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Thapar S, Nguyen M, Khan BN, Fanaieyan R, Kishimoto V, Liu R, Bolea-Alamañac B, Leon-Carlyle M, O'Riordan A, Keresteci M, Bhattacharyya O. Patient and Therapist Perceptions of a Publicly Funded Internet-Based Cognitive Behavioral Therapy (iCBT) Program for Ontario Adults During the COVID-19 Pandemic: Qualitative Study. JMIR Form Res 2024; 8:e50113. [PMID: 38373027 PMCID: PMC10912991 DOI: 10.2196/50113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND To address the anticipated rise in mental health symptoms experienced at the population level during the COVID-19 pandemic, the Ontario government provided 2 therapist-assisted internet-delivered cognitive behavioral therapy (iCBT) programs to adults free of charge at the point of service. OBJECTIVE The study aims to explore the facilitators of and barriers to implementing iCBT at the population level in Ontario, Canada, from the perspective of patients and therapists to better understand how therapist-assisted iCBT programs can be effectively implemented at the population level and inform strategies for enhancing service delivery and integration into the health care system. METHODS Using a convenience sampling methodology, semistructured interviews were conducted with 10 therapists who delivered iCBT and 20 patients who received iCBT through either of the publicly funded programs to explore their perspectives of the program. Interview data were analyzed using inductive thematic analysis to generate themes. RESULTS Six salient themes were identified. Facilitators included the therapist-assisted nature of the program; the ease of registration and the lack of cost; and the feasibility of completing the psychoeducational modules given the online and self-paced nature of the program. Barriers included challenges with the online remote modality for developing the therapeutic alliance; the program's generalized nature, which limited customization to individual needs; and a lack of formal integration between the iCBT program and the health care system. CONCLUSIONS Although the program was generally well-received by patients and therapists due to its accessibility and feasibility, the digital format of the program presented both benefits and unique challenges. Strategies for improving the quality of service delivery include opportunities for synchronous communication between therapists and patients, options for increased customization, and the formal integration of iCBT into a broader stepped-care model that centralizes patient referrals between care providers and promotes continuity of care.
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Affiliation(s)
- Serena Thapar
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Megan Nguyen
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Bilal Noreen Khan
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Roz Fanaieyan
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Vanessa Kishimoto
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Rebecca Liu
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Blanca Bolea-Alamañac
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Marisa Leon-Carlyle
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Anne O'Riordan
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Patient Advisors Network, Toronto, ON, Canada
| | - Maggie Keresteci
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Patient Advisors Network, Toronto, ON, Canada
| | - Onil Bhattacharyya
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Goldbloom D, Gratzer D. Commentary: Minding the Gap in Access to Mental Health Services - Calling for Smart Funding, Not Just More Funding. Healthc Policy 2023; 19:49-53. [PMID: 37695706 PMCID: PMC10519338 DOI: 10.12927/hcpol.2023.27158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
In response to the paper by Gatov and colleagues (2023), the authors of this commentary, both psychiatrists, consider ways of addressing long-standing gaps in access to mental health services in Canada. They note the innovation seen during the COVID-19 pandemic with the rise of virtual care because of viral threat and economic imperative. Drawing on examples, including the UK-based experiment with publicly funded psychotherapy, they discuss the need for more flexible provider models of care (read: non-physician), better data collection and the potential of artificial intelligence. They conclude by calling for smarter funding, not just more funding.
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Affiliation(s)
- David Goldbloom
- Professor Department of Psychiatry University of Toronto Toronto, ON
| | - David Gratzer
- Attending Psychiatrist Centre for Addiction and Mental Health Associate Professor Department of Psychiatry University of Toronto Toronto, ON
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Rotenberg M, Gozdyra P, Anderson KK, Kurdyak P. The role of geography and distance on physician follow-up after a first hospitalization with a diagnosis of a schizophrenia spectrum disorder: A retrospective population-based cohort study in Ontario, Canada. PLoS One 2023; 18:e0287334. [PMID: 37327247 PMCID: PMC10275454 DOI: 10.1371/journal.pone.0287334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/02/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Timely follow-up after hospitalization for a schizophrenia spectrum disorder (SSD) is an important quality indicator. We examined the proportion of individuals who received physician follow-up within 7 and 30 days post-discharge by health region and estimated the effect of distance between a person's residence and discharging hospital on follow-up. METHODS We created a retrospective population-based cohort of incident hospitalizations with a discharge diagnosis of a SSD between 01/01/2012 and 30/03/2019. The proportion of follow-up with a psychiatrist and family physician within 7 and 30 days were calculated for each region. The effect of distance between a person's residence and discharging hospital on follow-up was estimated using adjusted multilevel logistic regression models. RESULTS We identified 6,382 incident hospitalizations for a SSD. Only 14.2% and 49.2% of people received follow-up care with a psychiatrist within 7 and 30 days of discharge, respectively, and these proportions varied between regions. Although distance from hospital was not associated with follow-up within 7 days of discharge, increasing distance was associated with lower odds of follow-up with a psychiatrist within 30 days. CONCLUSION Post-discharge follow-up is poor across the province. Geospatial factors may impact post-discharge care and should be considered in further evaluation of quality of care.
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Affiliation(s)
- Martin Rotenberg
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Kelly K. Anderson
- ICES, Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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Torales J, Vilallba-Arias J, Bogado JA, O'Higgins M, Almirón-Santacruz J, Ruiz Díaz N, García O, Amarilla-Salvioni D, Castaldelli-Maia JM, Ventriglio A, Barrios I. Satisfaction with Telepsychiatry during the COVID-19 pandemic: Patients' and psychiatrists' report from a University Hospital. Int J Soc Psychiatry 2023; 69:156-160. [PMID: 34991382 PMCID: PMC9936176 DOI: 10.1177/00207640211070762] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The COVID-19 pandemic has led to important changes in the approach to patients worldwide. Different agencies have proposed and implemented telemedicine-based care services in order to ensure access to health care for all people. AIM The aim of this study was to determine the satisfaction of patients using the Telepsychiatry service offered by the Department of Psychiatry of the Hospital de Clínicas (National University of Asunción, Paraguay). METHODS A cross sectional and descriptive study has been conducted. Participants were recruited through a phone-based survey. Satisfaction with Telepsychiatry has been measured with an adapted version of a satisfaction survey in Teleneurology. As a complement, psychiatrists from the Hospital de Clínicas were also interviewed about their rate of satisfaction with Telepsychiatry. RESULTS A total of 530 patients were included, 51.3% of whom were women. The consultation satisfaction scale ranged between 2.15 and 4.30 with a mean score of 3.02 ± 0.32. Cronbach's alpha for the scale was .897, indicating a good internal consistency. Patients' satisfaction was higher for the perception of Telepsychiatry and lower for the doctor-patient relationship. Of the physicians, 87.5% were satisfied with the Telepsychiatry service. CONCLUSION The satisfaction overall score indicates patients' general satisfaction with the quality of care in Telepsychiatry, mainly regarding the perception of health care. and lower satisfaction with the doctor-patient relationship. Nine out of 10 psychiatrists felt satisfied with the Telepsychiatry service and considered that the degree of patient's satisfaction was acceptable during the Telepsychiatry consultation.
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Affiliation(s)
- Julio Torales
- Department of Medical Psychology, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay.,Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Jorge Vilallba-Arias
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay.,Department of Psychiatry (Santa Rosa Campus), School of Medical Sciences, National University of Asunción, Santa Rosa del Aguaray, Paraguay
| | - José Andrés Bogado
- Department of Psychiatry (Santa Rosa Campus), School of Medical Sciences, National University of Asunción, Santa Rosa del Aguaray, Paraguay
| | - Marcelo O'Higgins
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - José Almirón-Santacruz
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Noelia Ruiz Díaz
- Department of Medical Psychology, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay.,Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Oscar García
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Diego Amarilla-Salvioni
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Fundação do ABC, Santo André, Brazil.,Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Iván Barrios
- Department of Statistics (Santa Rosa Campus), School of Medical Sciences, National University of Asunción, Santa Rosa del Aguaray, Paraguay
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Barry R, Rehm J, de Oliveira C, Gozdyra P, Chen S, Kurdyak P. Help-seeking behavior among adults who attempted or died by suicide in Ontario, Canada. Suicide Life Threat Behav 2023; 53:54-63. [PMID: 36098239 DOI: 10.1111/sltb.12921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study aims to determine the relationship between rurality and help-seeking behavior prior to a suicide or suicide attempt. METHODS Data from 2007 to 2017 were obtained from administrative databases held at ICES, which capture all hospital, emergency department (ED), and general practitioner (GP) visits across Ontario. Rurality was defined using the Rurality Index of Ontario scores. Help-seeking was based on accessing health services 1 year prior to the event. RESULTS Among those who died by suicide (N = 9848), those living in rural areas were less likely to seek help from a psychiatrist (rural males: AOR = 0.42, 95% CI = 0.31-0.57; rural females: AOR = 0.46, 95% CI = 0.29-0.97) compared with those living in urban areas. We found a similar association among those who attempted suicide (N = 82,480) (rural males: AOR = 0.49, 95% CI = 0.43-0.56; rural females: AOR = 0.51, 95% CI = 0.46-0.57). Rural males and females were more likely to seek care from an ED for mental health reasons compared with urban males and females. CONCLUSIONS Among people who died by suicide, those living in rural areas are generally less likely to access psychiatrists and GPs and more likely to access EDs, suggesting that people living in rural areas may have less access to care than their urban counterparts.
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Affiliation(s)
| | - Jürgen Rehm
- University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dresden University of Technology, Dresden, Germany.,I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Claire de Oliveira
- University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Centre for Health Economics and Hull York Medical School, University of York, York, UK
| | | | | | - Paul Kurdyak
- University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
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Abstract
Introduction: Despite a good evidence base for telepsychiatry (TP), economic cost analyses are infrequent and vary in quality. Methods: A scoping review was conducted based on the research question, "From the perspective of an economic cost analysis for telehealth and telepsychiatry, what are the most meaningful ways to ensure a study/intervention improved clinical care, provided value to participants, had population level impact, and is sustainable?" The search in seven databases focused on keywords in four concept areas: (1) economic cost analysis, (2) evaluation, (3) telehealth and telepsychiatry, and (4) quantifiable health status outcomes. The authors reviewed the full-text articles based on the inclusion (Medical Subject Headings [MeSH] of the keywords) and exclusion criteria. Results: Of a total of 2,585 potential references, a total of 99 articles met the inclusion criteria. The evaluation of telehealth and TP has focused on access, quality, patient outcomes, feasibility, effectiveness, outcomes, and cost. Cost-effectiveness, cost-benefit, and other analytic models are more common with telehealth than TP studies, and these studies show favorable clinical, quality of life, and economic impact. A standard framework for economic cost analysis should include: an economist for planning, implementation, and evaluation; a tool kit or guideline; comprehensive analysis (e.g., cost-effectiveness or cost-benefit) with an incremental cost-effectiveness ratio; measures for health, quality of life, and utility outcomes for populations; methods to convert outcomes into economic benefits (e.g., monetary, quality of adjusted life year); broad perspective (e.g., societal perspective); sensitivity analysis for uncertainty in modeling; and adjustments for differential timing (e.g., discounting and future costs). Conclusions: Technology assessment and economic cost analysis-such as effectiveness and implementation science approaches-contribute to clinical, training, research, and other organizational missions. More research is needed with a framework that enables comparisons across studies and meta-analyses.
