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Staab EM, Wan W, Campbell A, Gedeon S, Schaefer C, Quinn MT, Laiteerapong N. Elements of Integrated Behavioral Health Associated with Primary Care Provider Confidence in Managing Depression at Community Health Centers. J Gen Intern Med 2022; 37:2931-2940. [PMID: 34981360 PMCID: PMC9485335 DOI: 10.1007/s11606-021-07294-3] [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: 04/05/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Depression is most often treated by primary care providers (PCPs), but low self-efficacy in caring for depression may impede adequate management. We aimed to identify which elements of integrated behavioral health (BH) were associated with greater confidence among PCPs in identifying and managing depression. DESIGN Mailed cross-sectional surveys in 2016. PARTICIPANTS BH leaders and PCPs caring for adult patients at community health centers (CHCs) in 10 midwestern states. MAIN MEASURES Survey items asked about depression screening, systems to support care, availability and integration of BH, and PCP attitudes and experiences. PCPs rated their confidence in diagnosing, assessing severity, providing counseling, and prescribing medication for depression on a 5-point scale. An overall confidence score was calculated (range 4 (low) to 20 (high)). Multilevel linear mixed models were used to identify factors associated with confidence. KEY RESULTS Response rates were 60% (N=77/128) and 52% (N=538/1039) for BH leaders and PCPs, respectively. Mean overall confidence score was 15.25±2.36. Confidence was higher among PCPs who were satisfied with the accuracy of depression screening (0.38, p=0.01), worked at CHCs with depression tracking systems (0.48, p=0.045), had access to patients' BH treatment plans (1.59, p=0.002), and cared for more patients with depression (0.29, p=0.003). PCPs who reported their CHC had a sufficient number of psychiatrists were more confident diagnosing depression (0.20, p=0.02) and assessing severity (0.24, p=0.03). Confidence in prescribing was lower at CHCs with more patients living below poverty (-0.66, p<0.001). Confidence in diagnosing was lower at CHCs with more Black/African American patients (-0.20, p=0.03). CONCLUSIONS PCPs who had access to BH treatment plans, a system for tracking patients with depression, screening protocols, and a sufficient number of psychiatrists were more confident identifying and managing depression. Efforts are needed to address disparities and support PCPs caring for vulnerable patients with depression.
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Affiliation(s)
| | - Wen Wan
- University of Chicago, Chicago, IL, USA
| | | | - Stacey Gedeon
- Mid-Michigan Community Health Services, Houghton Lake, MI, USA
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Abstract
The population worldwide is aging and prevalence of obesity in this population is increasing. The range of consequences that effect these at-risk patients include increased risk of falls, fractures, reduced quality of life, and cognitive decline. This article describes the epidemiology of obesity, risks and benefits of weight loss, and importance of treating obesity to help promote healthy aging. Health care professionals should encourage older adults with obesity to implement healthy lifestyle behaviors including exercise and diet routine. Treating obesity in older adults mitigates the significant public health crisis, and reduces health care utilization and risk of long-term adverse events.
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Affiliation(s)
- Meredith N Roderka
- Section of Weight & Wellness, Department of Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Sadhana Puri
- Geisel School of Medicine, 1 Rope Ferry Road, Hanover, NH 03755, USA
| | - John A Batsis
- Section of Weight & Wellness, Department of Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA; Geisel School of Medicine, 1 Rope Ferry Road, Hanover, NH 03755, USA; The Dartmouth Institute for Health & Clinical Practice, 1 Medical Center Drive, Lebanon, NH 03756, USA; Dartmouth Centers for Health and Aging Hitchcock Loop Road, Lebanon, NH 03766, USA; Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
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Jones EB, Staab EM, Wan W, Quinn MT, Schaefer C, Gedeon S, Campbell A, Chin MH, Laiteerapong N. Addiction Treatment Capacity in Health Centers: The Role of Medicaid Reimbursement and Targeted Grant Funding. Psychiatr Serv 2020; 71:684-690. [PMID: 32438889 DOI: 10.1176/appi.ps.201900409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Expanding access to addiction screening and treatment in primary care, particularly in underserved communities, is a key part of the fight against the opioid epidemic. This study explored correlates of addiction treatment capacity in federally qualified health centers participating in the Midwest Clinicians' Network (MWCN). METHODS Two surveys were fielded to 132 MWCN health centers: the Health Center Survey and the Behavioral Health and Diabetes Provider Survey. A total of 77 centers and 515 primary care clinicians, respectively, responded to the surveys. Data were combined with data from the 2016 Uniform Data System and information about receipt of targeted Health Resources and Services Administration (HRSA) grant funding for addiction treatment capacity. Multivariable models examined associations between Medicaid reimbursement for addiction services, HRSA targeted grant funding, and different types of on-site addiction treatment capacity: psychiatrist and certified addiction counselor staffing, addiction counseling services, and medication-assisted treatment (MAT) for opioid addiction. RESULTS Health centers that received Medicaid behavioral health reimbursement were five times as likely as those that did not to offer addiction counseling and to employ certified addiction counselors. Health centers that received targeted HRSA funding for addiction services were more than 20 times as likely as those that did not to provide MAT and more than three times as likely to employ psychiatrists. Training needs and privacy protections on data related to addiction treatment were cited as barriers to building addiction treatment capacity. CONCLUSIONS Medicaid funding and targeted grant funding were associated with addiction treatment capacity in health centers.
