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Pankratz L, Gill G, Pirzada S, Papineau K, Reynolds K, Riviere CL, Bolton JM, Hensel JM, Olafson K, Kredentser MS, El-Gabalawy R, Hiebert T, Chochinov HM. "It took so much of the humanness away": Health care professional experiences providing care to dying patients during COVID-19. Death Stud 2023; 48:706-718. [PMID: 37938174 DOI: 10.1080/07481187.2023.2266639] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
COVID-19 has affected healthcare in profound and unprecedented ways, distorting the experiences of patients and healthcare professionals (HCPs) alike. One area that has received little attention is how COVID-19 affected HCPs caring for dying patients. The goal of this study was to examine the experiences of HCPs working with dying patients during the COVID-19 pandemic. Between July 2020-July 2021, we recruited HCPs (N = 25) across Canada. We conducted semi-structured interviews, using a qualitative study design rooted in constructivist grounded theory methodology. The core themes identified were the impact of the pandemic on care utilization, the impact of infection control measures on provision of care, moral distress in the workplace, impact on psychological wellbeing, and adaptive strategies to help HCPs manage emotions and navigate pandemic imposed changes. This is the first Canadian study to qualitatively examine the experiences of HCPs providing care to dying patients during the COVID-19 pandemic. Implications include informing supportive strategies and shaping policies for HCPs providing palliative care.
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Affiliation(s)
- Lily Pankratz
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gagan Gill
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Salina Pirzada
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kelsey Papineau
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristin Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christian La Riviere
- Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kendiss Olafson
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maia S Kredentser
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Anesthesiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tim Hiebert
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Harvey Max Chochinov
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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Castillo BA, Shterenberg R, Bolton JM, Dewa CS, Pullia K, Hensel JM. Virtual Acute Psychiatric Ward: Evaluation of Outcomes and Cost Savings. Psychiatr Serv 2023; 74:1045-1051. [PMID: 37016824 DOI: 10.1176/appi.ps.20220332] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE The COVID-19 pandemic motivated rapid expansion of virtual care. In Winnipeg, Canada, the authors launched a virtual psychiatric acute care ward (vWARD) to divert patients from hospitalization through daily remote treatment by a psychiatry team using telephone or videoconferencing. This study examined vWARD patient characteristics, predictors of transfer to a hospital, use of acute care postdischarge, and costs of the vWARD compared with in-person hospitalization. METHODS Data for all vWARD admissions from March 23, 2020, to April 30, 2021, were retrieved from program documents and electronic records. Emergency department visits and hospitalizations in the 6 months before admission and the 30 days after discharge were documented. Logistic regression identified factors associated with transfer to a hospital. Thirty-day acute care use after discharge was modeled with Kaplan-Meier curves. A break-even cost analysis was generated with data for usual hospital-based care. RESULTS The 132 vWARD admissions represented a diverse demographic and clinical population. Overall, 57% involved suicidal behavior, and 29% involved psychosis or mania. Seventeen admissions (13%) were transferred to a hospital. Only presence of psychosis or mania significantly predicted transfer (OR=34.2, 95% CI=3.3-354.6). Eight individuals were hospitalized in the 30 days postdischarge (cumulative survival=0.93). vWARD costs were lower than usual care across several scenarios. CONCLUSIONS A virtual ward is a feasible, effective, and potentially cost-saving intervention to manage acute psychiatric crises in the community and avoid hospitalization. It has benefits for both the health system and the individual who prefers to receive care at home.