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Affiliation(s)
- Donald M Hilty
- Northern California Veterans Administration Health Care System, Mather, California, USA.,Department of Psychiatry & Behavioral Sciences, UC Davis, Sacramento, California, USA
| | - Eva Serhal
- ECHO Ontario Mental Health and ECHO Ontario Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Allison Crawford
- ECHO Ontario Mental Health and ECHO Ontario Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
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Ceniti AK, Abdelmoemin WR, Ho K, Kang Y, Placenza F, Laframboise R, Bhat V, Foster JA, Frey BN, Lam RW, Milev R, Rotzinger S, Soares CN, Uher R, Kennedy SH. "One Degree of Separation": A Mixed-Methods Evaluation of Canadian Mental Health Care User and Provider Experiences With Remote Care During COVID-19. Can J Psychiatry 2022; 67:712-722. [PMID: 34986035 PMCID: PMC9445628 DOI: 10.1177/07067437211070656] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The COVID-19 pandemic has contributed to a shift from in-person to remote mental health care. While remote care methods have long existed, their widespread use is unprecedented. There is little research about mental health care user and provider experiences with this transition, and no published studies to date have compared satisfaction between these groups. METHODS Canadian mental health care users (n = 332) and providers (n = 107) completed an online self-report survey from October 2020 to February 2021 hosted by the Canadian Biomarker Integration Network in Depression. Using a mixed-methods approach, participants were asked about their use of remote care, including satisfaction, barriers to use, helpful and unhelpful factors, and suggestions for improvement. RESULTS Overall, 59% to 63% of health care users and 59% of health care providers were satisfied with remote care. Users reported the greatest satisfaction with the convenience of remote care, while providers were most satisfied with the speed of provision of care; all groups were least satisfied with therapeutic rapport. Health care providers were less satisfied with the user-friendliness of remote care (P < 0.001) than users, while health care users were less satisfied than providers with continuity of care (P < 0.001). The use of a video-based platform was associated with remote care satisfaction among health care users (P < 0.02), and qualitative responses support the importance of visual cues in maintaining therapeutic rapport remotely. The majority of users (55%) and providers (87%) reported a likelihood of using remote care after the pandemic. CONCLUSIONS Remote mental health care is generally accepted by both users and providers, and the majority would consider using remote care following the pandemic. Suggestions for improvement include greater use of video, increased attention to body language and eye contact, consistency with in-person care, as well as increased provider training and administrative support.
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Affiliation(s)
- Amanda K Ceniti
- Arthur Sommer Rotenberg Suicide & Depression Studies Program, 10071St. Michael's Hospital, Toronto, Canada.,Centre for Depression and Suicide Studies, 10071St. Michael's Hospital, Toronto, Canada.,Institute of Medical Science, 7938University of Toronto, Toronto, Canada
| | - Wegdan R Abdelmoemin
- Centre for Depression and Suicide Studies, 10071St. Michael's Hospital, Toronto, Canada
| | - Keith Ho
- Centre for Depression and Suicide Studies, 10071St. Michael's Hospital, Toronto, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Canada
| | - Yudi Kang
- Centre for Mental Health, 7989University Health Network, Toronto, Canada
| | - Franca Placenza
- Centre for Mental Health, 7989University Health Network, Toronto, Canada
| | - Rachel Laframboise
- Centre for Mental Health, 7989University Health Network, Toronto, Canada
| | - Venkat Bhat
- Arthur Sommer Rotenberg Suicide & Depression Studies Program, 10071St. Michael's Hospital, Toronto, Canada.,Centre for Depression and Suicide Studies, 10071St. Michael's Hospital, Toronto, Canada.,Institute of Medical Science, 7938University of Toronto, Toronto, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Canada.,Department of Psychiatry, 7938University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Toronto, Canada
| | - Jane A Foster
- Centre for Mental Health, 7989University Health Network, Toronto, Canada.,Department of Psychiatry and Behavioural Neurosciences, 3710McMaster University, Hamilton, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, 3710McMaster University, Hamilton, Canada.,Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Raymond W Lam
- Department of Psychiatry, 8166University of British Columbia, Vancouver, Canada
| | - Roumen Milev
- Departments of Psychiatry and Psychology, 4257Queen's University, Kingston, Canada.,Providence Care, Kingston, ON, Canada
| | - Susan Rotzinger
- Arthur Sommer Rotenberg Suicide & Depression Studies Program, 10071St. Michael's Hospital, Toronto, Canada.,Centre for Depression and Suicide Studies, 10071St. Michael's Hospital, Toronto, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Canada.,Department of Psychiatry, 7938University of Toronto, Toronto, Canada
| | - Claudio N Soares
- Departments of Psychiatry and Psychology, 4257Queen's University, Kingston, Canada.,Providence Care, Kingston, ON, Canada
| | - Rudolf Uher
- Department of Psychiatry, 3688Dalhousie University, Halifax, Canada
| | - Sidney H Kennedy
- Arthur Sommer Rotenberg Suicide & Depression Studies Program, 10071St. Michael's Hospital, Toronto, Canada.,Centre for Depression and Suicide Studies, 10071St. Michael's Hospital, Toronto, Canada.,Institute of Medical Science, 7938University of Toronto, Toronto, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Canada.,Department of Psychiatry, 7938University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Toronto, Canada
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Friesen EL, Myran D, Yu W, Rosella L, Selby P, Kurdyak P. Rural-urban disparities in post-discharge outcomes following alcohol-related hospitalizations in Ontario, Canada: A retrospective cohort study. Drug Alcohol Depend 2022; 238:109568. [PMID: 35850027 DOI: 10.1016/j.drugalcdep.2022.109568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited access to mental health and addiction (MHA) services in rural areas may increase the risk of recurrent alcohol-related harm among rural, relative to urban, residents. This study evaluated (1) rural-urban differences in clinical trajectories following alcohol-related hospitalizations and (2) whether limited access to MHA services mediates an increased risk of adverse post-discharge outcomes in rural areas. METHODS This was a population-based retrospective cohort study of individuals in Ontario, Canada, who experienced an alcohol-related hospitalization between 2016 and 2018. The primary exposure was rurality. The outcomes of interest were outpatient MHA care, alcohol-related emergency department visits, alcohol-related hospitalizations, and all-cause mortality within one-year of discharge from the index alcohol-related hospitalization. Data were collected using provincial health administrative databases. The associations between rurality and the time to each outcome were assessed using multivariable time-to-event regression. Mediation analyses were conducted using a counterfactual approach. RESULTS 46,657 individuals were included. 11.5% of the cohort died within one year of discharge from the index alcohol-related hospitalization. Relative to urban residents, rural residents were less likely to receive MHA outpatient care (adjusted hazard ratio (aHR): 0.80, 95% confidence interval (CI): 0.75-0.86) and more likely to die (aHR: 1.19, 95% CI: 1.06-1.34) in the year following discharge. The lower likelihood of post-discharge MHA-related care among rural residents mediated 31% (95% CI: 13-46%) of the increased risk of mortality. CONCLUSIONS A lack of follow-up MHA care mediates an increased risk of short-term mortality following alcohol-related hospitalizations in rural, relative to urban, communities.
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Affiliation(s)
- Erik Loewen Friesen
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; ICES, Toronto, ON, Canada.
| | - Daniel Myran
- ICES, Toronto, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Laura Rosella
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Kurdyak
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; ICES, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Toulany A, Kurdyak P, Gandhi S, Fu L, Grewal S, Kulkarni C, Saunders N, Vigod S, Guttmann A, Chiu M, Pignatiello A. Health System-Level Evaluation of Tele-Mental Health Services Among Children and Adolescents in Ontario, Canada. Can J Psychiatry 2022; 67:462-469. [PMID: 34569295 PMCID: PMC9149526 DOI: 10.1177/07067437211043395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the characteristics of children and adolescents receiving tele-mental health services in Ontario, Canada and examine access to a psychiatrist, in-person or via tele-mental health services, following a mental health and addictions (MHA)-related emergency department (ED) visit or hospitalization. METHOD Using linked health and administrative data, we described two cohorts: (1) children and adolescents (1-18 years) who used a provincial tele-mental health programme from January 1, 2013 to March 31, 2017, comparing their MHA-related service use (outpatient, ED, hospitalization) in the 1 year prior to and the 1 year following initial consultation; (2) children and adolescents with high mental health service needs, defined as those with an incident MHA-related ED visit or hospitalization between January 1, 2013 and December 31, 2016, examining their 1-year follow-up with telemedicine and other health care utilization. RESULTS In the first cohort, 7,216 children and adolescents (mean age 11.8 [±3.8] years) received tele-mental health services. The proportion of MHA-related ED visits [15.1% pre vs. 12.6% post (test statistic 23.57, P < 0.001)] or hospitalizations [10.2% pre vs. 8.7% post (test statistic 11.96, P < 0.001)] declined in the year following tele-mental health consultation, while local psychiatry visits increased [8.4% pre vs. 17.0% post (test statistic 298.69, P < 0.001)]. In the second cohort (n = 84,033), only 1.5% received tele-mental health services, 40.7% saw a psychiatrist in-person, and 32.5% received no MHA-related outpatient care in follow-up. CONCLUSIONS Tele-mental health services were rarely used in Ontario, even among high-needs children and adolescents, despite their association with increased access to care and less need for acute mental health care.
