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Foster M, Weaver J, Shalaby R, Eboreime E, Poong K, Gusnowski A, Snaterse M, Surood S, Urichuk L, Agyapong VIO. Shared Care Practices in Community Addiction and Mental Health Services: A Qualitative Study on the Experiences and Perspectives of Stakeholders. Healthcare (Basel) 2022; 10:healthcare10050831. [PMID: 35627967 PMCID: PMC9140640 DOI: 10.3390/healthcare10050831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 12/04/2022] Open
Abstract
Shared care involves collaboration between primary care, secondary and tertiary care that enables the allocation of responsibilities of care according to the treatment needs of patients over the course of a mental illness. This study aims to determine stakeholders’ perspectives on the features of an ideal shared care model and barriers to practicing shared care within addiction and mental health programs in Edmonton, Canada. This is a qualitative cross-sectional study with data collected through focus group discussions. Participants included patients, general practitioners, psychiatrists, management, and therapists working in primary and secondary addiction and mental health. Responses were audio-recorded, transcribed, and analyzed thematically. Perceived barriers to the implementation of an ideal shared care model identified by participants include fragmented communication between primary and secondary healthcare providers, patient and family physician discomfort with discussing addiction and mental health, a lack of staff capacity, confidentiality issues, and practitioner buy-in. Participants also identified enablers to include implementing shared electronic medical record systems, improving communication and collaboration, physical co-location, and increasing practitioner awareness of appropriate referrals and services. This original research provides stakeholders’ perspectives on the features of an ideal shared care model and barriers to practicing shared care within addiction and mental health programs.
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Affiliation(s)
- Michele Foster
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.F.); (R.S.); (E.E.); (L.U.)
| | - Julia Weaver
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB T5J 0G5, Canada; (J.W.); (K.P.); (A.G.); (M.S.); (S.S.)
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.F.); (R.S.); (E.E.); (L.U.)
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.F.); (R.S.); (E.E.); (L.U.)
| | - Kimberly Poong
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB T5J 0G5, Canada; (J.W.); (K.P.); (A.G.); (M.S.); (S.S.)
| | - April Gusnowski
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB T5J 0G5, Canada; (J.W.); (K.P.); (A.G.); (M.S.); (S.S.)
| | - Mark Snaterse
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB T5J 0G5, Canada; (J.W.); (K.P.); (A.G.); (M.S.); (S.S.)
| | - Shireen Surood
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB T5J 0G5, Canada; (J.W.); (K.P.); (A.G.); (M.S.); (S.S.)
| | - Liana Urichuk
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.F.); (R.S.); (E.E.); (L.U.)
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB T5J 0G5, Canada; (J.W.); (K.P.); (A.G.); (M.S.); (S.S.)
| | - Vincent I. O. Agyapong
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.F.); (R.S.); (E.E.); (L.U.)
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Correspondence: ; Tel.: +1-780-215-7771; Fax: +1-902-473-4887
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Lachaud J, Mejia-Lancheros C, Wang R, Wiens K, Nisenbaum R, Stergiopoulos V, Hwang SW, O'Campo P. Mental and substance use disorders and food insecurity among homeless adults participating in the At Home/Chez Soi study. PLoS One 2020; 15:e0232001. [PMID: 32324795 PMCID: PMC7179857 DOI: 10.1371/journal.pone.0232001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 04/03/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Few studies have examined how food insecurity changes over time when living with severe mental disorders or substance use disorders. This study identifies food insecurity trajectories of homeless adults participating in a trial of a housing intervention and examines whether receiving the intervention and having specific mental and substance disorders predict food insecurity trajectories. MATERIALS AND METHODS We studied 520 participants in the Toronto site of the At Home/Chez-Soi project. Food insecurity data were collected at seven times during a follow-up period of up to 5.5 years. Mental and substance use disorders were assessed at baseline. Food insecurity trajectories were identified using group based-trajectory modeling. Multinomial logistic regression was used to examine the effects of the intervention and mental and substance use disorders on food insecurity trajectories. RESULTS Four food insecurity trajectories were identified: persistently high food insecurity, increasing food insecurity, decreasing food insecurity, and consistently low food insecurity. Receiving the intervention was not a predictor of membership in any specific food insecurity trajectory group. Individuals with major depressive episode, mood disorder with psychotic features, substance disorder, and co-occurring disorder (defined as having at least one alcohol or other substance use disorder and at least one non-substance related mental disorder] were more likely to remain in the persistently high food insecurity group than the consistently low food insecurity group. CONCLUSION A persistently high level of food insecurity is common among individuals with mental illness who have experienced homelessness, and the presence of certain mental health disorders increases this risk. Mental health services combined with access to resources for basic needs, and re-adaptation training are required to enhance the health and well-being of this population.