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Affiliation(s)
- Bon A Castillo
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - Ravit Shterenberg
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - Carolyn S Dewa
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - Katrina Pullia
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - Jennifer M Hensel
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
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Palay J, Bolton JM, Sareen J, Hensel JM. Increasing access to specialist care with group medical visits: summary of a pilot in a post-crisis psychiatric clinic. Front Health Serv 2023; 3:1127725. [PMID: 37435511 PMCID: PMC10332818 DOI: 10.3389/frhs.2023.1127725] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/14/2023] [Indexed: 07/13/2023]
Abstract
Background Group medical visits (GMVs) have strong evidence of acceptability and effectiveness in the management of chronic medical diseases. Adaptation of GMVs for psychiatric care has potential to increase access, decrease stigma and save costs. Despite promise, this model has not been widely adopted. Methods A novel GMV pilot was implemented for psychiatric care post-crisis among patients with primary mood or anxiety disorders who required medication management. Participants filled out PHQ-9 and GAD-7 scales at each visit in order to track their progress. After discharge, charts were reviewed for demographics, medication changes and symptom changes. Patient characteristics were compared between those who attended and those who didn't. Changes in total PHQ-9 and GAD-7 scores among attendees were assessed with paired t-tests. Results Forty-eight patients were enrolled between October 2017 and the end of December 2018, 41 of whom consented to participate. Of those, 10 did not attend, 8 attended but did not complete, and 23 completed. Baseline PHQ-9 and GAD-7 scores did not differ significantly between groups. Significant and meaningful reductions in PHQ-9 and GAD-7 scores from baseline to last visit attended occurred among those who attended at least 1 visit (decrease of 5.13 and 5.26 points, respectively). Conclusions This GMV pilot demonstrated feasibility of the model as well as positive outcomes for patients recruited in a post-crisis setting. This model has the potential to increase access to psychiatric care in the face of limited resources, however the failure of the pilot to sustain highlights challenges to be addressed in future pivots.
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Pullia K, Clavio A, Bolton JM, Hunzinger E, Svenne S, Hensel JM. Providing crisis care in a pandemic: a virtual based crisis stabilization unit. Front Health Serv 2023; 3:1030396. [PMID: 37260632 PMCID: PMC10227504 DOI: 10.3389/frhs.2023.1030396] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 04/21/2023] [Indexed: 06/02/2023]
Abstract
Background Winnipeg, Canada operates a 16-bed subacute unit, the Crisis Stabilization Unit (CSU), for voluntary patients in crisis not requiring hospital admission. The virtual CSU (vCSU) launched in March 2020 as an adjunct to the in-person CSU during the COVID-19 pandemic, providing the same resources virtually, allowing patients to remain at home. Methods Program data were collected for vCSU admissions between April 1, 2020 and April 7, 2021 (n = 266) to examine patient characteristics and discharge outcomes. Data were retrieved from the electronic patient record (EPR) for both in-person and vCSU admissions during the same period for comparison (n = 712). vCSU admissions (n = 191) were summarized by patient demographics, clinical factors/outcomes, and compared on the same measures to in-person CSU admissions (n = 521) using binary logistic regression. Results 30.1% of patients admitted to the vCSU received initial mental health assessment virtually (phone/videoconference), therefore receiving all care at home. Clinical symptoms at assessment included depression/anxiety (39.0%), psychosis/mania (2.7%), suicidal behaviour/self-harm (27.4%), psychosocial event/stressor (19.8%). Average stay was 4.9 days. Compared to the in-person CSU, vCSU referrals were associated with the absence of psychosis [odds ratio (OR).40, 95% confidence interval (CI).18-0.89] and no prior 1-year contact with referral site (OR.43, 95% CI.28-0.64). Those living farther away from the referral site were more likely to receive a vCSU referral. Conclusion The vCSU model is feasible for a diverse group of patients experiencing mental health crises. Future work is needed to better determine who the model is right for and examine longer term outcomes.
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Affiliation(s)
- Katrina Pullia
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Avery Clavio
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - James M. Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
- Crisis Response Services, Shared Health, Winnipeg, MB, Canada
| | - Erika Hunzinger
- Crisis Response Services, Shared Health, Winnipeg, MB, Canada
| | - Sasha Svenne
- Department of Psychology, University of Winnipeg, Winnipeg, MB, Canada
| | - Jennifer M. Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
- Crisis Response Services, Shared Health, Winnipeg, MB, Canada
