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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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Djalalinia S, Hejabi A, Bolhari J, Asadi A, Naseri H, Sadeghi MM, Mehrabadi MS, Dejman M, Eftekhari M, Atoofi MK. Situation Analysis for Promotion of Hot-Lines: An Experience from Iran. Int J Prev Med 2020; 11:183. [PMID: 33456739 PMCID: PMC7804869 DOI: 10.4103/ijpvm.ijpvm_175_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 01/23/2020] [Indexed: 11/24/2022] Open
Abstract
Background: The hot line services were developed in response to the perceived need for 24-hour help services in crises ranging from suicide to unwanted pregnancy. This study is aimed at analyzing the strengths, weaknesses, challenges, and suggestions of improving the performance of the help centers from the perspective of key stakeholders. Methods: We conducted a qualitative study to elicit the key informants' opinion regarding the performance of Iranian hot-lines. All the conversations were audio-recorded with the permission of the participants. To reach the saturation limit, the number of interviews was completed in the saturation of data. Data was gathered from 15 individual in-depth interviews. Collecting and analyses of data was based on content analysis through which simultaneously during texts open coding, main concepts were extracted and then in axial coding similar concepts were categorized. Results: According to the study results, there is no specific and independent system for assessing the hot- lines. One of the major weaknesses was the lack of standard protocols. Most participants believed that most of these guidelines came from the general principles of counseling and are not standard. As another point, the existence of referral services is one of the main problems of counseling lines. The most important suggestion from the majority of experts were the development of services and modification of their investments. Conclusions: The findings, in addition to providing the applied data for policy-making in the health system, will significantly contribute to the creation of scientific, technical, and skillful personnel in the community of researchers.
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Affiliation(s)
- Shirin Djalalinia
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Ahmad Hejabi
- Mental, Social, and Addiction Office, Ministry of Health and Medical Education, Tehran, Iran.,Research Center for Addiction and Risky Behavior, Department of Psychiatric, Iran University of Medical Sciences, Tehran, Iran
| | - Jafar Bolhari
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran.,School of Behavioral Sciences and Mental Health, Tehran Psychiatric Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Asadi
- Mental, Social, and Addiction Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Hossein Naseri
- Deputy of Prevention, Welfare Organization of Iran, Tehran, Iran
| | | | - Mohammad Shams Mehrabadi
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran.,School of Behavioral Sciences and Mental Health, Tehran Psychiatric Institute, Iran University of Medical Sciences, Tehran, Iran
| | | | - Monir Eftekhari
- Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Mehrdad Kazemzadeh Atoofi
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran.,School of Behavioral Sciences and Mental Health, Tehran Psychiatric Institute, Iran University of Medical Sciences, Tehran, Iran
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3
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Nurse Specialist Assessment and Management of Palliative Care Patients who are Depressed—a Study of Perceptions and Attitudes. J Palliat Care 2019. [DOI: 10.1177/082585970201800404] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Depression is a frequent symptom in palliative care patients but is often not diagnosed. In the U.K., the majority of patients with advanced cancer are referred to a clinical nurse specialist (CNS) whose remit includes the assessment of psychological symptoms and depression. Clinical nurse specialists have a key role in the diagnosis and management of patients with depression and it is important that they have the skills to do so. A postal questionnaire of all U.K. hospital, hospice, and community palliative care clinical nurse specialist teams was carried out to determine how they assessed depression in their patients. The response rate was 40%. Seventy-nine percent of all clinical nurse specialists believed their skills were poor in this area, and 92% felt they required further training. These beliefs were substantiated by the difficulties nurses encountered in assessing depression and by their beliefs regarding antidepressant medication. Clinical nurse specialists have a pivotal role in improving the detection and management of depression in palliative care patients, and require further training in this area.