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Affiliation(s)
- James Lachaud
- MAP|Centre for Urban Health Solutions, Li Ka-Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Cilia Mejia-Lancheros
- MAP|Centre for Urban Health Solutions, Li Ka-Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Ri Wang
- MAP|Centre for Urban Health Solutions, Li Ka-Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Kathryn Wiens
- MAP|Centre for Urban Health Solutions, Li Ka-Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Rosane Nisenbaum
- MAP|Centre for Urban Health Solutions, Li Ka-Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Applied Health Research Centre, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- MAP|Centre for Urban Health Solutions, Li Ka-Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Stephen W. Hwang
- MAP|Centre for Urban Health Solutions, Li Ka-Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Patricia O'Campo
- MAP|Centre for Urban Health Solutions, Li Ka-Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Joseph R, Kester R, O’Brien C, Huang H. The Evolving Practice of Psychiatry in the Era of Integrated Care. PSYCHOSOMATICS 2017; 58:466-473. [DOI: 10.1016/j.psym.2017.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/08/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
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Abstract
Patients with symptoms that elude medical explanation are a perennial challenge to practicing physicians of all disciplines. Articles appear virtually monthly advising physicians how to care for them. Efforts at postgraduate education have attempted to ameliorate the situation but have shown limited or disappointing results at best. Physicians continue either to avoid these patients or to resort to a "seat-of-the-pants" approach to management. Literature on patients with medically unexplained symptoms, along with extensive experience consulting with primary care physicians, suggests that it is not primarily lack of physician skills but rather a series of barriers to adequate care that may account for suboptimal management. Barriers to implementation of effective care reside in the nature of medical education, the doctor-patient relationship, heterogeneity of symptoms and labels, changes in the health care system, and other variables. These impediments are considered here, with suggested potential remedies, in the conviction that the proper care of patients with medically unexplained symptoms can, among other things, bring satisfaction to both the patient and the physician, and help to reduce ineffective health resource utilization.
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Chakrabarti S. Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches. World J Psychiatry 2015; 5:286-304. [PMID: 26425443 PMCID: PMC4582305 DOI: 10.5498/wjp.v5.i3.286] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 05/07/2015] [Accepted: 06/09/2015] [Indexed: 02/05/2023] Open
Abstract
Telepsychiatry, i.e., the use of information and communication technologies to provide psychiatric services from a distance, has been around for more than half a century now. Research over this period has shown that videoconferencing-based telepsychiatry is an enabling and empowering form of service delivery, which promotes equality of access, and high levels of satisfaction among patients. The range of services offered by videoconferencing-based telepsychiatry, potential users and points of delivery of such services are theoretically limitless. Telepsychiatry has both clinical utility and non-clinical uses such as administrative, learning and research applications. A large body of accumulated evidence indicates that videoconferencing-based telepsychiatric assessments are reliable, and clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among diverse patient populations, ages and diagnostic groups, and on a wide range of measures. However, on many aspects of effectiveness, the evidence base is still relatively limited and often compromised by methodological problems. The lack of cost-effectiveness data in particular, is a major hindrance, raising doubts about the continued viability of telepsychiatric services. Added to this are the vagaries of technology, negative views among clinicians, poor uptake by providers, and several legal, ethical and administrative barriers. These hamper the widespread implementation of telepsychiatry and its integration with routine care. Though further advances in technology and research are expected to solve many of these problems, the way forward would be to promote telepsychiatry as an adjunct to conventional care, and to develop hybrid models, which incorporate both traditional and telepsychiatric forms of mental health-care.
