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Poremski D, Alexander M, Fang T, Tan GMY, Ong S, Su A, Fung D, Chua HC. Psychiatric Advance Directives and their relevance to improving psychiatric care in Asian countries. Asia Pac Psychiatry 2020; 12:e12374. [PMID: 31872576 PMCID: PMC7027531 DOI: 10.1111/appy.12374] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 11/07/2019] [Indexed: 12/12/2022]
Abstract
People with mental illness may be unable to provide critical input about the care they wish to receive during a psychiatric crisis because of altered mental states. It is therefore imperative that clinicians seek to understand service users' wishes for care while they are well and able to provide meaningful input into the discussion. Achieving such an end may be done by discussing and completing a psychiatric advance directive. However, very few Asian countries have legislation that supports such advance directives. The present article seeks to give physicians more information about advance psychiatric directives and the potential role they could play to improve the healthcare provided in Asia to people at risk of losing capacity due to a mental illness. The degree to which mental health legislation supports psychiatric advance directives is documented for each country of South East Asia and Eastern Asia.
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Affiliation(s)
- Daniel Poremski
- Health Intelligence Unit, Institute of Mental Health, Singapore
| | | | - Tina Fang
- Health Intelligence Unit, Institute of Mental Health, Singapore
| | - Giles Ming-Yee Tan
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore
| | - Samantha Ong
- Nursing Department, Institute of Mental Health, Singapore
| | - Alex Su
- Medical Board, Institute of Mental Health, Singapore
| | - Daniel Fung
- Medical Board, Institute of Mental Health, Singapore
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Kuntz JL, Safford MM, Singh JA, Phansalkar S, Slight SP, Her QL, Lapointe NA, Mathews R, O'Brien E, Brinkman WB, Hommel K, Farmer KC, Klinger E, Maniam N, Sobko HJ, Bailey SC, Cho I, Rumptz MH, Vandermeer ML, Hornbrook MC. Patient-centered interventions to improve medication management and adherence: a qualitative review of research findings. PATIENT EDUCATION AND COUNSELING 2014; 97:310-26. [PMID: 25264309 PMCID: PMC5830099 DOI: 10.1016/j.pec.2014.08.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 08/26/2014] [Accepted: 08/30/2014] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Patient-centered approaches to improving medication adherence hold promise, but evidence of their effectiveness is unclear. This review reports the current state of scientific research around interventions to improve medication management through four patient-centered domains: shared decision-making, methods to enhance effective prescribing, systems for eliciting and acting on patient feedback about medication use and treatment goals, and medication-taking behavior. METHODS We reviewed literature on interventions that fell into these domains and were published between January 2007 and May 2013. Two reviewers abstracted information and categorized studies by intervention type. RESULTS We identified 60 studies, of which 40% focused on patient education. Other intervention types included augmented pharmacy services, decision aids, shared decision-making, and clinical review of patient adherence. Medication adherence was an outcome in most (70%) of the studies, although 50% also examined patient-centered outcomes. CONCLUSIONS We identified a large number of medication management interventions that incorporated patient-centered care and improved patient outcomes. We were unable to determine whether these interventions are more effective than traditional medication adherence interventions. PRACTICE IMPLICATIONS Additional research is needed to identify effective and feasible approaches to incorporate patient-centeredness into the medication management processes of the current health care system, if appropriate.
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Affiliation(s)
- Jennifer L Kuntz
- Center for Health Research, Kaiser Permanente Northwest, Portland, USA.