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Affiliation(s)
- Alene Toulany
- Division of Adolescent Medicine, Hospital for Sick Children, Toronto, Ontario.,ICES, Toronto, Ontario.,Department of Pediatrics, Faculty of Medicine, 7938University of Toronto, Toronto, Ontario.,206712Institute for Health Policy Management and Evaluation, 12366University of Toronto, Toronto, Ontario.,50010Child Health Evaluative Sciences, 483367SickKids Research Institute, Toronto, Ontario
| | - Paul Kurdyak
- ICES, Toronto, Ontario.,206712Institute for Health Policy Management and Evaluation, 12366University of Toronto, Toronto, Ontario.,Department of Psychiatry, Faculty of Medicine, 7938University of Toronto, Toronto, Ontario.,Institute for Mental Health Policy Research, 7978Centre for Addiction and Mental Health, Toronto, Ontario
| | | | | | - Seena Grewal
- Department of Psychiatry, Faculty of Medicine, 7938University of Toronto, Toronto, Ontario.,TeleLink Mental Health Program, Department of Psychiatry, 7979The Hospital for Sick Children, Toronto, Ontario
| | - Chetana Kulkarni
- Department of Psychiatry, Faculty of Medicine, 7938University of Toronto, Toronto, Ontario.,TeleLink Mental Health Program, Department of Psychiatry, 7979The Hospital for Sick Children, Toronto, Ontario
| | - Natasha Saunders
- ICES, Toronto, Ontario.,Department of Pediatrics, Faculty of Medicine, 7938University of Toronto, Toronto, Ontario.,206712Institute for Health Policy Management and Evaluation, 12366University of Toronto, Toronto, Ontario.,50010Child Health Evaluative Sciences, 483367SickKids Research Institute, Toronto, Ontario.,Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario.,Women's College Research Institute, 7985Women's College Hospital, Toronto, Ontario
| | - Simone Vigod
- ICES, Toronto, Ontario.,206712Institute for Health Policy Management and Evaluation, 12366University of Toronto, Toronto, Ontario.,Department of Psychiatry, Faculty of Medicine, 7938University of Toronto, Toronto, Ontario.,Women's College Research Institute, 7985Women's College Hospital, Toronto, Ontario
| | - Astrid Guttmann
- ICES, Toronto, Ontario.,Department of Pediatrics, Faculty of Medicine, 7938University of Toronto, Toronto, Ontario.,206712Institute for Health Policy Management and Evaluation, 12366University of Toronto, Toronto, Ontario.,50010Child Health Evaluative Sciences, 483367SickKids Research Institute, Toronto, Ontario.,Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario.,Women's College Research Institute, 7985Women's College Hospital, Toronto, Ontario.,Leong Centre for Healthy Children, 12366University of Toronto, Toronto, Ontario
| | - Maria Chiu
- ICES, Toronto, Ontario.,206712Institute for Health Policy Management and Evaluation, 12366University of Toronto, Toronto, Ontario
| | - Antonio Pignatiello
- Department of Psychiatry, Faculty of Medicine, 7938University of Toronto, Toronto, Ontario.,TeleLink Mental Health Program, Department of Psychiatry, 7979The Hospital for Sick Children, Toronto, Ontario
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10
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Johnson S, Dalton‐Locke C, Baker J, Hanlon C, Salisbury TT, Fossey M, Newbigging K, Carr SE, Hensel J, Carrà G, Hepp U, Caneo C, Needle JJ, Lloyd‐Evans B. Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care. World Psychiatry 2022; 21:220-236. [PMID: 35524608 PMCID: PMC9077627 DOI: 10.1002/wps.20962] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with people in crisis. Evidence on best ap-proaches to initial assessment and immediate management is particularly lacking, but some innovative models involving extended assessment, brief interventions, and diversifying settings and strategies for providing support are potentially helpful. Acute wards continue to be central in the intensive treatment phase following a crisis, but new approaches need to be developed, evaluated and implemented to reducing coercion, addressing trauma, diversifying treatments and the inpatient workforce, and making decision-making and care collaborative. Intensive home treatment services, acute day units, and community crisis services have supporting evidence in diverting some service users from hospital admission: a greater understanding of how best to implement them in a wide range of contexts and what works best for which service users would be valuable. Approaches to crisis management in the voluntary sector are more flexible and informal: such services have potential to complement and provide valuable learning for statutory sector services, especially for groups who tend to be underserved or disengaged. Such approaches often involve staff with personal experience of mental health crises, who have important potential roles in improving quality of acute care across sectors. Large gaps exist in many low- and middle-income countries, fuelled by poor access to quality mental health care. Responses need to build on a foundation of existing community responses and contextually relevant evidence. The necessity of moving outside formal systems in low-resource settings may lead to wider learning from locally embedded strategies.
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Affiliation(s)
- Sonia Johnson
- Division of PsychiatryUniversity College LondonLondonUK,Camden and Islington NHS Foundation TrustLondonUK
| | | | - John Baker
- School of Healthcare, University of LeedsLeedsUK
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUK,Department of PsychiatrySchool of Medicine, and Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa UniversityAddis AbabaEthiopia
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUK
| | - Matt Fossey
- Faculty of Health, Education, Medicine and Social CareAnglia Ruskin UniversityChelmsfordUK
| | - Karen Newbigging
- Department of PsychiatryUniversity of OxfordOxfordUK,Institute for Mental Health, University of BirminghamBirminghamUK
| | - Sarah E. Carr
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUK
| | - Jennifer Hensel
- Department of PsychiatryUniversity of ManitobaWinnipegMBCanada
| | - Giuseppe Carrà
- Department of Medicine and SurgeryUniversity of Milano BicoccaMilanItaly
| | - Urs Hepp
- Integrated Psychiatric Services Winterthur, Zürcher UnterlandWinterthurSwitzerland
| | - Constanza Caneo
- Departamento de Psiquiatría, Facultad de MedicinaPontificia Universidad Católica de ChileSantiagoChile
| | - Justin J. Needle
- Centre for Health Services Research, School of Health Sciences, City, University of LondonLondonUK
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11
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Benudis A, Re'em Y, Kanellopoulos D, Moreno A, Zonana J. Patient and provider experiences of telemental health during the COVID-19 pandemic in a New York City academic medical center. Psychiatry Res 2022; 311:114496. [PMID: 35306378 PMCID: PMC8898588 DOI: 10.1016/j.psychres.2022.114496] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 02/26/2022] [Accepted: 03/05/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We aimed to evaluate patient and provider experiences with telemental health (TMH) at an academic outpatient psychiatry department in New York City during the first wave of the COVID-19 pandemic. METHODS Patients and providers completed online surveys evaluating their experience with TMH during the first wave of the COVID-19 pandemic. Surveys were distributed to 1,178 patients and 287 providers from July 2020 through October 2020. RESULTS 42.5% of providers and 21% of patients responded to the survey. The majority of patient and provider respondents rated the quality of phone and video visits as "equally good" or "somewhat worse" than in-person visits, while the majority of respondents were "somewhat satisfied" or "very satisfied" with video visits. Patients and providers preferred a hybrid model for future care. Common barriers to TMH included privacy, technical difficulties, and wi-fi access. CONCLUSIONS Patients and providers appeared willing to exchange some degree of quality for satisfaction with TMH. This study did not demonstrate with statistical significance any specific patient populations that would benefit more or less from TMH, suggesting that TMH may be a successful model for diverse patient populations. Our results suggest that providers, payors, and regulators should facilitate hybrid care delivery models that incorporate TMH beyond the pandemic.
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Affiliation(s)
- Abigail Benudis
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
| | - Yochai Re'em
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Dora Kanellopoulos
- NewYork-Presbyterian Hospital/Westchester Behavioral Health Center, White Plains, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | | | - Jess Zonana
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
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12
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Saunders NR, Kurdyak P, Stukel TA, Strauss R, Fu L, Guan J, Fiksenbaum L, Cohen E, Guttmann A, Vigod S, Chiu M, Hepburn CM, Moran K, Gardner W, Cappelli M, Sundar P, Toulany A. Utilization of Physician-Based Mental Health Care Services Among Children and Adolescents Before and During the COVID-19 Pandemic in Ontario, Canada. JAMA Pediatr 2022; 176:e216298. [PMID: 35129604 PMCID: PMC8822447 DOI: 10.1001/jamapediatrics.2021.6298] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Public health measures to reduce the spread of COVID-19 have heightened distress among children and adolescents and contributed to a shift in delivery of mental health care services. OBJECTIVES To measure and compare physician-based outpatient mental health care utilization before and during the COVID-19 pandemic and quantify the extent of uptake of virtual care delivery. DESIGN, SETTING, AND PARTICIPANTS Population-based repeated cross-sectional study using linked health and administrative databases in Ontario, Canada. All individuals aged 3 to 17 years residing in Ontario from January 1, 2017, to February 28, 2021. EXPOSURES Pre-COVID-19 period from January 1, 2017, to February 29, 2020, and post-COVID-19 onset from March 1, 2020, to February 28, 2021. MAIN OUTCOMES AND MEASURES Physician-based outpatient weekly visit rates per 1000 population for mental health diagnoses overall and stratified by age group, sex, and mental health diagnostic grouping and proportion of virtual visits. Poisson generalized estimating equations were used to model 3-year pre-COVID-19 trends and forecast expected trends post-COVID-19 onset and estimate the change in visit rates before and after the onset of COVID-19. The weekly proportions of virtual visits were calculated. RESULTS In a population of almost 2.5 million children and adolescents (48.7% female; mean [SD] age, 10.1 [4.3] years), the weekly rate of mental health outpatient visits was 6.9 per 1000 population. Following the pandemic onset, visit rates declined rapidly to below expected (adjusted relative rate [aRR], 0.81; 95% CI, 0.79-0.82) in April 2020 followed by a growth to above expected (aRR, 1.07; 95% CI, 1.04-1.09) by July 2020 and sustained at 10% to 15% above expected as of February 2021. Adolescent female individuals had the greatest increase in visit rates relative to expected by the end of the study (aRR, 1.26; 95% CI, 1.25-1.28). Virtual care accounted for 5.0 visits per 1000 population (72.5%) of mental health visits over the study period, with a peak of 5.3 visits per 1000 population (90.1%) (April 2020) and leveling off to approximately 70% in the latter months. CONCLUSIONS AND RELEVANCE Physician-based outpatient mental health care in Ontario increased during the pandemic, accompanied by a large, rapid shift to virtual care. There was a disproportionate increase in use of mental health care services among adolescent female individuals. System-level planning to address the increasing capacity needs and to monitor quality of care with such large shifts is warranted.
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Affiliation(s)
- Natasha Ruth Saunders
- The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada,Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada,Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Therese A. Stukel
- ICES, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Lisa Fiksenbaum
- The Hospital for Sick Children, Toronto, Ontario, Canada,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Eyal Cohen
- The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada,Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Astrid Guttmann
- The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada,Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Simone Vigod
- ICES, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada,Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Women’s College Hospital and Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | | | - Charlotte Moore Hepburn
- The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kimberly Moran
- Children’s Mental Health Ontario, Toronto, Ontario, Canada
| | - William Gardner
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Mario Cappelli
- Ontario Centre of Excellence for Child and Youth Mental Health, Ottawa, Ontario, Canada
| | - Purnima Sundar
- Ontario Centre of Excellence for Child and Youth Mental Health, Ottawa, Ontario, Canada
| | - Alene Toulany
- The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada,Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
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13
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Serhal E, Pereira C, Armata R, Hardy J, Sockalingam S, Crawford A. Describing implementation outcomes for a virtual community of practice: The ECHO Ontario Mental Health experience. Health Res Policy Syst 2022; 20:17. [PMID: 35135565 PMCID: PMC8822668 DOI: 10.1186/s12961-022-00818-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/20/2022] [Indexed: 01/01/2023] Open
Abstract
Background Project ECHO is a virtual education model aimed at building capacity among healthcare providers to support optimal management for a range of health conditions. The expansion of the ECHO model, further amplified by the pandemic, has demonstrated an increased need to evaluate implementation success to ensure that interventions are implemented as planned. This study describes how Proctor et al.’s implementation outcomes (acceptability, adoption, appropriateness, costs, feasibility, fidelity, penetration, and sustainability) were adapted and used to assess the implementation of ECHO Ontario Mental Health (ECHO-ONMH), a mental health-focused capacity-building programme. Methods Using Proctor et al.’s implementation outcomes, the authors developed an implementation outcomes framework for ECHO-ONMH more generally. Using this, outcome measures and success thresholds were identified for each outcome for the ECHO-ONMH context, and then applied to evaluate the implementation of ECHO-ONMH using data from the first 4 years of the programme. Results An ECHO-ONMH implementation outcomes framework was developed using Proctor’s implementation outcomes. ECHO-ONMH adapted implementation outcomes suggest that ECHO-ONMH was implemented successfully in all domains except for penetration, which only had participation from 13/14 regions. Acceptability, appropriateness and adoption success thresholds were surpassed for all 4 years, showing strong signs of sustainability. The programme was deemed feasible all 4 years and was found to be more cost-effective. ECHO-ONMH also showed high rates of fidelity to the ECHO model, and high rates of penetration. Conclusions This is the first study to use Proctor et al.’s implementation outcomes to describe implementation success for a virtual capacity-building model. The proposed ECHO implementation outcomes framework provides a base for similar interventions to evaluate implementation success, which is an important precursor to understanding learning, service or health outcomes related to the model. Additionally, these findings can act as a benchmark for other international ECHOs and educational programmes.