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Wodarski JS, Curtis SV. Empirically Supported Interventions. JOURNAL OF EVIDENCE-INFORMED SOCIAL WORK 2015; 13:111-31. [PMID: 26151851 DOI: 10.1080/23761407.2015.1006934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Within the past four decades the social work profession has responded to the challenge to base practice on empirical evidence to adequately meet client needs. Most social workers would agree that the challenge has resulted in positive changes in the majority of cases-for example, in the execution of relevant research studies; the incorporation of more research findings into practice; the development of a technology of interpersonal helping; an emphasis on the incorporation of new knowledge bases, such as socio-behavioral and systems theory, in the curricula of schools of social work; and the development of services to meet emerging client needs and evidence-based practice. In this article the authors outline different references available pertaining to empirically supported interventions. A literature review revealed several textbooks, reference resources, journals, and handbooks that contain the most current research on therapeutic interventions. Different treatment components were explored in an effort to uncover the most cutting-edge developments in psychosocial treatments. These treatment components include treatment configuration, worker traits, compatibility of worker and client characteristics, professionals versus paraprofessionals, treatment length, and behavior acquisition.
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Affiliation(s)
- John S Wodarski
- a College of Social Work, University of Tennessee , Knoxville , Tennessee , USA
| | - Sarah V Curtis
- a College of Social Work, University of Tennessee , Knoxville , Tennessee , USA
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Happell B, Platania-Phung C, Scott D, Stanton R. Predictors of Nurse Support for the Introduction of the Cardiometabolic Health Nurse in the Australian Mental Health Sector. Perspect Psychiatr Care 2015; 51:162-70. [PMID: 24957751 DOI: 10.1111/ppc.12077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/22/2014] [Accepted: 05/29/2014] [Indexed: 11/28/2022] Open
Abstract
PURPOSE A cardiometabolic specialist nursing role could potentially improve physical health of people with serious mental illness. DESIGN AND METHODS A national survey of Australian nurses working in mental health settings investigated predictors of support for the role. FINDINGS Predictors included belief in physical healthcare neglect, interest in training; higher perceived value of improving physical health care. PRACTICE IMPLICATIONS The findings suggest that nurses see the cardiometabolic health nurse role as a promising initiative for closing gaps in cardiometabolic health care and skilling other nurses in mental health. However, as the majority of variance in cardiometabolic health nurse support was unexplained, more research is urgently needed on factors that explain differences in cardiometabolic health nurse endorsement.
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Affiliation(s)
- Brenda Happell
- Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
| | - Chris Platania-Phung
- Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
| | - David Scott
- Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
| | - Robert Stanton
- Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
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Happell B, Platania-Phung C, Scott D. Mental Health Nurse Incentive Program: facilitating physical health care for people with mental illness? Int J Ment Health Nurs 2013; 22:399-408. [PMID: 23279365 DOI: 10.1111/inm.12006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 11/28/2022]
Abstract
People with serious mental illness have increased rates of physical ill-health and reduced contact with primary care services. In Australia, the Mental Health Nurse Incentive Program (MHNIP) was developed to facilitate access to mental health services. However, as a primary care service, the contribution to physical health care is worthy of consideration. Thirty-eight nurses who were part of the MHNIP participated in a national survey of nurses working in mental health about physical health care. The survey invited nurses to report their views on the physical health of consumers and the regularity of physical health care they provide. Physical health-care provision in collaboration with general practitioners (GPs) and other health-care professionals was reported as common. The findings suggest that the MHNIP provides integrated care, where nurses and GPs work in collaboration, allowing enough time to discuss physical health or share physical health activities. Consumers of this service appeared to have good access to physical and mental health services, and nurses had access to primary care professionals to discuss consumers' physical health and develop their clinical skills in the physical domain. The MHNIP has an important role in addressing physical health concerns, in addition to the mental health issues of people accessing this service.