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Brooks SE, Burruss SK, Mukherjee K. Suicide in the Elderly: A Multidisciplinary Approach to Prevention. Clin Geriatr Med 2018; 35:133-145. [PMID: 30390980 DOI: 10.1016/j.cger.2018.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Suicide in the elderly is a growing problem. The elderly population is increasing, and elderly patients have multiple issues that place them at higher risk of suicidality. These issues include physical illnesses, mental illness, loss of functional status, isolation, and family, financial, and social factors. Access to firearms is another significant risk factor, because elderly patients are more likely to use firearms in suicide attempts; interventions to reduce firearms mortality may save lives. Tackling the difficult problem of suicide in the elderly may require a multidisciplinary, community-based series of interventions.
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Affiliation(s)
- Steven E Brooks
- Division of Trauma and Surgical Critical Care, Texas Tech University Health Sciences Center, 3601 4th Street MS 8312, Lubbock, TX 79430, USA
| | - Sigrid K Burruss
- Division of Acute Care Surgery, Loma Linda University Medical Center, 11175 Campus Street, CP 21109, Loma Linda, CA 92350, USA
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Loma Linda University Medical Center, 11175 Campus Street, CP 21109, Loma Linda, CA 92350, USA.
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Contandriopoulos D, Duhoux A, Roy B, Amar M, Bonin JP, Borges Da Silva R, Brault I, Dallaire C, Dubois CA, Girard F, Jean E, Larue C, Lessard L, Mathieu L, Pépin J, Perroux M, Cockenpot A. Integrated Primary Care Teams (IPCT) pilot project in Quebec: a protocol paper. BMJ Open 2015; 5:e010559. [PMID: 26700294 PMCID: PMC4691711 DOI: 10.1136/bmjopen-2015-010559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 11/26/2015] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The overall aim of this project is to help develop knowledge about primary care delivery models likely to improve the accessibility, quality and efficiency of care. Operationally, this objective will be achieved through supporting and evaluating 8 primary care team pilot sites that rely on an expanded nursing role within a more intensive team-based, interdisciplinary setting. METHODS AND ANALYSIS The first research component is aimed at supporting the development and implementation of the pilot projects, and is divided into 2 parts. The first part is a logical analysis based on interpreting available scientific data to understand the causal processes by which the objectives of the intervention being studied may be achieved. The second part is a developmental evaluation to support teams in the field in a participatory manner and thereby learn from experience. Operationally, the developmental evaluation phase mainly involves semistructured interviews. The second component of the project design focuses on evaluating pilot project results and assessing their costs. This component is in turn made up of 2 parts. Part 1 is a pre-and-post survey of patients receiving the intervention care to analyse their care experience. In part 2, each patient enrolled in part 1 (around 4000 patients) will be matched with 2 patients followed within a traditional primary care model, so that a comparative analysis of the accessibility, quality and efficiency of the intervention can be performed. The cohorts formed in this way will be followed longitudinally for 4 years. ETHICS AND DISSEMINATION The project, as well as all consent forms and research tools, have been accepted by 2 health sciences research ethics committees. The procedures used will conform to best practices regarding the anonymity of patients.