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Affiliation(s)
- Eva Serhal
- Virtual Care, Outreach, and ECHO Department, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Cheryl Pereira
- Virtual Care, Outreach, and ECHO Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rosaria Armata
- Virtual Care, Outreach, and ECHO Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jenny Hardy
- Virtual Care, Outreach, and ECHO Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sanjeev Sockalingam
- Department of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Allison Crawford
- Virtual Care, Outreach, and ECHO Department, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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14
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Xu W, Gu G, Dong L, Wang L. Analysis of Factors Influencing Telemedicine-Based Psychiatric Extended Care and Care of Psychiatric Patients. J Healthc Eng 2022; 2022:9434820. [PMID: 35083029 PMCID: PMC8786483 DOI: 10.1155/2022/9434820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022]
Abstract
The aim of this paper is to understand the current situation of the care burden of patients with mental illness in remission and the factors affecting it in order to provide a scientific basis for targeted interventions. This paper reviews the concept of telemedicine, the application of telemedicine in home hospice care, and the remaining problems and improvement strategies of telemedicine in home hospice care, with the aim of providing a reference for the application of telemedicine in home hospice care in China. The Zarit Burden Scale, Family Care Scale, and Social Functioning Scale were used to conduct one-to-one interviews with 201 schizophrenic patients in remission and their primary caregivers in Hubei Province. Among them, 66, 72, and 25 cases (32.8%, 35.9%, and 12.4%) had mild, moderate, and severe burdens, respectively. Caregivers' family care and patients' social functioning were generally poor. The results of multiple linear regression analysis showed that caregiver age, caregiver education, caregiver family care, patient medical costs, and patient social functioning were factors influencing the burden of care for patients with schizophrenia in remission (P < 0.05). The government, mental health centers, and families should understand the level of caregiving burden of patients with schizophrenia in remission and the factors influencing it and provide targeted measures to reduce the caregiving burden.
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Affiliation(s)
- Wenjian Xu
- Tian Jin An Ding Hospital, Tianjin 300000, China
| | - Guang Gu
- Liaocheng Fourth People's Hospital, Liaocheng 252000, China
| | - Libo Dong
- Heilongjiang Armed Police Corps Hospital, Harbin 150010, China
| | - Lina Wang
- Tian Jin An Ding Hospital, Tianjin 300000, China
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15
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Shakeri A, Chu C, Stamenova V, Fang J, Barker LC, Vigod SN, Bhatia RS, Tadrous M. Comparison of Healthcare Utilization Between Telemedicine and Standard Care: A Propensity-Score Matched Cohort Study Among Individuals With Chronic Psychotic Disorders in Ontario, Canada. Schizophrenia Bulletin Open 2022; 3:sgac046. [PMID: 35996531 PMCID: PMC9384485 DOI: 10.1093/schizbullopen/sgac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Telemedicine adoption has grown significantly due to the coronavirus of 2019 pandemic; however, it remains unclear what the impact of widespread telemedicine use is on healthcare utilization among individuals with psychosis. Objectives To investigate the impact of telemedicine use on changes in healthcare utilization among patients with chronic psychotic disorders (CPDs). Study Design We conducted a population-based, retrospective propensity-matched cohort study using healthcare administrative data in Ontario, Canada. Patients were included if they had at least one ambulatory visit between March 14, 2020 and September 30, 2020 and a CPD diagnosis any time before March 14, 2020. Telemedicine users (2+ virtual visits after March 14, 2020) were propensity score-matched 1:1 with standard care users (minimum of 1 in-person or virtual ambulatory visit and maximum of 1 virtual visit after March 14, 2020) based on several baseline characteristics. Monthly use of various healthcare services was compared between the two groups from 12 months before to 3 months after their index in-person or virtual ambulatory visit after March 14, 2020 using generalized estimating equations (eg, hospitalizations, emergency department [ED] visits, and outpatient physician visits). The slope of change over the study period (ie, rate ratio) as well as a ratio of slopes, were calculated for both telemedicine and standard care groups for each outcome. Study Results A total of 18 333 pairs of telemedicine and standard care patients were identified after matching (60.8% male, mean [SD] age 45.4 [16.3] years). There was a significantly greater decline across time in the telemedicine group compared to the standard care group for ED visits due to any psychiatric conditions (ratio of slopes for telemedicine vs standard care (95% CI), 0.98 (0.98 to 0.99)). However, declines in primary care visit rates (ratio of slopes for telemedicine vs standard care (1.01 (1.01 to 1.02)), mental health outpatient visits with primary care (1.03 (1.03 to 1.04)), and all-cause outpatient visits with primary care (1.01 (1.01 to 1.02)), were steeper among the standard care group than telemedicine group. Conclusions Overall, patients with CPDs appeared to benefit from telemedicine as evidenced by increased outpatient healthcare utilization and reductions in ED visits due to psychiatric conditions. This suggests that telemedicine may have allowed this patient group to have better access and continuity of care during the initial waves of the pandemic.
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Affiliation(s)
- Ahmad Shakeri
- Women’s College Hospital Research Institute, Women’s College Hospital , Toronto, ON , Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto, ON , Canada
| | - Cherry Chu
- Women’s College Hospital Research Institute, Women’s College Hospital , Toronto, ON , Canada
| | - Vess Stamenova
- Women’s College Hospital Research Institute, Women’s College Hospital , Toronto, ON , Canada
| | | | - Lucy C Barker
- Women’s College Hospital Research Institute, Women’s College Hospital , Toronto, ON , Canada
- ICES , Toronto, ON , Canada
- Department of Psychiatry, University of Toronto , Toronto, ON , Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, ON , Canada
| | - Simone N Vigod
- Women’s College Hospital Research Institute, Women’s College Hospital , Toronto, ON , Canada
- ICES , Toronto, ON , Canada
- Department of Psychiatry, University of Toronto , Toronto, ON , Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, ON , Canada
| | - R Sacha Bhatia
- Women’s College Hospital Research Institute, Women’s College Hospital , Toronto, ON , Canada
- ICES , Toronto, ON , Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, ON , Canada
| | - Mina Tadrous
- Women’s College Hospital Research Institute, Women’s College Hospital , Toronto, ON , Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto, ON , Canada
- ICES , Toronto, ON , Canada
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16
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Danseco E, Kurzawa J, Sundar P, Brown J, Huang C. Evaluating the sector-wide implementation of virtual child and youth mental health services in response to the COVID-19 pandemic: Perspectives from service providers, agency leaders and clients. Implementation Research and Practice 2021; 2:26334895211045690. [PMID: 37089999 PMCID: PMC9978610 DOI: 10.1177/26334895211045690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The COVID-19 pandemic prompted an abrupt shift in the delivery of community-based child and youth mental health services as virtual care was rapidly adopted. The objective of this study was to evaluate the sector-wide transition to virtual care across Ontario, with a focus on implementation facilitators and barriers. Methods We used a multi-level mixed-methods design where agency leaders, service providers, and clients shared their experiences planning, implementing, and accessing virtual care. In total, 97 agency leaders, and 192 youth and family members responded to the surveys; 13 agency leaders, and 11 service providers participated in interviews or focus groups. Results Most agencies undertook a similar journey to implement virtual care. Stakeholders described common facilitators such as staff engagement, leadership support, and training activities. Barriers included internet connection issues, lack of resources, and privacy concerns. Service providers innovated as they implemented by partnering with agencies to meet clients’ needs, using multiple platforms to engage clients, and altering session duration to reduce fatigue. Clients found virtual care easy to use, felt confident using it, and intend to continue accessing virtual care. Conclusion Implementation of virtual care during the pandemic was complex and the evaluation involved obtaining perspectives at multiple levels. This research provides a blueprint for evaluations of the implementation of virtual mental health services, particularly in a child/youth context. Virtual care is a viable way to deliver mental health services, however, equity, accessibility, and appropriateness need to be addressed to ensure services are effective for children, youth, and their families. Plain language abstract Academic literature suggests that using technology to deliver child and youth mental health services is a promising way to enhance access to care and improve engagement for many children and youth. Despite this, the provision of virtual child and youth mental health services in Ontario prior to the COVID-19 pandemic was limited. Efforts that did exist were largely focused on providing care to those in rural and remote areas. The COVID-19 pandemic prompted a rapid shift to virtual care, as most in-person mental health services were suspended. This paper presents new insight into how virtual mental health services were quickly established and used across Ontario from the perspectives of senior leaders, service providers, and clients. Results from this evaluation showed that agencies followed similar steps to prepare to use virtual services. Staff engagement, support from leadership, and opportunities for staff training supported the implementation of virtual care while internet connections issues, lack of resources (like computers or phones), and privacy and safety concerns hindered the implementation. Most youth and family members found virtual services easy to use and intend to continue using them. Most agencies intend to continue to offer virtual services post-pandemic but noted that it was not appropriate or accessible for all clients. This study provides a foundation for additional research to examine situations and conditions that are most conducive to virtual care delivery to address child and youth mental health concerns. These results may encourage agencies to rely more confidently on virtual services as another means to meet clients’ needs and preferences.