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Myran D, Milani C, Pugliese M, Hensel JM, Sood M, Kendall CE, Kendzerska T, Tanuseputro P. Physician benzodiazepine self-use prior to and during the COVID-19 pandemic in Ontario, Canada: a population-level cohort study. BMJ Open 2023; 13:e062742. [PMID: 37085307 PMCID: PMC10123848 DOI: 10.1136/bmjopen-2022-062742] [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] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate physician benzodiazepine (BZD) self-use pre-COVID-19 pandemic and to examine changes in BZD self-use during the first year of the pandemic. DESIGN Population-based retrospective cohort study using linked routinely collected administrative health data comparing the first year of the pandemic to the period before the pandemic. SETTING Province of Ontario, Canada between March 2016 and March 2021. PARTICIPANTS INTERVENTION: Onset of the COVID-19 pandemic in March 2020. OUTCOMES MEASURES The primary outcome measure was the receipt of one or more prescriptions for BZD, which was captured via the Narcotics Monitoring System. RESULTS In a cohort of 30 798 physicians (mean age 42, 47.8% women), we found that during the year before the pandemic, 4.4% of physicians had 1 or more BZD prescriptions. Older physicians (6.8% aged 50+ years), female physicians (5.1%) and physicians with a prior mental health (MH) diagnosis (12.4%) were more likely than younger (3.7% aged <50 years), male physicians (3.8%) and physicians without a prior MH diagnosis (2.9%) to have received 1 or more BZD prescriptions. The first year of the COVID-19 pandemic was associated with a 10.5% decrease (adjusted OR (aOR) 0.85, 95% CI: 0.80 to 0.91) in the number of physicians with 1 or more BZD prescriptions compared with the year before the pandemic. Female physicians were less likely to reduce BZD self-use (aORfemale=0.90, 95% CI: 0.83 to 0.98) compared with male physicians (aORmale=0.79, 95% CI: 0.72 to 0.87, pinteraction=0.046 during the pandemic. Physicians presenting with an incident MH visit had higher odds of filling a BZD prescription during COVID-19 compared with the prior year. CONCLUSIONS Physicians' BZD prescriptions decreased during the first year of the COVID-19 pandemic in Ontario, Canada. These findings suggest that previously reported increases in mental distress and MH visits among physicians during the pandemic did not lead to greater self-use of BZDs.
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Affiliation(s)
- Daniel Myran
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
| | - Christina Milani
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Michael Pugliese
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
| | | | - Manish Sood
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Claire E Kendall
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Tetyana Kendzerska
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- Respirology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- Division of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
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Myran DT, Roberts R, McArthur E, Jeyakumar N, Hensel JM, Kendall C, Gerin-Lajoie C, McFadden T, Simon C, Garg AX, Sood MM, Tanuseputro P. Mental health and addiction health service use by physicians compared to non-physicians before and during the COVID-19 pandemic: A population-based cohort study in Ontario, Canada. PLoS Med 2023; 20:e1004187. [PMID: 37071611 PMCID: PMC10112788 DOI: 10.1371/journal.pmed.1004187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/26/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND The Coronavirus Disease 2019 (COVID-19) pandemic has exacerbated mental health challenges among physicians and non-physicians. However, it is unclear if the worsening mental health among physicians is due to specific occupational stressors, reflective of general societal stressors during the pandemic, or a combination. We evaluated the difference in mental health and addictions health service use between physicians and non-physicians, before and during the COVID-19 pandemic. METHODS AND FINDINGS We conducted a population-based cohort study in Ontario, Canada between March 11, 2017 and August 11, 2021 using data collected from Ontario's universal health system. Physicians were identified using registrations with the College of Physicians and Surgeons of Ontario between 1990 and 2020. Participants included 41,814 physicians and 12,054,070 non-physicians. We compared the first 18 months of the COVID-19 pandemic (March 11, 2020 to August 11, 2021) to the period before COVID-19 pandemic (March 11, 2017 to February 11, 2020). The primary outcome was mental health and addiction outpatient visits overall and subdivided into virtual versus in-person, psychiatrists versus family medicine and general practice clinicians. We used generalized estimating equations for the analyses. Pre-pandemic, after adjustment for age and sex, physicians had higher rates of psychiatry visits (aIRR 3.91 95% CI 3.55 to 4.30) and lower rates of family medicine visits (aIRR 0.62 95% CI 0.58 to 0.66) compared to non-physicians. During the first 18 months of the COVID-19 pandemic, the rate of outpatient mental health and addiction (MHA) visits increased by 23.2% in physicians (888.4 pre versus 1,094.7 during per 1,000 person-years, aIRR 1.39 95% CI 1.28 to 1.51) and 9.8% in non-physicians (615.5 pre versus 675.9 during per 1,000 person-years, aIRR 1.12 95% CI 1.09 to 1.14). Outpatient MHA and virtual care visits increased more among physicians than non-physicians during the first 18 months of the pandemic. Limitations include residual confounding between physician and non-physicians and challenges differentiating whether observed increases in MHA visits during the pandemic are due to stressors or changes in health care access. CONCLUSIONS The first 18 months of the COVID-19 pandemic was associated with a larger increase in outpatient MHA visits in physicians than non-physicians. These findings suggest physicians may have had larger negative mental health during COVID-19 than the general population and highlight the need for increased access to mental health services and system level changes to promote physician wellness.