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Affiliation(s)
| | - Arnaud Duhoux
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | - Bernard Roy
- Faculty of Nursing, University of Laval, Québec, Québec, Canada
| | - Maxime Amar
- Faculty of Medicine, University of Laval, Québec, Québec, Canada
| | - Jean-Pierre Bonin
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | | | - Isabelle Brault
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | | | - Carl-Ardy Dubois
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | - Francine Girard
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | | | - Caroline Larue
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | - Lily Lessard
- University of Québec in Rimouski, Rimouski, Québec, Canada
| | - Luc Mathieu
- University of Sherbrook, School of Nursing, Sherbrooke, Québec, Canada
| | - Jacinthe Pépin
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | - Mélanie Perroux
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
| | - Aurore Cockenpot
- Faculty of Nursing, University of Montreal, Montréal, Québec, Canada
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Kalafat J, Gould MS, Munfakh JLH, Kleinman M. An evaluation of crisis hotline outcomes. Part 1: Nonsuicidal crisis callers. Suicide Life Threat Behav 2007; 37:322-37. [PMID: 17579544 DOI: 10.1521/suli.2007.37.3.322] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The effectiveness of telephone crisis services/hotlines, examining proximal outcomes as measured by changes in callers' crisis state from the beginning to the end of their calls to eight centers in the U.S. and intermediate outcomes within 3 weeks of their calls, was evaluated. Between March 2003 and July 2004, 1,617 crisis callers were assessed during their calls and 801 (49.5%) participated in the followup assessment. Significant decreases in callers' crisis states and hopelessness were found during the course of the telephone session, with continuing decreases in crisis states and hopelessness in the following weeks. A majority of callers were provided with referrals and/or plans of actions for their concerns and approximately one third of those provided with mental health referrals had followed up with the referral by the time of the follow-up assessment. While crisis service staff coded these callers as nonsuicidal, at follow-up nearly 12% of them reported having suicidal thoughts either during or since their call to the center. The need to conduct suicide risk assessments with crisis callers and to identify strategies to improve referral follow-up is highlighted.
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Affiliation(s)
- John Kalafat
- Rutgers Graduate School of Applied and Professional Psychology, Piscataway, NJ 08854, USA.
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Hustey FM, Smith MD. A depression screen and intervention for older ED patients. Am J Emerg Med 2007; 25:133-7. [PMID: 17276800 DOI: 10.1016/j.ajem.2006.05.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Revised: 05/24/2006] [Accepted: 05/28/2006] [Indexed: 11/21/2022] Open
Abstract
The objectives of this study were to determine the effect of screening examinations for depression on the care of older emergency department (ED) patients and to assess recognition of depression by emergency physicians (EPs). This was a prospective interventional study of 267 patients 70 years or older. Patients were screened for depression using the Short-Form Geriatric Depression Scale, and the results were presented to EPs after assessing EP recognition of depression. The prevalence of depression was 16.5% (44/267; 95% confidence interval, 12.0%-20.9%). Fifteen (34.1%) of 44 patients with depression were recognized by EPs as being depressed. Screening results did not alter care in any of the 44 patients with depression. No patients were given referrals or discharge instructions specifically to address depression. Depression is highly prevalent and poorly recognized in older ED patients. Use of the Short-Form Geriatric Depression Scale did not alter care of older patients with depression.
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Affiliation(s)
- Fredric M Hustey
- Department of Emergency Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Schulberg HC, Lee PW, Bruce ML, Raue PJ, Lefever JJ, Williams JW, Dietrich AJ, Nutting PA. Suicidal ideation and risk levels among primary care patients with uncomplicated depression. Ann Fam Med 2005; 3:523-8. [PMID: 16338916 PMCID: PMC1466932 DOI: 10.1370/afm.377] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We investigated the prevalence, severity, and course of passive and active suicidal ideation occurring in primary care patients with an uncomplicated depressive disorder. METHODS We studied suicidal ideation experienced by patients recruited in 60 primary care practices participating in a randomized controlled trial of depression management. Risk levels associated with suicidal ideation and plans were determined by a 2-stage procedure using pertinent items of the Patient Health Questionnaire-9, the Hopkins Symptom Checklist-20, and the Cornell structured assessment interview and management algorithm. RESULTS Of the 761 patients whom physicians judged in need of treatment for a clinical depression, 405 (53%) were experiencing uncomplicated dysthymia, major depression, or both. Among these depressed patients, about 90% had no risk or a low risk of self-harm based on the presence and nature of suicidal ideation; the rest had an intermediate risk. Almost all patients who were initially classified at the no or low risk levels remained at these levels during the subsequent 6 months. The incidence of suicidal ideation at a risk level requiring the physician's immediate attention in this no- or low-risk subgroup was 1.1% at 3 months and 2.6% at 6 months. CONCLUSIONS Almost all patients with uncomplicated dysthymia, major depression, or both acknowledging suicidal ideation of the minimal risk type when initially assessed maintained this minimal risk status during the subsequent 6 months.
