.0574 in 2018, evidencing pro-rich inequity; however, a trend towards the easing of inequity was observed.

CONCLUSIONS

Pro-rich inequity was present in both OHSU and IHSU among middle-aged and elderly MCCs patients in China. Economic status, area, education and age were the main contributors to pro-rich inequity. Concerted efforts are needed to allocate resources for mitigating health service utilisation inequity in middle-aged and elderly people with MCCs.