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Morris ME, Brusco NK, McAleer R, Billett S, Brophy L, Bryant R, Carey L, Wright AC, East C, Eckert M, Edvardsson K, Fetherstonhaugh D, Fowler-Davis S, Frederico M, Gray R, McCaskie D, McKinstry C, Mitchell R, Oldenburg B, Shields N, Smith K, Spelten E, Taylor N, Thwaites C, Young S, Blackberry I. Professional care workforce: a rapid review of evidence supporting methods of recruitment, retention, safety, and education. HUMAN RESOURCES FOR HEALTH 2023; 21:95. [PMID: 38093376 PMCID: PMC10720209 DOI: 10.1186/s12960-023-00879-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Across the care economy there are major shortages in the health and care workforce, as well as high rates of attrition and ill-defined career pathways. The aim of this study was to evaluate current evidence regarding methods to improve care worker recruitment, retention, safety, and education, for the professional care workforce. METHODS A rapid review of comparative interventions designed to recruit, retain, educate and care for the professional workforce in the following sectors: disability, aged care, health, mental health, family and youth services, and early childhood education and care was conducted. Embase and MEDLINE databases were searched, and studies published between January 2015 and November 2022 were included. We used the Quality Assessment tool for Quantitative Studies and the PEDro tools to evaluate study quality. RESULTS 5594 articles were initially screened and after applying the inclusion and exclusion criteria, 30 studies were included in the rapid review. Studies most frequently reported on the professional nursing, medical and allied health workforces. Some studies focused on the single domain of care worker education (n = 11) while most focused on multiple domains that combined education with recruitment strategies, retention strategies or a focus on worker safety. Study quality was comparatively low with a median PEDro score of 5/10, and 77% received a weak rating on the Quality Assessment tool for Quantitative Studies. Four new workforce strategies emerged; early career rural recruitment supports rural retention; workload management is essential for workforce well-being; learning must be contextually relevant; and there is a need to differentiate recruitment, retention, and education strategies for different professional health and care workforce categories as needs vary. CONCLUSIONS Given the critical importance of recruiting and retaining a strong health and care workforce, there is an immediate need to develop a cohesive strategy to address workforce shortfalls. This paper presents initial evidence on different interventions to address this need, and to inform care workforce recruitment and retention. Rapid Review registration PROSPERO 2022 CRD42022371721 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022371721.
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Affiliation(s)
- Meg E Morris
- The Victorian Rehabilitation Centre, Academic and Research Collaborative in Health (ARCH), and CERI, La Trobe University, Bundoora, VIC, 3083, Australia
| | - Natasha K Brusco
- La Trobe University, Bundoora, VIC, 3086, Australia.
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, 3150, Australia.
| | - Rachael McAleer
- La Trobe Rural Health School, La Trobe University, Bendigo, 3550, Australia
| | | | - Lisa Brophy
- La Trobe University, Bundoora, VIC, 3086, Australia
| | - Rosemary Bryant
- AO Research Centre, University of South Australia, Adelaide, 5001, Australia
| | - Leeanne Carey
- La Trobe University, Bundoora, VIC, 3086, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, 3084, Australia
| | | | - Christine East
- La Trobe University, Bundoora, VIC, 3086, Australia
- Mercy Health, Richmond, 3121, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, 5001, Australia
| | | | | | - Sally Fowler-Davis
- Centre for Health and Care Research, Collegiate Crescent, Sheffield Hallam University, Sheffield, S1 1WB, UK
| | | | - Richard Gray
- La Trobe University, Bundoora, VIC, 3086, Australia
| | - Doug McCaskie
- Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Carol McKinstry
- La Trobe Rural Health School, La Trobe University, Bendigo, 3550, Australia
| | | | - Brian Oldenburg
- La Trobe University, Bundoora, VIC, 3086, Australia
- Baker Heart and Diabetes Institute, Melbourne, 3004, Australia
| | - Nora Shields
- La Trobe University, Bundoora, VIC, 3086, Australia
| | - Karen Smith
- Silver Chain, Bourke Street, Melbourne, VIC, 3000, Australia
| | - Evelien Spelten
- La Trobe Rural Health School, La Trobe University, Bendigo, 3550, Australia
| | - Nicholas Taylor
- Eastern Health Academic and Research Collaborative in Health (ARCH), La Trobe University, Bundoora, 3086, Australia
| | - Claire Thwaites
- The Victorian Rehabilitation Centre and Academic and Research Collaborative in Health (ARCH) La Trobe University, Bundoora, VIC, 3083, Australia
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So M, Makofane J, Hernandez M. "We want to be heard": A Qualitative Study of Mental Health Care Access among Patients of an Urban Federally Qualified Health Center. MENTAL HEALTH SCIENCE 2023; 1:261-269. [PMID: 38774821 PMCID: PMC11104551 DOI: 10.1002/mhs2.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/12/2023] [Indexed: 05/24/2024]