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Affiliation(s)
- Daniel T Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rhiannon Roberts
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Eric McArthur
- ICES Western, London Health Sciences Centre, London, Ontario, Canada
| | | | - Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Claire Kendall
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Caroline Gerin-Lajoie
- Canadian Medical Association, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Amit X Garg
- ICES Western, London Health Sciences Centre, London, Ontario, Canada
- Departments of Medicine, Epidemiology & Biostatistics, Western University, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Manish M Sood
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
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Love K, Bolton JM, Hunzinger E, Hensel JM. Needs Assessment of Clients Accessing a Community Mental Health Crisis Stabilization Unit. Community Ment Health J 2023; 59:400-408. [PMID: 36040635 DOI: 10.1007/s10597-022-01019-4] [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: 11/03/2021] [Accepted: 08/08/2022] [Indexed: 01/25/2023]
Abstract
This study aimed to examine the needs of clients accessing a community mental health crisis stabilization unit (CSU) in Winnipeg, Canada. Sociodemographics, service connections, and need were assessed among CSU clients. The Camberwell Assessment of Need Short Appraisal Schedule - Patient (CANSAS-P) was administered to differentiate need domains that were met and unmet. An ordinal regression examined sociodemographics and level of total unmet need; client characteristics were correlated with unmet need. In total, 271 questionnaires were analyzed. On average, respondents had 6.2 areas of unmet need, with "psychosocial distress" (n = 186, 68.6%), "safety to self" (n = 140, 51.7%), "company" (n = 139, 51.3%), and "physical health" (n = 124, 45.8%) being reported most often. Higher level of unmet need was predicted by disability income and absence of income. Overall, CSU clients had high rates of unmet need reflecting important determinants of health. This information can inform community mental health crisis service delivery to positively impact mental health recovery.
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Affiliation(s)
- Karin Love
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, R3E 3N4, Winnipeg, MB, Canada.,Crisis Response Services, 817 Bannatyne Ave, R3E 0W4, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, R3E 3N4, Winnipeg, MB, Canada.,Crisis Response Services, 817 Bannatyne Ave, R3E 0W4, Winnipeg, MB, Canada
| | - Erika Hunzinger
- Crisis Response Services, 817 Bannatyne Ave, R3E 0W4, Winnipeg, MB, Canada
| | - Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, R3E 3N4, Winnipeg, MB, Canada. .,Crisis Response Services, 817 Bannatyne Ave, R3E 0W4, Winnipeg, MB, Canada.
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Lee K, Bolton SL, Shterenberg R, Bolton JM, Hensel JM. Early Learning From a Low-Resource COVID-Response Virtual Mental Health Crisis Ward: Mixed Methods Study. JMIR Form Res 2022; 6:e39861. [PMID: 36252139 PMCID: PMC9640197 DOI: 10.2196/39861] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/26/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Background The COVID-19 pandemic was accompanied by the accelerated uptake of virtual care, leading to a proliferation of virtual ward models as alternatives to facility-based care. Early in the pandemic, our program implemented a virtual mental health crisis ward (vWard) to provide options for individuals requiring intense psychiatric and/or crisis support but who preferred to remain in the community and were deemed safe to do so. Objective The aim of this study was to identify early learnings from the vWard, which was implemented rapidly in a resource-constrained environment, to inform the future state should it be sustained beyond the pandemic. Methods Mixed methods of data collection were used to evaluate provider perspectives on the vWard, develop archetypes for individuals who are a good fit for the vWard model, and create a driver diagram. Data sources included an anonymous survey of clinical and managerial staff involved in the vWard, a service planning workshop, and program discharge forms for all individuals admitted between March 2020 and April 2021. Survey responses were coded for themes under categories of “benefits” and “challenges.” Discharge forms where the team indicated that the vWard was a good fit for an individual were examined for characteristics common to these admissions. These findings were reviewed in the service planning workshop and refined with input from the participants into patient archetypes. A driver diagram was created for the future state. Results Survey respondents (N=60) represented diverse roles in crisis services and the vWard team. Ten providers took part in the service planning workshop. A total of 467 discharge forms were reviewed. The vWard was felt to be a model that worked by 39 survey respondents, one respondent felt it did not work, and the remaining participants had no response. Several benefits for the individual and the system were identified alongside challenges, including certain processes and materials related to the nature of rapid implementation during the pandemic, and others due to lack of fit for certain individuals. The model was felt to be a good fit for 67.5% of admissions. Four patient archetypes representing a good fit with the model were developed. The driver diagram connected the program aim with primary drivers of (1) reduce barriers to care; (2) improve outcomes; and (3) provide collaborative, patient- and family-centered care to secondary drivers and interventions that leveraged virtual technology among other crisis care interventions. Conclusions Despite some challenges, the vWard demonstrated high levels of provider acceptance and a range of mechanisms by which the model works for a variety of patient archetypes. These early learnings provide a foundation for growth, sustainability, and spread of this model going forward beyond the pandemic.