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Affiliation(s)
- Emily B Jones
- National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell)
| | - Erin M Staab
- National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell)
| | - Wen Wan
- National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell)
| | - Michael T Quinn
- National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell)
| | - Cynthia Schaefer
- National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell)
| | - Stacey Gedeon
- National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell)
| | - Amanda Campbell
- National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell)
| | - Marshall H Chin
- National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell)
| | - Neda Laiteerapong
- National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell)
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Damschroder LJ, Lutes LD, Kirsh S, Kim HM, Gillon L, Holleman RG, Goodrich DE, Lowery JC, Richardson CR. Small-changes obesity treatment among veterans: 12-month outcomes. Am J Prev Med 2014; 47:541-53. [PMID: 25217098 DOI: 10.1016/j.amepre.2014.06.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/25/2014] [Accepted: 06/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Weight-loss trials tend to recruit highly selective, non-representative samples. Effective weight-loss approaches are needed for real-world challenging populations. PURPOSE To test whether a small-changes intervention, delivered in groups or via telephone, promotes greater weight loss than standard obesity treatment in a predominantly male, high-risk Veteran population. Data were collected in 2010-2012 and analyzed in 2013. DESIGN A three-arm, 12-month randomized pragmatic effectiveness trial. SETTING/PARTICIPANTS Four-hundred eighty-one overweight/obese participants from two Midwestern Veterans Affairs (VA) Medical Centers were randomly assigned to one of three programs: the 12-month Aspiring to Lifelong Health (ASPIRE) weight-loss program delivered (1) individually over the phone (ASPIRE-Phone) or (2) in-person group sessions (ASPIRE-Group); compared to (3) VA's standard weight-loss program (MOVE!). INTERVENTION Twenty-eight sessions with a non-clinician coach via telephone or in-person groups using a small-changes obesity treatment approach compared to a 15-30-session standard VA program. MAIN OUTCOME MEASURES Twelve-month change in weight (kilograms). RESULTS Participants in all three arms lost significant (p<0.01) weight at 12 months. Participants in the ASPIRE-Group arm lost significantly more weight at 12 months than those in the other two treatment arms (-2.8 kg, 95% CI=-3.8, -1.9, in ASPIRE-Group vs -1.4 kg, 95% CI=-2.4, -0.5, in ASPIRE-Phone and -1.4 kg, 95% CI=-2.3, -0.4) in MOVE!(®). ASPIRE-Group resulted in greater improvements in all other anthropometric measures compared to MOVE! at 12 months (p<0.05) and for all (p<0.05) but waist circumference (p=0.23) compared to ASPIRE-Phone. CONCLUSIONS Group-based delivery of the ASPIRE weight management program is more effective than MOVE! and the phone-based version of ASPIRE at promoting sustained weight loss in a predominantly male population with multiple comorbidities. The incremental benefits of group-based ASPIRE over the current MOVE! program could yield significant population-level benefits if implemented on a large scale.
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Affiliation(s)
- Laura J Damschroder
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Lesley D Lutes
- Department of Psychology, East Carolina University, Greenville, North Carolina
| | - Susan Kirsh
- Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
| | - Hyungjin Myra Kim
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan; Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan
| | - Leah Gillon
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Robert G Holleman
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - David E Goodrich
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Julie C Lowery
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Caroline R Richardson
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan; Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan.
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