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Affiliation(s)
- Evangeline Danseco
- Ontario Centre of Excellence for Child & Youth Mental Health, Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | - Julia Kurzawa
- Ontario Centre of Excellence for Child & Youth Mental Health, Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | - Purnima Sundar
- Ontario Centre of Excellence for Child & Youth Mental Health, Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | - Jaime Brown
- Ontario Centre of Excellence for Child & Youth Mental Health, Children’s Hospital of Eastern Ontario, Ottawa, Canada
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17
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Reccord C, Power N, Hatfield K, Karaivanov Y, Mulay S, Wilson M, Pollock N. Rural-Urban Differences in Suicide Mortality: An Observational Study in Newfoundland and Labrador, Canada: Différences de la Mortalité Par Suicide en Milieu Rural-Urbain: Une Étude Observationnelle à Terre-Neuve et Labrador, Canada. Can J Psychiatry 2021; 66:918-928. [PMID: 33576277 PMCID: PMC8573702 DOI: 10.1177/0706743721990315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Suicide rates are higher in rural compared to urban areas. Although this pattern appears to be driven by higher rates among men, there is limited evidence about the characteristics of rural people who die by suicide in Canada. The objective of this study was to examine the demographics, manner of death, and social and clinical antecedents of people who died by suicide in rural areas compared to urban areas. METHODS We conducted an observational study of all suicide deaths that occurred among Newfoundland and Labrador residents between 1997 and 2016 using a linked data set derived from a comprehensive review of provincial medical examiner records. We used t tests and χ2 to assess associations between rural/urban status and variables related to demographics, circumstances, and manner of death, as well as social and medical history. Logistic regression was utilized to assess the independent contribution of any variable found to be significant in univariate analysis. RESULTS Rural people who died by suicide accounted for 54.8% of all deaths over a 20-year period. Overall, 81.6% of people who died were male. Compared to urban, rural people who died by suicide were younger, more likely to use firearms or hanging, and had a higher mean blood alcohol content at the time of death (27.69 vs. 22.95 mmol/L). Rural people were also less likely to have had a known history of a prior suicide attempt, psychiatric disorder, alcohol or substance abuse, or chronic pain. DISCUSSION The demographic and clinical differences between rural and urban people who died by suicide underscore the need for suicide prevention approaches that account for place-based differences. A key challenge for suicide prevention in rural communities is to ensure that interventions are developed and implemented in a manner that fits local contexts.
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Affiliation(s)
- Charlene Reccord
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Nicole Power
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Keeley Hatfield
- Department of Research, Eastern Health, St. John's, Newfoundland and Labrador, Canada.,McMaster University, Hamilton, Ontario, Canada
| | - Yordan Karaivanov
- Medical Services, Labrador Health Centre, Labrador-Grenfell Health, Labrador, Newfoundland and Labrador, Canada.,Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shree Mulay
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Margo Wilson
- Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.,Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Nathaniel Pollock
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.,School of Public Health, University of Alberta, Edmonton, Canada.,School of Arctic and Subarctic Studies, Labrador Institute, Memorial University, Happy Valley-Goose Bay, NL
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18
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Robillard R, Daros AR, Phillips JL, Porteous M, Saad M, Pennestri MH, Kendzerska T, Edwards JD, Solomonova E, Bhatla R, Godbout R, Kaminsky Z, Boafo A, Quilty LC. Emerging New Psychiatric Symptoms and the Worsening of Pre-existing Mental Disorders during the COVID-19 Pandemic: A Canadian Multisite Study: Nouveaux symptômes psychiatriques émergents et détérioration des troubles mentaux préexistants durant la pandémie de la COVID-19: une étude canadienne multisite. Can J Psychiatry 2021; 66:815-826. [PMID: 33464115 PMCID: PMC8504288 DOI: 10.1177/0706743720986786] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has caused global disruptions with serious psychological impacts. This study investigated the emergence of new psychiatric symptoms and the worsening of pre-existing mental disorders during the COVID-19 pandemic, identified factors associated with psychological worsening, and assessed changes in mental health service use. METHODS An online survey was circulated between April 3 and June 23, 2020. Respondents were asked to complete mental health questionnaires based on 2 time referents: currently (i.e., during the outbreak) and in the month preceding the outbreak. A total of 4,294 Canadians between 16 and 99 years of age were subdivided based on the presence of self-reported psychiatric diagnoses. RESULTS The proportion of respondents without prior psychiatric history who screened positive for generalized anxiety disorder and depression increased by 12% and 29%, respectively, during the outbreak. Occurrences of clinically important worsening in anxiety, depression, and suicidal ideation symptoms relative to pre-outbreak estimates were significantly higher in those with psychiatric diagnoses. Furthermore, 15% to 19% of respondents reported increased alcohol or cannabis use. Worse psychological changes relative to pre-outbreak estimate were associated with female sex, younger age, lower income, poorer coping skills, multiple psychiatric comorbidities, previous trauma exposure, deteriorating physical health, poorer family relationships, and lower exercising. Reductions in mental health care were associated with increased suicidal ideation. CONCLUSION The worsening in mental health symptoms and the decline in access to care call for the urgent development of adapted interventions targeting both new mental disorders and pre-existing psychiatric conditions affected by the COVID-19 pandemic.
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Affiliation(s)
- Rebecca Robillard
- The Royal’s Institute of Mental Health Research, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ontario, Canada
| | | | - Jennifer L. Phillips
- The Royal’s Institute of Mental Health Research, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ontario, Canada
| | - Meggan Porteous
- The Royal’s Institute of Mental Health Research, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ontario, Canada
| | - Mysa Saad
- The Royal’s Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Marie-Helene Pennestri
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
- Hopital en santé mentale Rivières-des-Prairies, CIUSSS du Nord-de-l’Ile-de-Montreal, Quebec, Canada
| | - Tetyana Kendzerska
- The Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | - Jodi D. Edwards
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Elizaveta Solomonova
- Mind and Brain research group, Division of Social and Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Rajiv Bhatla
- Department of Psychiatry, University of Ottawa, Ontario, Canada
- The Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada
| | - Roger Godbout
- Hopital en santé mentale Rivières-des-Prairies, CIUSSS du Nord-de-l’Ile-de-Montreal, Quebec, Canada
- Department of PSychiatry, Université de Montréal, Québec, Canada
| | - Zachary Kaminsky
- The Royal’s Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Addo Boafo
- The Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Lena C. Quilty
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
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19
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de Oliveira C, Mason J, Jacobs R. Examining equity in the utilisation of psychiatric inpatient care among patients with severe mental illness (SMI) in Ontario, Canada. BMC Psychiatry 2021; 21:420. [PMID: 34425787 PMCID: PMC8381537 DOI: 10.1186/s12888-021-03419-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 08/09/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Severe mental illness (SMI) comprises a range of chronic and disabling conditions, such as schizophrenia, bipolar disorder and other psychoses. Despite affecting a small percentage of the population, these disorders are associated with poor outcomes, further compounded by disparities in access, utilisation, and quality of care. Previous research indicates there is pro-poor inequality in the utilisation of SMI-related psychiatric inpatient care in England (in other words, individuals in more deprived areas have higher utilisation of inpatient care than those in less deprived areas). Our objective was to determine whether there is pro-poor inequality in SMI-related psychiatric admissions in Ontario, and understand whether these inequalities have changed over time. METHODS We selected all adult psychiatric admissions from April 2006 to March 2011. We identified changes in socio-economic equity over time across deprivation groups and geographic units by modeling, through ordinary least squares, annual need-expected standardised utilisation as a function of material deprivation and other relevant variables. We also tested for changes in socio-economic equity of utilisation over years, where the number of SMI-related psychiatric admissions for each geographic unit was modeled using a negative binomial model. RESULTS We found pro-poor inequality in SMI-related psychiatric admissions in Ontario. For every one unit increase in deprivation, psychiatric admissions increased by about 8.1%. Pro-poor inequality was particularly present in very urban areas, where many patients with SMI reside, and very rural areas, where access to care is problematic. Our main findings did not change with our sensitivity analyses. Furthermore, this inequality did not change over time. CONCLUSIONS Individuals with SMI living in more deprived areas of Ontario had higher psychiatric admissions than those living in less deprived areas. Moreover, our findings suggest this inequality has remained unchanged over time. Despite the debate around whether to make more or less use of inpatient versus other care, policy makers should seek to address suboptimal supply of primary, community or social care for SMI patients. This may potentially be achieved through the elimination of barriers to access psychiatrist care and the implementation of universal coverage of psychotherapy.
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Affiliation(s)
- Claire de Oliveira
- Centre for Health Economics, University of York, Alcuin A Block, Heslington, York, YO10 5DD, UK. .,Hull York Medical School, University of York, Alcuin A Block, Heslington, York, YO10 5DD, UK. .,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, M5S 2S1, Canada. .,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, M5T 3M6, Canada. .,ICES, Toronto, Ontario, M4N 3M5, Canada.
| | - Joyce Mason
- grid.155956.b0000 0000 8793 5925Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario M5S 2S1 Canada ,grid.418647.80000 0000 8849 1617ICES, Toronto, Ontario M4N 3M5 Canada
| | - Rowena Jacobs
- grid.5685.e0000 0004 1936 9668Centre for Health Economics, University of York, Alcuin A Block, Heslington, York, YO10 5DD UK
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20
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Slade M, Rennick-Egglestone S, Llewellyn-Beardsley J, Yeo C, Roe J, Bailey S, Smith RA, Booth S, Harrison J, Bhogal A, Penas Morán P, Hui A, Quadri D, Robinson C, Smuk M, Farkas M, Davidson L, van der Krieke L, Slade E, Bond C, Nicholson J, Grundy A, Charles A, Hare-Duke L, Pollock K, Ng F. Recorded Mental Health Recovery Narratives as a Resource for People Affected by Mental Health Problems: Development of the Narrative Experiences Online (NEON) Intervention. JMIR Form Res 2021; 5:e24417. [PMID: 34042595 PMCID: PMC8193481 DOI: 10.2196/24417] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The internet enables sharing of narratives about health concerns on a substantial scale, and some digital health narratives have been integrated into digital health interventions. Narratives describing recovery from health problems are a focus of research, including those presented in recorded (eg, invariant) form. No clinical trial has been conducted on a web-based intervention providing access to a collection of Recorded Recovery Narratives (RRNs). OBJECTIVE This study presents knowledge produced through the development of the Narrative Experiences Online (NEON) Intervention, a web-based intervention incorporating the algorithmic recommendation of RRNs. METHODS Knowledge was gathered through knowledge integration (KI) activities. KI1 synthesized previous studies to produce the NEON Impact Model describing how accessing RRNs produces health-related outcomes. KI2 developed curation principles for the NEON Collection of RRNs through consultation with the NEON Lived Experience Advisory Panel and the curation of a preliminary collection. KI3 identified harm minimization strategies for the NEON Intervention through consultation with the NEON International Advisory Board and Lived Experience Advisory Panel. The NEON Intervention was finalized through 2 research studies (RS). In RS1, mental health service users (N=40) rated the immediate impact of randomly presented narratives to validate narrative feedback questions used to inform the recommendation algorithm. In RS2, mental health service users (n=25) were interviewed about their immediate response to a prototype of the NEON Intervention and trial procedures and then were interviewed again after 1 month of use. The usability and acceptability of the prototype and trial procedures were evaluated and refinements were made. RESULTS KI1 produced the NEON Impact Model, which identifies moderators (recipient and context), mechanisms of connection (reflection, comparison, learning, and empathy), processes (identification of change from narrative structure or content and internalization of observed change), and outcomes (helpful and unhelpful). KI2 identified 22 curation principles, including a mission to build a large, heterogeneous collection to maximize opportunities for connection. KI3 identified seven harm minimization strategies, including content warnings, proactive and reactive blocking of narratives, and providing resources for the self-management of emotional distress. RS1 found variation in the impact of narratives on different participants, indicating that participant-level feedback on individual narratives is needed to inform a recommender system. The order of presentation did not predict narrative feedback. RS2 identified amendments to web-based trial procedures and the NEON Intervention. Participants accessed some narratives multiple times, use reduced over the 4-week period, and narrative feedback was provided for 31.8% (105/330) of narrative accesses. CONCLUSIONS RRNs can be integrated into web-based interventions. Evaluating the NEON Intervention in a clinical trial is feasible. The mixed methods design for developing the NEON Intervention can guide its extension to other clinical populations, the design of other web-based mental health interventions, and the development of narrative-based interventions in mental health.