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Burman ME, McCabe S, Pepper CM. Treatment Practices and Barriers for Depression and Anxiety by Primary Care Advanced Practice Nurses in Wyoming. ACTA ACUST UNITED AC 2005; 17:370-80. [PMID: 16115116 DOI: 10.1111/j.1745-7599.2005.00064.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to investigate barriers to treatment and screening related to depression and anxiety and the diagnostic and treatment practices of primary care advanced practice nurses (APNs) in the state of Wyoming. DATA SOURCES Every primary care APN in Wyoming received a mailed questionnaire asking them about treatment barriers, screening and treatment practices, and attitudes toward depression and anxiety. CONCLUSIONS Wyoming APNs in primary care routinely identify, evaluate, and treat patients with both depression and anxiety. APNs generally felt positive about treating these patients, although they reported that their patients encounter a number of financial barriers in accessing treatment. Routine screening practices for depression and anxiety were relatively low among the APNs, and they used a wide variety of interventions for these patients. IMPLICATIONS FOR PRACTICE The findings identify a lack of standardized approaches to assessment, referral, and treatment, especially pharmacologic intervention, and may indicate the need for alterations in the educational preparation of primary providers in order to improve clinical outcomes of treatment for depression and anxiety.
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Affiliation(s)
- Mary E Burman
- Fay W. Whitney School of Nursing, University of Wyoming, Laramie, WY 82071, USA.
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Schulberg HC, Bruce ML, Lee PW, Williams JW, Dietrich AJ. Preventing suicide in primary care patients: the primary care physician's role. Gen Hosp Psychiatry 2004; 26:337-45. [PMID: 15474633 DOI: 10.1016/j.genhosppsych.2004.06.007] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2004] [Accepted: 06/28/2004] [Indexed: 11/15/2022]
Abstract
Suicide is a critical public health problem that primary care physicians potentially can help address given that distressed patients frequently visit them in the weeks and months preceding the successful suicide. This article considers factors placing the patient at high risk for successful suicide and clinical assessment techniques available to the primary care physician. Patients who wish to harm themselves but still lack an articulated plan for doing so can be treated by the primary care physician with the monitoring assistance of a depression care manager and appropriate consultation by a mental health specialist.
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Lloyd Williams M, Payne S. A qualitative study of clinical nurse specialists' views on depression in palliative care patients. Palliat Med 2003; 17:334-8. [PMID: 12822850 DOI: 10.1191/0269216303pm747oa] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Depression is the most common psychiatric illness in patients with terminal cancer. Depression not only lowers the quality of life for the patients and their families, but patients who are depressed may also have physical symptoms that are difficult to palliate and that improve as their depression is appropriately treated. However, up to 80% of the psychological and psychiatric morbidity that develops in cancer patients goes unrecognized and untreated and patients are often reluctant to spontaneously discuss symptoms with medical and nursing staff. In the UK, palliative care clinical nurse specialists have a key role in the assessment of symptoms and advising on management in patients with advanced metastatic cancer. A qualitative study was carried out to determine how specialist palliative care nurses, working both in the community and within a hospital, perceive, assess and manage depression in their patients. Seventeen nurses were interviewed. Nurses found it difficult to discuss depression with their patients and tended to focus on physical symptoms. The lack of training in identifying psychological and psychiatric symptoms was a source of concern to nurses as was the difficulties they encountered in trying to persuade medical staff that patients required further assessment or antidepressant medication. Nurses also felt that psychiatric expertise was not utilized as fully as it could be. The findings of this study have implications for the training and support of nurse specialists in the psychological and psychiatric assessment and management of palliative care patients.
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