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Affiliation(s)
- Katherine Lee
- Max Rady School of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Shay-Lee Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Ravit Shterenberg
- Max Rady School of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
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Vakil T, Svenne DC, Bolton JM, Jiang D, Svenne S, Hensel JM. Analysis of the uptake and associated factors for virtual crisis care during the pandemic at a 24-h mental health crisis centre in Manitoba, Canada. BMC Psychiatry 2022; 22:527. [PMID: 35927672 PMCID: PMC9351177 DOI: 10.1186/s12888-022-04166-w] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The coronavirus pandemic necessitated the rapid transition to virtual care. At a 24-h walk-in mental health Crisis Response Centre (CRC) in Winnipeg, Canada we adapted crisis mental health assessments to be offered virtually while the crisis centre also remained open to in person visits. Little is known about the sustainability of virtual visits in the presence of comparable in person care, and which visits are more likely to be done virtually, particularly in the crisis setting. METHODS An analysis of visits to the CRC from the first local lockdown on March 19, 2020 through the third local wave with heightened public health restrictions in June 2021. Analysis of Variance was used to compare the proportion of visits occurring virtually (telephone or videoconference) during the first wave of heightened public health restrictions (lockdown 1) and subsequent lockdowns as well as the in-between periods. A binary logistic regression examined visit, sociodemographic and clinical factors associated with receipt of a virtual visit compared to an in person visit over the first year of the pandemic. RESULTS Out of 5,357 visits, 993 (18.5%) occurred virtually. There was a significant difference in proportion of virtual visits across the pandemic time periods (F(4, 62) = 8.56, p < .001). The proportion of visits occurring virtually was highest during lockdown 1 (mean 32.6% by week), with no differences between the other time periods. Receipt of a virtual visit was significantly associated with daytime weekday visits, age, non-male gender, living further away from the CRC, no prior year contact with the CRC, and visits that did not feature suicidal behaviour, substance use, psychosis or cognitive impairment. CONCLUSIONS A large proportion of virtual care occurring at the outset of the pandemic reflects public anxiety and care avoidance paired with health system rapid transformation. The use of virtual visits reduced over subsequent pandemic periods but was sustained at a meaningful level. Specific visit, sociodemographic and clinical characteristics are more likely to be present in visits occurring virtually compared to those in person. These results can help to inform the future planning and delivery of virtual crisis care.
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Affiliation(s)
- Tanvi Vakil
- grid.21613.370000 0004 1936 9609Rady School of Medicine, University of Manitoba, 750 Bannatyne Ave., Winnipeg, MB Canada
| | | | - James M. Bolton
- grid.21613.370000 0004 1936 9609Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, MB Canada
| | - Depeng Jiang
- grid.21613.370000 0004 1936 9609Department of Community Health Sciences, University of Manitoba, 750 Bannatyne Ave, Winnipeg, MB Canada
| | - Sasha Svenne
- grid.267457.50000 0001 1703 4731Department of Psychology, University of Winnipeg, 515 Portage Ave., Winnipeg, MB Canada
| | - Jennifer M. Hensel
- grid.21613.370000 0004 1936 9609Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, MB Canada
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Chartier MJ, Bolton JM, Ekuma O, Mota N, Hensel JM, Nie Y, McDougall C. Suicidal Risk and Adverse Social Outcomes in Adulthood Associated with Child and Adolescent Mental Disorders. Can J Psychiatry 2022; 67:512-523. [PMID: 34796744 PMCID: PMC9234896 DOI: 10.1177/07067437211055417] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The life course of children and adolescents with mental disorders is an important area of investigation, yet it remains understudied. This study provides a first-ever comprehensive examination of the relationship between child and adolescent mental disorders and subsequent suicidal and adverse social outcomes in early adulthood using population-based data. METHODS De-identified administrative databases were used to create a birth cohort of 60,838 residents of Manitoba born between April 1980 to March 1985 who were followed until March 2015. Unadjusted and adjusted hazard ratios (aHRs) and odds ratios (aORs) were calculated to determine