| | - Monika M Safford
- Division Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, USA
| | - Jasvinder A Singh
- Division Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, USA
| | - Shobha Phansalkar
- Partners Healthcare Systems, Inc., Wellesley, USA; Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Sarah P Slight
- Partners Healthcare Systems, Inc., Wellesley, USA; Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | | | | | | | | | | | - Kevin Hommel
- Cincinnati Children's Hospital and Medical Center, Cincinnati, USA
| | - Kevin C Farmer
- The University of Oklahoma College of Pharmacy, Oklahoma City, USA
| | - Elissa Klinger
- Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | | | - Heather J Sobko
- Division Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, USA
| | - Stacy C Bailey
- University of North Carolina, Eshelman School of Pharmacy, Chapel Hill, USA
| | - Insook Cho
- Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Maureen H Rumptz
- Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | | | - Mark C Hornbrook
- Center for Health Research, Kaiser Permanente Northwest, Portland, USA
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Fraenkel L, Suter L, Cunningham CE, Hawker G. Understanding preferences for disease-modifying drugs in osteoarthritis. Arthritis Care Res (Hoboken) 2014; 66:1186-92. [PMID: 24470354 DOI: 10.1002/acr.22280] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 01/07/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Numerous disease-modifying drugs for osteoarthritis (DMOADs) are under investigation. However, patients' preferences for drugs to prevent progression of OA are not known. The objective of this study was to quantify patient preferences for potential DMOADs. METHODS We administered a conjoint analysis survey to 304 patients attending outpatient general medicine and specialty clinics. All patients seated in the waiting rooms were asked if they would participate in a survey to elicit opinions about arthritis treatments. We performed simulations to estimate preferences for 4 options to prevent worsening of knee OA: best case (pill, highest benefit, lowest risk, lowest cost), worst case (infusion, lowest benefit, highest risk, highest cost), moderate subcutaneous injection (injection, mid-level benefit, mid-level risk, mid-level cost), and moderate infusion (same as subcutaneous injection except administered by infusion). RESULTS Subjects' median age was 57 years; 55% were women and 76% were white. Segmentation analyses revealed 4 patterns of preferences. A minority (5%) did not want to perform subcutaneous injections and would only consider DMOADs under the best-case scenario. Approximately 20% were risk sensitive and were willing to take DMOADs under the best-case scenario, but would start rejecting these medications as risk increased. A significant number rejected DMOADs under all conditions (16.4%); however, the largest segment (59.2%) had a strong preference for DMOADs across all scenarios. CONCLUSION Our results suggest that a significant percentage of a nonselected outpatient population might be willing to accept at least a moderate degree of risk in order to prevent worsening knee OA.
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Affiliation(s)
- Liana Fraenkel
- Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven
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Khazaal Y, Manghi R, Delahaye M, Machado A, Penzenstadler L, Molodynski A. Psychiatric advance directives, a possible way to overcome coercion and promote empowerment. Front Public Health 2014; 2:37. [PMID: 24809041 PMCID: PMC4010761 DOI: 10.3389/fpubh.2014.00037] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 04/14/2014] [Indexed: 11/13/2022] Open
Abstract
Psychiatric advance directives (ADs) allow an individual to state their preferences for future treatment at times when they may be unable to make considered decisions. There are differences in their form and legal value and the process associated with their use and completion. Several studies have now been completed to assess the impact of ADs on service use and coercion. Their results give a mixed picture but directives nevertheless have the potential to support the empowerment process, minimize experienced coercion, and improve coping strategies. These may in turn reduce the frequency of in-patient service use. Further studies on the different processes of facilitation involved and on different populations are necessary to improve our knowledge and use of these potentially powerful interventions.
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Affiliation(s)
- Yasser Khazaal
- Geneva University Hospitals , Geneva , Switzerland ; Geneva University , Geneva , Switzerland
| | - Rita Manghi
- Geneva University Hospitals , Geneva , Switzerland
| | | | | | | | - Andrew Molodynski
- Oxford Health NHS Foundation Trust , Oxford , UK ; Department of Psychiatry, Oxford University , Oxford , UK
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De las Cuevas C, Peñate W, Sanz EJ. Psychiatric outpatients' self-reported adherence versus psychiatrists' impressions on adherence in affective disorders. Hum Psychopharmacol 2013; 28:142-50. [PMID: 23475396 DOI: 10.1002/hup.2293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 01/11/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The objective of this study is to explore correlation between patients' self-reported adherence to medication and their treating psychiatrists' impressions on adherence. METHODS During a 9-month period, 140 consecutive psychiatric outpatients with affective disorders attending two community mental health centers, and their treating psychiatrists, took part. Data were collected on socio-demographic, clinical, and therapeutic variables. The Clinical Global Impression-Severity and Improvement scales and the Beck Depression Inventory were used for clinical assessment. Adherence was assessed by the psychiatrist's report and the Morisky scale from patients. In addition, "Drug Attitude Inventory," "Beliefs about Medicine Questionnaire," and "Leeds Attitude towards concordance scale" were applied to all participants. A multivariate analysis of variance (Bonferroni control) and a subsequent stepwise regression were performed. RESULTS The allocation of patients to "adherent" or "non-adherent" categories by the patients themselves and their treating psychiatrists was divergent in more than 40% of the cases. The best agreement appears when treatment is prolonged. There is a better agreement with patients having a positive view of the medicines. When patients consider the medication harmful, this is when psychiatrists perceive more non-adherence. The agreement is also better in mild cases of depression. CONCLUSIONS Adherence was principally compromised by patient-related factors, especially their beliefs and attitudes toward their treatment and its duration.