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Affiliation(s)
- Brenda Happell
- Central Queensland University, Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation and School of Nursing and Midwifery, Rockhampton, QLD 4072, Australia.
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Ungar T, Goldman S, Marcus M. Reversed Shared Care in Mental Health: Bringing Primary Physical Health Care to Psychiatric Patients. ACTA ACUST UNITED AC 2013. [DOI: 10.7870/cjcmh-2013-022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Thomas Ungar
- North York General Hospital and University of Toronto
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Castro Pérez SM, Rudolph Quezada CI, Aguilar Romero JE. Psychiatric consulting in primary care. Medwave 2013. [DOI: 10.5867/medwave.2013.03.5646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Cerimele JM, Katon WJ. Associations between health risk behaviors and symptoms of schizophrenia and bipolar disorder: a systematic review. Gen Hosp Psychiatry 2013; 35:16-22. [PMID: 23044246 PMCID: PMC3543518 DOI: 10.1016/j.genhosppsych.2012.08.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 08/08/2012] [Accepted: 08/20/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To systematically review the literature to determine if health risk behaviors in patients with schizophrenia or bipolar disorder are associated with subsequent symptom burden or level of functioning. METHOD Using the PRISMA systematic review method we searched PubMed, Cochrane, PsychInfo and EMBASE databases with key words: health risk behaviors, diet, obesity, overweight, BMI, smoking, tobacco use, cigarette use, sedentary lifestyle, sedentary behaviors, physical inactivity, activity level, fitness, sitting AND schizophrenia, bipolar disorder, bipolar illness, schizoaffective disorder, severe and persistent mental illness, and psychotic to identify prospective, controlled studies of greater than 6 months duration. Included studies examined associations between sedentary lifestyle, smoking, obesity, physical inactivity and subsequent symptom severity or functional impairment in patients with schizophrenia or bipolar disorder. RESULTS Eight of the 2130 articles identified met inclusion criteria and included 508 patients with a health risk behavior and 825 controls. Six studies examined tobacco use, and two studies examined weight gain/obesity. Seven studies found that patients with schizophrenia or bipolar illness and at least one health risk behavior had more severe subsequent psychiatric symptoms and/or decreased level of functioning. CONCLUSION Tobacco use and weight gain/obesity may be associated with increased severity of symptoms of schizophrenia and bipolar disorder or decreased level of functioning.
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Affiliation(s)
- Joseph M Cerimele
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Box 356560, Seattle, WA 98195, USA.
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Bauer AM, Bonilla P, Grover MW, Meyer F, Riselli C, White L. The role of psychosomatic medicine in global health care. Curr Psychiatry Rep 2011; 13:10-7. [PMID: 20978952 DOI: 10.1007/s11920-010-0162-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This article reviews the principles and skills involved with psychosomatic medicine and their potential ability to improve global health care. New awareness of the escalating global public health impact of noncommunicable diseases, including chronic medical conditions and mental disorders, has stimulated interest in determining how best to organize health services. Home to the biopsychosocial model, the field of psychosomatic medicine is well-suited to inform such efforts by virtue of its emphasis on cross-disciplinary collaboration and specialized knowledge at the interface of medicine and psychiatry that takes into account individual and contextual influences on health. Consistent with the principles of psychosomatic medicine, promising strategies to improve global health care include integrating mental health care into primary care, applying the chronic care model in programs aimed at enhancing disease self-management, and using innovative models such as Internet-based therapy and telemedicine to increase access to quality care.
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Affiliation(s)
- Amy M Bauer
- Department of Psychiatry, Cambridge Health Alliance, MA 02140, USA.
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