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Affiliation(s)
- Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Caroline Yeo
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - James Roe
- National Institute for Health Research, ARC East Midlands, University of Nottingham, Nottingham, United Kingdom
| | - Sylvia Bailey
- NEON Lived Experience Advisory Panel, Nottingham, United Kingdom
| | | | - Susie Booth
- NEON Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Julian Harrison
- NEON Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Adaresh Bhogal
- NEON Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Patricia Penas Morán
- Department of Personality, Assessment and Psychological Treatment, University of Deusto, Bilbao, Spain
| | - Ada Hui
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Dania Quadri
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - Clare Robinson
- Centre for Primary Care & Public Health, Pragmatic Clinical Trials Unit, Queen Mary University of London, London, United Kingdom
| | - Melanie Smuk
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marianne Farkas
- College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
| | - Larry Davidson
- Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Lian van der Krieke
- University Medical Center Groningen, University Center of Psychiatry, University of Groningen, Groningen, Netherlands
| | - Emily Slade
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Carmel Bond
- Nottingham University Business School, University of Nottingham, Nottingham, United Kingdom
| | - Joe Nicholson
- School of Humanities, University of Nottingham, Nottingham, United Kingdom
| | - Andrew Grundy
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Laurie Hare-Duke
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
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21
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Ganapathy A, Clough BA, Casey LM. Organizational and Policy Barriers to the Use of Digital Mental Health by Mental Health Professionals. Telemed J E Health 2021; 27:1332-1343. [PMID: 33646057 DOI: 10.1089/tmj.2020.0455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Digital mental health (DMH) provides effective methods of overcoming issues of time constraints, accessibility, and availability of mental health care. They can provide a valuable means to deliver mental health care in the present pandemic. However, adoption of these methods has been slow. Mental health professional (MHP) concerns at the organizational and policy level that influence this slow adoption need to be examined. Materials and Methods: A narrative review was conducted to identify the barriers. Searches using the databases Scopus, Embase, and PubMed were conducted to identify research focused on barriers reported by MHPs to use DMH. Results: The search resulted in 356 unique citations, and 21 papers met the inclusion and exclusion criteria. Forward and backward sampling resulted in identifying an additional 19 relevant papers. Discussion: Unmet needs for information, training, and infrastructure, challenges to the workflow and excessive workloads, and ambiguous policies serve as barriers to DMH use. This article recommends strategies for researchers, organizations, DMH designers, and governmental institutions to ensure efficient utilization of DMH. Conclusion: Concerted efforts at individual, organizational, and governmental levels are essential to ensure efficient utilization of DMH.
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Affiliation(s)
- Aarthi Ganapathy
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute, Mount Gravatt, Australia
| | - Bonnie A Clough
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute, Mount Gravatt, Australia
| | - Leanne M Casey
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute, Mount Gravatt, Australia
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22
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Abstract
Telepsychiatry, the use of televideo in psychiatric assessment and treatment, is utilized throughout Canada. Major depressive disorder (MDD) is common, with significant burdens of suffering and cost. This systematic review explores the literature on the use of televideo to diagnose and treat MDD, particularly acceptability and patient satisfaction, efficacy, and cost-effectiveness. A literature search was conducted for years 1946 to 2019. Study eligibility criteria included: MDD as the condition of interest, use of televideo technology, randomized controlled trials (RCTs), Adult (18 years or older) population, any clinical setting, and any healthcare professional providing care. The study must have included at least one of the following measures, satisfaction, efficacy, and cost-effectiveness. Fourteen studies were included. Satisfaction is equivalent to or significantly higher than face-to-face intervention. Both televideo and control groups found relief from depressive symptoms, with differences either statistically insignificant or in favour of televideo. Despite increased cost upfront for televideo due to the technology required, televideo would eventually be more cost-effective due to reducing travel expenses. Limitations include that there is little RCT data, and what exists often uses a collaborative treatment model. Many studies consisted solely of U.S. Veterans, and have limited generalizability. Further research needed to directly compare psychiatrist assessment over televideo versus in-person, and determine if particular patient subgroups benefit more from televideo or in-person intervention.Systematic review registration number: CRD42016048224.
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Affiliation(s)
- Giuseppe Guaiana
- Department of Psychiatry and Department of Epidemiology and Biostatistics, Western University, London, Canada.
| | | | - Shawn Hendrikx
- Collections & Content Strategies, Western Libraries, Western University, London, Canada
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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23
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Abstract
INTRODUCTION Telepsychiatry can improve access to psychiatric services for those who otherwise cannot easily access care. Family physicians are gatekeepers to specialized care in Ontario, so it is essential to understand predictors relating to referrals to telepsychiatry to better plan services and increase telepsychiatry adoption. METHODS This study used an annual retrospective cross-sectional study design to compare physicians who referred their patients to telepsychiatry each year from fiscal year (FY) 2008 to FY 2016. A 1-year (FY 2016) comparison of family physicians who referred to telepsychiatry (FPTs) compared to family physicians who did not refer to telepsychiatry (FPNTs) matched (1:2) by region was also conducted. Finally, we used statistical modeling to understand the predictors of referring to telepsychiatry among physicians. RESULTS Between FY 2008 and FY 2016, the number of patients receiving telepsychiatry increased from 925 visits to 13,825 visits. Thirty-two percent of Ontario primary care physicians referred to telepsychiatry in 2016. Several characteristics were notably different between FPTs and FPNTs: FPTs were more likely to be from a residence with less than 10,000 people, to have more nurse practitioners in the practice, and to be from a family health team than FPNTs. Rostered patients of FPTs were more likely to reside in rural areas, have more clinical complexity, and to utilize more mental health services compared to FPNTs. CONCLUSIONS There has been an increase in the use of telepsychiatry by patients and family physicians over the study period, although there remains opportunity for significant growth. Family physicians who live in rural areas, are part of an FHT, have more NPs, with more rural and complex patients were more likely to refer to telepsychiatry. As recent pro-telemedicine policies support the growth of telepsychiatry, this study will serve as an important baseline.
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Affiliation(s)
- Eva Serhal
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Claire de Oliveira
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Allison Crawford
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Paul Kurdyak
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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24
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Gratzer D, Torous J, Lam RW, Patten SB, Kutcher S, Chan S, Vigo D, Pajer K, Yatham LN. Our Digital Moment: Innovations and Opportunities in Digital Mental Health Care. Can J Psychiatry 2021; 66:5-8. [PMID: 32603188 PMCID: PMC7890581 DOI: 10.1177/0706743720937833] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- David Gratzer
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - John Torous
- Department of Psychiatry, 1859Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott B Patten
- Departments of Psychiatry and Community Health Sciences, 2129University of Calgary, Alberta, Canada
| | - Stanley Kutcher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.,Senate of Canada, Ottawa, Ontario, Canada
| | - Steven Chan
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA.,Palo Alto VA Health, Palo Alto, CA, USA
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Kathleen Pajer
- Department of Psychiatry, University of Ottawa, Ontario, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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25
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Doan BT, Yang YB, Romanchych E, Grewal S, Monga S, Pignatiello T, Bryden P, Kulkarni C. From Pandemic to Progression: An Educational Framework for the Implementation of Virtual Mental Healthcare for Children and Youth as a Response to COVID-19. J Contemp Psychother 2020; 51:1-7. [PMID: 33110276 PMCID: PMC7582436 DOI: 10.1007/s10879-020-09478-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/30/2022]
Abstract
COVID-19 restrictions have necessitated child/youth mental health providers to shift towards virtually delivering services to patients’ homes rather than hospitals and community mental health clinics. There is scant guidance available for clinicians on how to address unique considerations for the virtual mental healthcare of children and youth as clinicians rapidly shift their practices away from in-person care in the context of the COVID-19 pandemic. Therefore, we bridge this gap by discussing a six-pillar framework developed at Hospital for Sick Children (SickKids) in Toronto, Ontario, Canada, for delivering direct to patient virtual mental healthcare to children, youth and their families. We also offer a discussion of the advantages, disadvantages, and future implications of such services.
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Affiliation(s)
- Bridget T Doan
- Hospital for Sick Children (SickKids), Toronto, ON Canada
| | - Yue Bo Yang
- MD Undergraduate Program, University of British Columbia, Vancouver, BC Canada
| | | | - Seena Grewal
- Hospital for Sick Children (SickKids), Toronto, ON Canada.,University of Toronto, Toronto, ON Canada
| | - Suneeta Monga
- Hospital for Sick Children (SickKids), Toronto, ON Canada.,University of Toronto, Toronto, ON Canada
| | - Tony Pignatiello
- Hospital for Sick Children (SickKids), Toronto, ON Canada.,University of Toronto, Toronto, ON Canada
| | - Pier Bryden
- Hospital for Sick Children (SickKids), Toronto, ON Canada.,University of Toronto, Toronto, ON Canada
| | - Chetana Kulkarni
- Hospital for Sick Children (SickKids), Toronto, ON Canada.,University of Toronto, Toronto, ON Canada
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26
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Serhal E, Kirvan A, Sanches M, Crawford A. Client Satisfaction and Experience With Telepsychiatry: Development and Validation of a Survey Using Clinical Quality Domains. J Med Internet Res 2020; 22:e19198. [PMID: 32755896 PMCID: PMC7556368 DOI: 10.2196/19198] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/19/2020] [Accepted: 07/25/2020] [Indexed: 01/23/2023] Open
Abstract
Background Telepsychiatry is an increasingly used model of mental health care that connects patients with psychiatrists at a distance via videoconference. Telepsychiatry is an effective clinical intervention that improves access to quality care in regions with limited resources or in clinical situations where in-person care is unavailable. Objective This study aims to develop a validated survey tool to measure patient experience and satisfaction with telepsychiatry based on the quality of care domains. This study also seeks to understand which health service outcomes were most strongly correlated with overall satisfaction in the context of telepsychiatry. Methods The survey created in this study was developed and validated with a panel of subject matter and process experts and was piloted with 274 patients who received clinical consultations through the TeleMental Health Program at the Centre for Addiction and Mental Health. Factor analysis was used to determine correlations between questions and quality of care domains and was also used to assess model fit. Results The study provides a validated survey to measure patient satisfaction and experience with telepsychiatry across 4 domains: access and timeliness, appropriateness, effectiveness, and safety. Both safety and access and timeliness were found to be statistically significant predictors of satisfaction in our sample. Conclusions By situating patient satisfaction and experience within this framework, the survey facilitates patient data collection and interpretation through a clinical quality lens.