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Springer SA, Dushaj A, Azar MM. The impact of DSM-IV mental disorders on adherence to combination antiretroviral therapy among adult persons living with HIV/AIDS: a systematic review. AIDS Behav 2012; 16:2119-43. [PMID: 22644066 PMCID: PMC3481055 DOI: 10.1007/s10461-012-0212-3] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This is a systematic review of eighty-two published studies investigating the impact of DSM-IV mental disorders on combination antiretroviral therapy (cART) adherence and persistence among persons living with HIV/AIDS (PLWHA). Sixty-two articles examined depression, with 58 % (N = 32/62) finding lower cART adherence and persistence. Seventeen articles examined one or more anxiety disorders, with the majority finding no association with cART adherence or persistence. Eighty percent of the studies that evaluated the impact of psychotic (N = 3), bipolar (N = 5) and personality disorders (N = 2) on cART adherence and persistence also found no association. Seven out of the nine studies (78 %) evaluating the impact of antidepressant treatment (ADT) on cART adherence found improvement. Adherence and depression measurements varied significantly in studies; common research measurements would improve data harmonization. More research specifically addressing the impact of other mental disorders besides depression on cART adherence and RCTs evaluating ADT on cART adherence are also needed.
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Affiliation(s)
- Sandra A Springer
- Yale AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06511, USA.
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[Use of joint crisis plans in psychiatric hospitals in Germany: results of a nationwide survey]. DER NERVENARZT 2012; 83:638-43. [PMID: 21633830 DOI: 10.1007/s00115-011-3311-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Joint crisis plans in psychiatry are consensus-oriented instruments for patients to state their will in case of a crisis. The aim of this survey is to determine the prevalence, practice and barriers for implementation of joint crisis plans in Germany. METHODS In spring 2009, 366 psychiatric hospitals in Germany were asked to complete a questionnaire. RESULTS The return rate was 46.4%; 68% of the participating hospitals offered joint crisis plans. The number of completed joint crisis plans was low (median 2.7/year per clinic). The demand did not increase according to a majority of the hospitals. The main reason for hospitals to abstain from joint crisis plans was low demand. Hospitals providing the option of joint crisis plans reported positive experiences. CONCLUSIONS A theoretical offer of joint crisis plans is widespread in German psychiatric hospitals. Despite positive experiences, patients do not ask for them frequently.
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Marcus MA, Westra HA, Eastwood JD, Barnes KL. What are young adults saying about mental health? An analysis of Internet blogs. J Med Internet Res 2012; 14:e17. [PMID: 22569642 PMCID: PMC3374526 DOI: 10.2196/jmir.1868] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 11/08/2011] [Accepted: 11/17/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the high prevalence of mental health concerns, few young adults access treatment. While much research has focused on understanding the barriers to service access, few studies have explored unbiased accounts of the experiences of young adults with mental health concerns. It is through hearing these experiences and gaining an in-depth understanding of what is being said by young adults that improvements can be made to interventions focused on increasing access to care. OBJECTIVE To move beyond past research by using an innovative qualitative research method of analyzing the blogs of young adults (18-25 years of age) with mental health concerns to understand their experiences. METHODS We used an enhanced Internet search vehicle, DEVONagent, to extract Internet blogs using primary keywords related to mental health. Blogs (N = 8) were selected based on age of authors (18-25 years), gender, relevance to mental health, and recency of the entries. Blogs excerpts were analyzed using a combination of grounded theory and consensual qualitative research methods. RESULTS Two core categories emerged from the qualitative analysis of the bloggers accounts: I am powerless (intrapersonal) and I am utterly alone (interpersonal). Overall, the young adult bloggers expressed significant feelings of powerlessness as a result of their mental health concerns and simultaneously felt a profound sense of loneliness, alienation, and lack of connection with others. CONCLUSIONS The present study suggests that one reason young adults do not seek care might be that they view the mental health system negatively and feel disconnected from these services. To decrease young adults' sense of powerlessness and isolation, efforts should focus on creating and developing resources and services that allow young adults to feel connected and empowered. Through an understanding of the experiences of young adults with mental health problems, and their experiences of and attitudes toward receiving care, we provide some recommendations for improving receptivity and knowledge of mental health care services.