Abstract
Introduction Although depression is common in primary care, challenges to timely intervention exist, particularly for communities of color and lower socioeconomic status. Our objective was to understand barriers and facilitators to mental healthcare access among a sample of patients receiving care at a federally qualified health center (FQHC) in Minnesota, United States. Methods We qualitatively interviewed 34 patients of an urban FQHC, purposively sampled on race/ethnicity, insurance status, language, and depression symptom status (based on Patient Health Questionnaire-9 responses). We inductively and deductively analyzed interview data, leveraging theory in both the codebook development and analysis processes. Results Participants, who were predominantly English-speaking, female, not privately insured, and people of color, shared numerous barriers and facilitators to accessing mental healthcare. Prominent barriers primarily concerned healthcare providers, including perceived dismissal of mental health concerns and challenges with provider continuity. Additional barriers included the costs of mental health care, communication breakdowns, the patient portal, and community-specific perceptions of mental health. Prominent facilitators included clinic organizational factors (internal and external) and staff friendliness and warmth. Other factors including consideration of patients' financial situation, integrated management of behavioral and physical health conditions, language concordant staff, the telehealth visit modality, and the clinic's social mission were also raised as facilitating access. Conclusion Patient voices from a single FQHC illustrate the challenges and possibilities of providing mental healthcare in safety net settings. Clinical, strategy, and policy solutions can be tailored to minimize barriers and optimize facilitators documented herein.
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Affiliation(s)
- Marvin So
- University of Minnesota Medical School, Minneapolis, MN
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Huo S, Bruckner TA, Xiong GL, Cooper E, Wade A, Neikrug AB, Gagliardi JP, McCarron R. Antidepressant Prescription Behavior Among Primary Care Clinician Providers After an Interprofessional Primary Care Psychiatric Training Program. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:926-935. [PMID: 37598371 PMCID: PMC10543424 DOI: 10.1007/s10488-023-01290-x] [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] [Accepted: 07/30/2023] [Indexed: 08/22/2023]
Abstract
Primary care providers (PCPs) are increasingly called upon to screen for and treat depression. However, PCPs often lack the training to diagnose and treat depression. We designed an innovative 12-month evidence and mentorship-based primary care psychiatric training program entitled the University of California, Irvine (UCI) School of Medicine Train New Trainers Primary Care Psychiatry (TNT PCP) Fellowship and examined whether this training impacted clinician prescription rates for antidepressants. We retrieved information on 18,844 patients and 192 PCPs from a publicly insured health program in Southern California receiving care between 2017 and 2021. Of the 192 PCPs, 42 received TNT training and 150 did not. We considered a patient as exposed to the provider's TNT treatment if they received care from a provider after the provider completed the 1-year fellowship. We utilized the number of antidepressant prescriptions per patient, per quarter-year as the dependent variable. Linear regression models controlled for provider characteristics and time trends. Robustness checks included clustering patients by provider identification. After PCPs completed TNT training, "exposed" patients received 0.154 more antidepressant prescriptions per quarter-year relative to expected levels (p < 0.01). Clustering of standard errors by provider characteristics reduced precision of the estimate (p < 0.10) but the direction and magnitude of the results were unchanged. Early results from the UCI TNT PCP Fellowship demonstrate enhanced antidepressant prescription behavior in PCPs who have undergone TNT training. A novel, and relatively low-cost, clinician training program holds the potential to empower PCPs to optimally deliver depression treatment.
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Affiliation(s)
- Shutong Huo
- University of California Irvine, Program in Public Health, Irvine, CA USA
| | - Tim A. Bruckner
- University of California Irvine, Program in Public Health, Irvine, CA USA
- Public Health & Planning, Policy and Design, University of California, Irvine, CA USA
| | - Glen L. Xiong
- University of California, Davis, Psychiatry and Behavioral Sciences, Sacramento, CA USA
| | - Emma Cooper
- University of California Irvine Department of Psychiatry and Human Behavior, Orange, CA USA
| | - Amy Wade
- Inland Empire Health Plan, Rancho Cucamonga, CA USA
| | - Ariel B. Neikrug
- University of California Irvine School of Medicine, Irvine, CA USA
| | - Jane P. Gagliardi
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC USA
| | - Robert McCarron
- University of California Irvine School of Medicine, Irvine, CA USA
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