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Affiliation(s)
- Eva Serhal
- Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anne Kirvan
- Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Marcos Sanches
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Allison Crawford
- Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
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27
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Markoulakis R, Chan S, Levitt A. The needs and service preferences of caregivers of youth with mental health and/or addictions concerns. BMC Psychiatry 2020; 20:409. [PMID: 32795285 PMCID: PMC7427896 DOI: 10.1186/s12888-020-02801-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 07/30/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Caregivers experience significant strains as a result of navigating the complex mental health and/or addiction (MHA) system for their youth with MHA issues. We examined the characteristics of Ontario families with youth with MHA issues and their service needs. METHODS A cross-sectional survey study investigated the characteristics and service needs of families with youth with MHA issues across the province of Ontario, Canada. A total of 840 caregivers were recruited. RESULTS 259 participants (Mage = 45.94, SD = 7.11) identified as caregiving for at least one youth with MHA issues. The majority of the participants were female (70.7%), married (73.4%), and completed at least some college/Bachelor degree (59.1%). The mean age of youth was 16.72 years (SD = 5.33) and the most frequently reported diagnoses were Depression (30.1%), ADHD (27.8%) and Generalized Anxiety Disorder (21.2%). Regression results demonstrated that presently accessing services, presently seeking services, and higher levels of barriers MHA services were significantly predictive of identifying navigation as helpful for finding appropriate MHA services (χ2(7) = 28.69, p < .001, Nagelkerke R2 = .16). Furthermore, presently accessing services was significantly predictive of identifying case management as helpful (χ2(7) = 29.59, p < .001, Nagelkerke R2 = .156), and of identifying a primary healthcare provider as helpful (χ2(7) = 38.75, p < .001, Nagelkerke R2 = .197) for finding appropriate MHA services. CONCLUSION Identifying the nature and extent of youth MHA issues, service needs, and family preferences can inform the development of services that address families' needs and lend vital support for accessing services within a complex system.
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Affiliation(s)
- Roula Markoulakis
- Family Navigation Project, Sunnybrook Research Institute, Toronto, Ontario, Canada.
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Samantha Chan
- Family Navigation Project, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Anthony Levitt
- Family Navigation Project, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program and Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Hensel J, Graham R, Isaak C, Ahmed N, Sareen J, Bolton J. A Novel Emergency Telepsychiatry Program in a Canadian Urban Setting: Identifying and Addressing Perceived Barriers for Successful Implementation: Un nouveau programme de télépsychiatrie d'urgence en milieu urbain canadien: Identifier et aborder les obstacles perçus d'une mise en œuvre réussie. Can J Psychiatry 2020; 65:559-567. [PMID: 31969011 PMCID: PMC7492888 DOI: 10.1177/0706743719900465] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To report on the perceived barriers surrounding the use of telepsychiatry for emergency assessments and our approach to overcoming those barriers to achieve successful implementation of a program to increase access to emergency psychiatric assessment in a Canadian urban setting. METHODS We conducted a survey of emergency care staff to inform the implementation of an emergency telepsychiatry program in the urban setting of Winnipeg, Manitoba, where hospitals have variable on-site emergency psychiatric coverage. We analyzed survey responses for perceived barriers we would need to address in implementation. We employed implementation strategies for each barrier and scaled the program to three sites over the first year. Data from the first year were collected including number of telepsychiatry assessments, reasons for referral, wait time, and percentage of patient transfers avoided. RESULTS Survey respondents (N = 111) had little prior exposure to telepsychiatry, but the majority were open to its use for emergency psychiatric assessments in the region. We identified three categories of perceived barriers: clinical, logistical/technical, and readiness barriers. Implementation planning addressed each barrier, and a hub-and-spoke program was launched. After the first year, the program had one hub serving three spokes, and 243 emergency telepsychiatry assessments had been completed. After 12 months, we were avoiding 65% of patient transfers. CONCLUSIONS By conducting a user survey to identify perceived barriers, and addressing these during implementation, we successfully scaled our emergency telepsychiatry program across our region. Our report of this experience may benefit others attempting to implement a similar program.
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Affiliation(s)
- Jennifer Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Reid Graham
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Naweed Ahmed
- Department of Family Practice, University of British Columbia, Victoria, British Columbia, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Abstract
The cost of providing health care in northern Canada is higher than the rest of Canada. Telehealth has the potential to reduce health care expenditures. Yet this is still underutilised in Canada and globally. This paper describes the services provided through telehealth in some northern regions of Canada. It provides recommendations on the requirements for setting up real presence telehealth and how utilisation can be enhanced. Telehealth offers potential benefits for health outcomes by increasing access to healthcare, and reducing expenditures.
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Affiliation(s)
- Michael Jong
- a Department of Family Medicine , Memorial University of Newfoundland , Happy Valley-Goose Bay , NL , Canada
| | - Ivar Mendez
- b Saskatoon Health Region , University of Saskatchewan , Saskatoon , Canada.,c Department of Surgery , Royal University Hospital , Saskatoon , SK , Canada
| | - Robert Jong
- d Faculty of Medicine , Memorial University of Newfoundland , St. John's , NL , Canada
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Asmundson GJ, Blackstock C, Bourque MC, Brimacombe G, Crawford A, Deacon SH, McMullen K, McGrath PJ, Mushquash C, Stewart SH, Stinson J, Taylor S, Campbell-Yeo M. Easing the disruption of COVID-19: supporting the mental health of the people of Canada—October 2020—an RSC Policy Briefing. Facets (Ott) 2020. [DOI: 10.1139/facets-2020-0082] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The COVID-19 pandemic has had a significant impact on the mental health of the people of Canada. Most have found it challenging to cope with social distancing, isolation, anxiety about infection, financial security and the future, and balancing demands of work and home life. For some, especially those who have had to face pre-existing challenges such as structural racism, poverty, and discrimination and those with prior mental health problems, the pandemic has been a major impact. The Policy Briefing Report focuses on the current situation, how the COVID-19 pandemic has exacerbated significant long-standing weaknesses in the mental health system and makes specific recommendations to meet these challenges to improve the well-being of the people of Canada. The COVID-19 pandemic has had a detrimental effect on mental health of people in Canada but the impact has been variable, impacting those facing pre-existing structural inequities hardest. Those living in poverty, and in some socially stratified groups facing greater economic and social disadvantage, such as some racialized and some Indigenous groups and those with preexisting mental health problems, have suffered the most. Some occupational groups have been more exposed to the virus and to psychological stress with the pandemic. The mental health care system was already overextended and under resourced. The pandemic has exacerbated the problems. The care system responded by a massive move to virtual care. The future challenge is for Canada to strengthen our knowledge base in mental health, to learn from the pandemic, and to provide all in Canada the support they need to fully participate in and contribute to Canada’s recovery from the pandemic.
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Affiliation(s)
| | - Cindy Blackstock
- First Nations Child and Family Caring Society of Canada, Ottawa, ON, Canada
- School of Social Work, McGill University, Montreal, QC, Canada
| | - Marie Claire Bourque
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Glenn Brimacombe
- Policy and Public Affairs, Canadian Psychological Association, Ottawa, ON, Canada
| | - Allison Crawford
- Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - S. Hélène Deacon
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Ken McMullen
- Emergency Services, The City of Red Deer, Red Deer, AB, Canada
| | - Patrick J. McGrath
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Chair of the Working Group, Halifax, NS, Canada
| | - Christopher Mushquash
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
- Dilico Anishinabek Family Care, Thunder Bay, ON, Canada
| | - Sherry H. Stewart
- Departments of Psychiatry and Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Jennifer Stinson
- Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Steven Taylor
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University and IWK Health, Halifax, NS, Canada
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Cowan KE, McKean AJ, Gentry MT, Hilty DM. Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers. Mayo Clin Proc 2019; 94:2510-2523. [PMID: 31806104 DOI: 10.1016/j.mayocp.2019.04.018] [Citation(s) in RCA: 201] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/15/2019] [Accepted: 04/24/2019] [Indexed: 12/17/2022]
Abstract
Telepsychiatry is effective and has generated hope and promise for improved access and enhanced quality of care with reasonable cost containment. Clinicians and organizations are informed about clinical, technological, and administrative telepsychiatric barriers via guidelines, but there are many practical patient and clinician factors that have slowed implementation and undermined sustainability. Literature describing barriers to use of telepsychiatry was reviewed. PubMed search terms with date limits from January 1, 1959, to April 25, 2019, included telepsychiatry, telemedicine, telemental health, videoconferencing, video based, Internet, synchronous, real-time, two-way, limitations, restrictions, barriers, obstacles, challenges, issues, implementation, utilization, adoption, perspectives, perceptions, attitudes, beliefs, willingness, acceptability, feasibility, culture/cultural, outcomes, satisfaction, quality, effectiveness, and efficacy. Articles were selected for inclusion on the basis of relevance. Barriers are described from both patient and clinicians' perspectives. Patients and clinicians are largely satisfied with telepsychiatry, but concerns about establishing rapport, privacy, safety, and technology limitations have slowed acceptance of telepsychiatry. Clinicians are also concerned about reimbursement/financial, legal/regulatory, licensure/credentialing, and education/learning issues. These issues point to system and policy concerns, which, in combination with other administrative concerns, raise questions about system design/workflow, efficiency of clinical care, and changing organizational culture. Although telepsychiatry service is convenient for patients, the many barriers from clinicians' perspectives are concerning, because they serve as gatekeepers for implementation and sustainability of telepsychiatry services. This suggests that solutions to overcome barriers must start by addressing the concerns of clinicians and enhancing clinical workflow.