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Wilder CM, Swanson JW, Bonnie RJ, Wanchek T, McLaughlin L, Richardson J. A Survey of Stakeholder Knowledge, Experience, and Opinions of Advance Directives for Mental Health in Virginia. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2012; 40:232-9. [DOI: 10.1007/s10488-011-0401-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Scheyett AM, Rooks A. University students' views on the utility of psychiatric advance directives. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2012; 60:90-93. [PMID: 22171734 DOI: 10.1080/07448481.2011.572326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Rates of serious mental illnesses (SMIs) among university students are increasing, and universities are struggling with how to respond to students who show SMI symptoms. Psychiatric advance directives (PADs) allow individuals, when well, to document their wishes for treatment during a psychiatric crisis. This project explored the feasibility of using PADs in university settings by examining students' views towards PADs. PARTICIPANTS Forty university students with SMIs were recruited for this study from 1 large university. METHODS A mixed-methods design was used, with both quantitative survey instruments and qualitative interviews with students. RESULTS Respondents were positive about PAD utility for students. Respondents saw PADs as beneficial because PADs gave students control over their treatment. However, students also considered PADs potentially problematic because PAD use raised a risk of breaching student privacy and stigmatizing students with SMIs. CONCLUSIONS Although a promising intervention for students with SMI, this approach requires further research.
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Affiliation(s)
- Anna M Scheyett
- College of Social Work, University of South Carolina, Columbia, South Carolina 29208, USA.
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Maidment ID, Brown P, Calnan M. An exploratory study of the role of trust in medication management within mental health services. Int J Clin Pharm 2011; 33:614-20. [PMID: 21541701 DOI: 10.1007/s11096-011-9510-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 04/11/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To develop understandings of the nature and influence of trust in the safe management of medication within mental health services. SETTING Mental health services in the UK. METHOD Qualitative methods were applied through focus groups across three different categories of service user--older adult, adults living in the community and forensic services. An inductive thematic analysis was carried out, using the method of constant comparison derived from grounded theory. MAIN OUTCOME MEASURE Participants' views on the key factors influencing trust and the role of trust in safe medication management. RESULTS The salient factors impacting trust were: the therapeutic relationship; uncertainty and vulnerability; and social control. Users of mental health services may be particularly vulnerable to adverse events and these can damage trust. CONCLUSION Safe management of medication is facilitated by trust. However, this trust may be difficult to develop and maintain, exposing service users to adverse events and worsening adherence. Practice and policy should be oriented towards developing trust.
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Affiliation(s)
- Ian D Maidment
- Pharmacy Department, Kent and Medway NHS and Social Care Partnership Trust, Eastern and Area Coastal Office, St Martin's Hospital, Littlebourne Rd., Canterbury, Kent CT1 1AZ, UK.
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De las Cuevas C, Rivero-Santana A, Perestelo-Perez L, Gonzalez-Lorenzo M, Perez-Ramos J, Sanz EJ. Adaptation and validation study of the Beliefs about Medicines Questionnaire in psychiatric outpatients in a community mental health setting. Hum Psychopharmacol 2011; 26:140-6. [PMID: 21455972 DOI: 10.1002/hup.1185] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The present study aims to establish the factor structure and reliability of the Spanish version of the Beliefs about Medicines Questionnaire (BMQ), adapted to psychiatric medication, and to analyze the potential differences between psychiatric outpatients, medical students, and psychology students. METHOD The BMQ was tested on a sample of 405 psychiatric outpatients, 216 medical students, and 222 psychology students. Students completed only the BMQ-General scale, adapted for psychiatric medication, and patients completed also the BMQ-Specific scale. RESULTS For the BMQ-General scale adapted items, the analysis shows a two-factor structure similar to that described for the Spanish validation of the original instrument, but when samples are analyzed separately, relevant differences are observed in the composition of the factor structures. Furthermore, the resulting scales show a medium-low internal consistency. For BMQ-Specific scale items, the results replicate previous data. Medical students tend to consider psychiatric medication as less harmful and less likely to be overprescribed than psychology students, with patients' scores in the middle of both groups. CONCLUSION The BMQ-Specific scale has satisfactory psychometric properties for use in psychiatric outpatients in a community mental health setting. The adapted Spanish BMQ-General scale for psychotropics identified three different structures of the factors for each of the three samples studied.
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