associations between physician-diagnosed mental disorders in childhood or adolescence and a range of adverse early adulthood (ages 18 to 35) outcomes. RESULTS Diagnoses of mood/anxiety disorders, attention-deficit hyperactivity disorder, substance use disorder, conduct disorder, psychotic disorder, personality disorders in childhood or adolescence were associated with having the same diagnoses in adulthood. These mental disorder diagnoses in childhood/adolescence were strongly associated with an increased risk of suicidal behaviors and adverse adult social outcomes in adulthood. Similarly, suicide attempts in adolescence conferred an increased risk in adulthood of suicide death (aHR: 3.6; 95% confidence interval [CI]: 1.9-6.9), suicide attempts (aHR: 6.2; CI: 5.0-7.6), social housing use (aHR: 1.7; CI 1.4-2.1), income assistance (aHR: 1.8; CI 1.6-2.1), criminal accusation (aHR: 2.2; CI 2.0-2.5), criminal victimization (aHR:2.5; CI 2.2-2.7), and not completing high school (aOR: 3.1; CI: 2.5-3.9). CONCLUSION Mental disorders diagnosed in childhood and adolescence are important risk factors not only for mental disorders in adulthood but also for a range of early adult adversity. These findings provide an evidence-based prognosis of children's long-term well-being and a rationale for ensuring timely access to mental health services. Better population-level mental health promotion and early intervention for children and adolescents with mental disorders are promising for improving future adult outcomes.
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Affiliation(s)
- Mariette J. Chartier
- Department of Community Health
Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Mariette J. Chartier PhD, Manitoba Centre
for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg,
Manitoba, R3E 3P5, Canada.
| | - James M. Bolton
- Department of Psychiatry and Community Health Sciences, Rady Faculty
of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Okechukwu Ekuma
- Department of Community Health Sciences, Rady Faculty of Health
Sciences, University of Manitoba, Winnipeg, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Jennifer M. Hensel
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Yao Nie
- Department of Community Health Sciences, Rady Faculty of Health
Sciences, University of Manitoba, Winnipeg, Canada
| | - Chelsey McDougall
- Department of Community Health Sciences, Rady Faculty of Health
Sciences, University of Manitoba, Winnipeg, Canada
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11
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Legatto T, Taylor VH, Kidane B, Anvari M, Hensel JM. The Impact of Psychiatric History and Peri-operative Psychological Distress on Weight Loss Outcomes 1 Year After Bariatric Surgery. Obes Surg 2021; 32:325-333. [PMID: 34783959 DOI: 10.1007/s11695-021-05781-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/31/2021] [Accepted: 11/08/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND To determine if self-reported baseline psychological distress moderates the association between lifetime psychiatric diagnosis and weight loss 1 year after bariatric surgery. An exploratory analysis assessed change in psychological distress from baseline on weight loss at 1 year. METHODS A retrospective cohort study using data from the Ontario Bariatric Registry for all individuals undergoing surgery between January 1, 2012, and December 31, 2018, with a complete baseline psychological assessment and 1-year post-operative weight recorded (N = 11,159). Multiple linear regressions assessed the relationship between psychiatric diagnosis and percentage of excess body mass index loss (%EBMIL) at 1-year post-surgery, controlling for baseline body mass index, socio-demographics, medical co-morbidities, and surgical complications. Baseline psychological distress, measured with the EQ-5D-5L anxiety/depression rating, was examined as a moderator of this relationship. %EBMIL was separately regressed on change in psychological distress from baseline to 1 year, controlling for psychiatric diagnosis. RESULTS In the adjusted model, psychiatric diagnosis was associated with lower %EBMIL at 1 year (B = - 1.00, P = .008). Baseline psychological distress was not a moderator, but had a significant main effect on %EBMIL (B = - .84, P = .001). Those who experienced a decrease in psychological distress at 1 year, or remained low throughout, fared better than those who increased or had persistently high symptoms. CONCLUSIONS These findings support use of a self-report assessment for psychological distress prior to bariatric surgery. Addressing active psychological distress prior to and/or following surgery may increase the likelihood of successful outcomes.