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Affiliation(s)
- Kirsten E Cowan
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Essentia Health, Duluth, MN
| | | | - Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Donald M Hilty
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
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Rennick-Egglestone S, Morgan K, Llewellyn-Beardsley J, Ramsay A, McGranahan R, Gillard S, Hui A, Ng F, Schneider J, Booth S, Pinfold V, Davidson L, Franklin D, Bradstreet S, Arbour S, Slade M. Mental Health Recovery Narratives and Their Impact on Recipients: Systematic Review and Narrative Synthesis. Can J Psychiatry 2019; 64:669-679. [PMID: 31046432 PMCID: PMC6783672 DOI: 10.1177/0706743719846108] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Mental health recovery narratives are often shared in peer support work and antistigma campaigns. Internet technology provides access to an almost unlimited number of narratives, and yet little is known about how they affect recipients. The aim of this study was to develop a conceptual framework characterizing the impact of recovery narratives on recipients. METHOD A systematic review of evidence about the impact of mental health recovery narratives was conducted. Searches used electronic databases (n = 9), reference tracking, hand-searching of selected journals (n = 2), grey literature searching, and expert consultation (n = 7). A conceptual framework was generated through a thematic analysis of included articles, augmented by consultation with a Lived Experience Advisory Panel. RESULTS In total, 8137 articles were screened. Five articles were included. Forms of impact were connectedness, understanding of recovery, reduction in stigma, validation of personal experience, affective responses, and behavioural responses. Impact was moderated by characteristics of the recipient, context, and narrative. Increases in eating disorder behaviours were identified as a harmful response specific to recipients with eating disorders. CONCLUSIONS Mental health recovery narratives can promote recovery. Recovery narratives might be useful for clients with limited access to peers and in online interventions targeted at reducing social isolation in rural or remote locations, but support is needed for the processing of the strong emotions that can arise. Caution is needed for use with specific clinical populations. Protocol registration: Prospero-CRD42018090923.
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Affiliation(s)
| | - Kate Morgan
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Amy Ramsay
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rose McGranahan
- Unit of Social and Community Psychiatry, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Steve Gillard
- Population Health Research Institute, St. George's University of London, London, UK
| | - Ada Hui
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Justine Schneider
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Susie Booth
- NEON Lived Experience Advisory Panel, Nottingham, UK
| | | | - Larry Davidson
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | | | - Simon Bradstreet
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Simone Arbour
- Ontario Shores Centre for Mental Health Science, Ontario
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
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Rezvy G, Andreeva E, Ryzhkova N, Yashkovich V, Sørlie T. Integrating mental health into primary care in Arkhangelsk County, Russia: the Pomor model in psychiatry. Int J Ment Health Syst 2019; 13:14. [PMID: 30911330 PMCID: PMC6416943 DOI: 10.1186/s13033-019-0271-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Primary health care is still peripheral in the identification and treatment of mental health and substance use disorders in the Russian Federation. However, the development of primary health services has been given priority. A long-standing collaboration between Arkhangelsk County and northern Norway on mental health service development in Arkhangelsk has promoted the integration of mental health into primary care. Aim To develop a model for mental health integration into primary care adapted to the conditions in Arkhangelsk County. Methods (a) Situational assessment, (b) development of a model for systematic cooperation between GPs and specialists, (c) initial evaluation of the model, (d) implementation and dissemination of the model. Results A local studies revealed major shortcomings in GPs’ diagnostic and treatment skills and in their collaboration with specialists in psychiatry. In order to promote better communication between GPs and specialists in this desolate and sparsely populated geographical area, an information communication technology (ICT)-based competence centre was established at a specialised community mental health centre in Arkhangelsk city (APND). Through a network including APND and involved primary health care centres, GPs gained access to specialists’ expertise when required in their work with psychiatric patients. GPs assess all patients’ mental health condition and treatment responsibility for patients in need of mental health care is divided between GPs and specialists according to problem severity. APND has the formal responsibility for ensuring that this collaboration with the health centres is established and practiced. Training in diagnostics and conversation skills ensures basic professional competence in the GPs. Initial evaluation showed that patients, GPs and specialists were satisfied with their experiences. The model is currently under implementation in 50% of the districts of the county. Conclusion Our cooperation has led to the development and implementation of a model for mental health care integration into primary care in an area with major geographical distances. Further improvements will be based on systematic evaluation of experiences with the model.
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Affiliation(s)
- Grigory Rezvy
- Finnmark Hospital Trust, Kirkenes, Norway.,2University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | | | | | - Vera Yashkovich
- Arkhangelsk Psychoneurological Dispenser, Arkhangelsk, Russia
| | - Tore Sørlie
- 2University of Tromsø-The Arctic University of Norway, Tromsø, Norway.,6Department of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
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Health Quality Ontario. Internet-Delivered Cognitive Behavioural Therapy for Major Depression and Anxiety Disorders: A Health Technology Assessment. Ont Health Technol Assess Ser 2019; 19:1-199. [PMID: 30873251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Major depression is defined as a period of depression lasting at least 2 weeks characterized by depressed mood, most of the day, nearly every day, and/or markedly diminished interest or pleasure in all, or almost all, activities. Anxiety disorders encompass a broad range of disorders in which people experience feelings of fear and excessive worry that interfere with normal day-to-day functioning.Cognitive behavioural therapy (CBT) is a form of evidence-based psychotherapy used to treat major depression and anxiety disorders. Internet-delivered CBT (iCBT) is structured, goal-oriented CBT delivered via the internet. It may be guided, in which the patient communicates with a regulated health care professional, or unguided, in which the patient is not supported by a regulated health care professional. METHODS We conducted a health technology assessment, which included an evaluation of clinical benefit, value for money, and patient preferences and values related to the use of iCBT for the treatment of mild to moderate major depression or anxiety disorders. We performed a systematic review of the clinical and economic literature and conducted a grey literature search. We reported Grading of Recommendations Assessment, Development, and Evaluation (GRADE) ratings if sufficient information was provided. When other quality assessment tools were used by the systematic review authors in the included studies, these were reported. We assessed the risk of bias within the included reviews. We also developed decision-analytic models to compare the costs and benefits of unguided iCBT, guided iCBT, face-to-face CBT, and usual care over 1 year using a sequential approach. We further explored the lifetime and short-term cost-effectiveness of stepped-care models, including iCBT, compared with usual care. We calculated incremental cost-effectiveness ratios (ICERs) from the perspective of the Ontario Ministry of Health and Long-Term Care and estimated the 5-year budget impact of publicly funding iCBT for mild to moderate major depression or anxiety disorders in Ontario. To contextualize the potential value of iCBT as a treatment option for major depression or anxiety disorders, we spoke with people with these conditions. RESULTS People who had undergone guided iCBT for mild to moderate major depression (standardized mean difference [SMD] = 0.83, 95% CI 0.59-1.07, GRADE moderate), generalized anxiety disorder (SMD = 0.84, 95% CI 0.45-1.23, GRADE low), panic disorder (small to very large effects, GRADE low), and social phobia (SMD = 0.85, 95% CI 0.66-1.05, GRADE moderate) showed a statistically significant improvement in symptoms compared with people on a waiting list. People who had undergone iCBT for panic disorder (SMD= 1.15, 95% CI: 0.94 to 1.37) and iCBT for social anxiety disorder (SMD=0.91, 95% CI: 0.74-1.07) showed a statistically significant improvement in symptoms compared with people on a waiting list. There was a statistically significant improvement in quality of life for people with generalized anxiety disorder who had undergone iCBT (SMD = 0.38, 95% CI 0.08-0.67) compared with people on a waiting list. The mean differences between people who had undergone iCBT compared with usual care at 3, 5, and 8 months were -4.3, -3.9, and -5.9, respectively. The negative mean difference at each follow-up showed an improvement in symptoms of depression for participants randomized to the iCBT group compared with usual care. People who had undergone guided iCBT showed no statistically significant improvement in symptoms of panic disorder compared with individual or group face-to-face CBT (d = 0.00, 95% CI -0.41 to 0.41, GRADE very low). Similarly, there was no statistically significant difference in symptoms of specific phobia in people who had undergone guided iCBT compared with brief therapist-led exposure (GRADE very low). There was a small statistically significant improvement in symptoms in favour of guided iCBT compared with group face-to-face CBT (d= 0.41, 95% CI 0.03-0.78, GRADE low) for social phobia. There was no statistically significant improvement in quality of life reported for people with panic disorder who had undergone iCBT compared with face-to-face CBT (SMD = -0.07, 95% CI -0.34 to 0.21).Guided iCBT was the optimal strategy in the reference case cost-utility analyses. For adults with mild to moderate major depression, guided iCBT was associated with increases in both quality-adjusted survival (0.04 quality-adjusted life-years [QALYs]) and cost ($1,257), yielding an ICER of $31,575 per QALY gained when compared with usual care. In adults with anxiety disorders, guided iCBT was also associated with increases in both quality-adjusted survival (0.03 QALYs) and cost ($1,395), yielding an ICER of $43,214 per QALY gained when compared with unguided iCBT. In this population, guided iCBT was associated with an ICER of $26,719 per QALY gained when compared with usual care. The probability of cost-effectiveness of guided iCBT for major depression and anxiety disorders, respectively, was 67% and 70% at willingness-to-pay of $100,000 per QALY gained. Guided iCBT delivered within stepped-care models appears to represent good value for money for the treatment of mild to moderate major depression and anxiety disorders.Assuming a 3% increase in access per year (from about 8,000 people in year 1 to about 32,000 people in year 5), the net budget impact of publicly funding guided iCBT for the treatment of mild to moderate major depression would range from about $10 million in year 1 to about $40 million in year 5. The corresponding net budget impact for the treatment of anxiety disorders would range from about $16 million in year 1 (about 13,000 people) to about $65 million in year 5 (about 52,000 people).People with depression or an anxiety disorder with whom we spoke reported that iCBT improves access for those who face challenges with face-to-face therapy because of costs, time, or the severity of their condition. They reported that iCBT provides better control over the pace, time, and location of therapy, as well as greater access to educational material. Some reported barriers to iCBT include the cost of therapy; the need for a computer and internet access, computer literacy, and the ability to understand complex written information. Language and disability barriers also exist. Reported limitations to iCBT include the ridigity of the program, the lack of face-to-face interactions with a therapist, technological difficulties, and the inability of an internet protocol to treat severe depression and some types of anxiety disorder. CONCLUSIONS Compared with waiting list, guided iCBT is effective and likely results in symptom improvement in mild to moderate major depression and social phobia. Guided iCBT may improve the symptoms of generalized anxiety disorder and panic disorder compared with waiting list. However, we are uncertain about the effectiveness of iCBT compared with individual or group face-to-face CBT. Guided iCBT represents good value for money and could be offered for the short-term treatment of adults with mild to moderate major depression or anxiety disorders. Most people with mild to moderate depression or anxiety disorders with whom we spoke felt that, despite some perceived limitations, iCBT provides greater control over the time, pace, and location of therapy. It also improves access for people who could not otherwise access therapy because of cost, time, or the nature of their health condition.
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Crawford A, Gratzer D, Jovanovic M, Rodie D, Sockalingam S, Sunderji N, Teshima J, Thomas Z. Building eHealth and Telepsychiatry Capabilities: Three Educational Reports Across the Learning Continuum. Acad Psychiatry 2018; 42:852-856. [PMID: 30311178 DOI: 10.1007/s40596-018-0989-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 09/24/2018] [Indexed: 06/08/2023]
Affiliation(s)
| | - David Gratzer
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - David Rodie
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | | | - John Teshima
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Zoe Thomas
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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36
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Affiliation(s)
- David Goldbloom
- 1 Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario
| | - David Gratzer
- 2 Department of Psychiatry, Scarborough and Rouge Hospital, University of Toronto, Toronto, Ontario
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