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Affiliation(s)
- Taylor Legatto
- Department of Psychiatry, University of Manitoba, Psychealth, 771 Bannatyne Ave, Winnipeg, MB, R3E 3N4, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Biniam Kidane
- Department of Surgery, University of Manitoba, Winnipeg, MB, R3A 1R9, Canada
| | - Mehran Anvari
- Department of Surgery, McMaster University, Hamilton, ON, L8N 4A6, Canada
| | - Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, Psychealth, 771 Bannatyne Ave, Winnipeg, MB, R3E 3N4, Canada.
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12
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Hensel JM, Yang R, Vigod SN, Desveaux L. Videoconferencing at home for psychotherapy in the postpartum period: Identifying drivers of successful engagement and important therapeutic conditions for meaningful use. Couns Psychother Res 2020. [DOI: 10.1002/capr.12372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Rebecca Yang
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care Toronto ON Canada
| | - Simone N. Vigod
- Department of Psychiatry University of Toronto Toronto ON Canada
| | - Laura Desveaux
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care Toronto ON Canada
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13
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Casiano H, Hensel JM, Chartier MJ, Ekuma O, MacWilliam L, Mota N, McDougall C, Bolton JM. The Intersection between Criminal Accusations, Victimization, and Mental Disorders: A Canadian Population-Based Study. Can J Psychiatry 2020; 65:492-501. [PMID: 32363932 PMCID: PMC7298584 DOI: 10.1177/0706743720919660] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Understand the relationship between criminal accusations, victimization, and mental disorders at a population level using administrative data from Manitoba, Canada. METHOD Residents aged 18 to 64 between April 1, 2007, and March 31, 2012 (N = 793,024) with hospital- and physician-diagnosed mental disorders were compared to those without. Overall and per-person rates of criminal accusations and reported victimization in the 2011/2012 fiscal year were examined. Relative risks were calculated, adjusting for age, sex, income, and presence of a substance use disorder. The overlap between diagnosed mental disorders, accusations, and victimization with a χ2 test of independence was studied. RESULTS Twenty-four percent (n = 188,693) of the population had a mental disorder over the 5-year time frame. Four to fifteen percent of those with a mental disorder had a criminal accusation, compared to 2.4% of the referent group. Individuals with mental disorders, especially psychotic or personality disorders, were often living in low-income, urban neighborhoods. The adjusted relative risk of accusations and victimization remained 2 to 5 times higher in those with mental disorders compared to the referent group. Criminal accusations and victimization were most prevalent among individuals with a history of attempted suicide (15.2% had an accusation and 8.1% were victims). The risk of victimization in the same year as a criminal accusation was significantly increased among those with mental disorders compared to those without (χ2 = 211.8, P < 0.001). CONCLUSIONS Individuals with mental disorders are at elevated risk of both criminal involvement and victimization. The identification of these multiply-stigmatized individuals may lead to better intervention and support.
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Affiliation(s)
- Hygiea Casiano
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mariette J Chartier
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leonard MacWilliam
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsey McDougall
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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14
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Doak S, Schwager A, Hensel JM. Exposure to and attitudes regarding electronic healthcare (e-Health) among physician assistants in Canada: A national survey study. Health Soc Care Community 2020; 28:1049-1057. [PMID: 31899587 DOI: 10.1111/hsc.12938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 06/10/2023]
Abstract
Physician assistants (PAs) are a growing group of healthcare providers who could facilitate the adoption of electronic healthcare (e-Health) into practice. In 2018, we conducted a Canada-wide web-based survey study of practicing PAs and student PAs regarding their current exposure to e-Health, as well as their perceived value for its use and interest in future adoption. For this study, e-Health was defined as technology that allows direct communication between patients and healthcare providers or facilitates patient self-management for the purpose of assessment and management. We focused on telehealth, direct messaging (e.g. text, email), patient-directed web-based applications (apps) and patient-provider shared web-based apps. Survey responses were analysed descriptively and compared between practicing and student PAs with Chi-square tests of independence. We also examined correlations between age, exposure, perceived value and interest in future adoption for practicing PAs and student PAs separately. About 186 respondents completed the survey; 145 practicing PAs and 39 student PAs. Fewer than half of respondents had exposure to the studied e-Health modalities. Compared to practicing PAs, student PAs more often perceived value in e-Health and expressed interest in its expanded adoption. In both groups, perceived value frequently correlated significantly with interest in adoption. Student PAs report little formal education during their training, and both practicing PAs and student PAs note a need for infrastructure support, and general knowledge about what is available and safe in order to enable them to expand their use of e-Health in practice. The most interest is present for patient-directed apps and patient-provider shared apps. With workload and remuneration barriers to physician adoption of e-Health, salary-based PAs could have a role in facilitating the integration of e-Health solutions into practice. Additional awareness, exposure and support for PAs to do so are required.
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Affiliation(s)
- Sara Doak
- Cardiac Science Program, St. Boniface Hospital, Winnipeg, MB, Canada
| | - Aimee Schwager
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada
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15
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Hensel JM, Molnar L, Bruno D. Cognitive-Behavioral Therapy in Dyads ("Shared CBT"): Expanding Options and Improving Access. Psychiatr Serv 2020; 71:525-526. [PMID: 32354305 DOI: 10.1176/appi.ps.201900507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jennifer M Hensel
- Women's College Hospital, Toronto, Ontario, Canada (all authors); Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada (Hensel); Factor-Inwentosh School of Social Work, University of Toronto, Toronto (Molnar); Department of Psychiatry, University of Toronto, Toronto (Bruno)
| | - Leslie Molnar
- Women's College Hospital, Toronto, Ontario, Canada (all authors); Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada (Hensel); Factor-Inwentosh School of Social Work, University of Toronto, Toronto (Molnar); Department of Psychiatry, University of Toronto, Toronto (Bruno)
| | - Deanna Bruno
- Women's College Hospital, Toronto, Ontario, Canada (all authors); Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada (Hensel); Factor-Inwentosh School of Social Work, University of Toronto, Toronto (Molnar); Department of Psychiatry, University of Toronto, Toronto (Bruno)
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16
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Hensel JM, Casiano H, Chartier MJ, Ekuma O, MacWilliam L, Mota N, McDougall C, Bolton JM. Prevalence of mental disorders among all justice-involved: A population-level study in Canada. Int J Law Psychiatry 2020; 68:101523. [PMID: 32033694 DOI: 10.1016/j.ijlp.2019.101523] [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] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/07/2019] [Accepted: 11/09/2019] [Indexed: 06/10/2023]
Abstract
More than 10 million people are imprisoned around the world, with many more who encounter the justice system. However, most studies examining the mental health burden in the justice system have examined only incarcerated individuals, with few looking at both criminal offending and victimization at the population-level. This study aimed to describe the population-level prevalence of mental disorders among the entirety of justice-involved individuals in a Canadian sample. The study was conducted using linked health and justice administrative data for all residents of Manitoba, Canada ages 18-64 between April 1, 2007 and March 31, 2012. All justice involvement (crime accusations and victimizations) and inpatient and outpatient mental disorder diagnoses (mood/anxiety, substance use, psychotic, personality disorders and suicidal behavior) were retrieved. Five-year age- and sex-adjusted prevalence of mental disorders and suicidal behaviour among those with any crime accusation and any victimization were compared to the general population of Manitoba. The study found that age- and sex-adjusted prevalence of any mental disorder was significantly higher among both adults accused of a crime and those victimized (38.9% and 38.6%, respectively) compared to the general population (26.1%). Rate ratios for specific mental disorders and suicidal behaviour were 1.4-3.6 among those accused of a crime, and 1.4-3.7 among those who were victims, compared to the general population. These findings highlight the need for urgent and expanded attention to this intersection of vulnerability. Victimization is especially an area of justice-related health that requires more attention.
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Affiliation(s)
- Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Hygiea Casiano
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mariette J Chartier
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leonard MacWilliam
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsey McDougall
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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17
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Mota NP, Chartier M, Ekuma O, Nie Y, Hensel JM, MacWilliam L, McDougall C, Vigod S, Bolton JM. Mental Disorders and Suicide Attempts in the Pregnancy and Postpartum Periods Compared with Non-Pregnancy: A Population-Based Study. Can J Psychiatry 2019; 64:482-491. [PMID: 30895808 PMCID: PMC6610562 DOI: 10.1177/0706743719838784] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To compare the rate of mental disorders (i.e., mood and anxiety, substance use, psychotic disorders) and suicide attempts within the same group of women across the pre-pregnancy, pregnancy, and postpartum periods, and between this perinatal cohort and a non-perinatal reference group. METHOD Data were from an administrative repository of residents in Manitoba, Canada. The perinatal cohort consisted of women aged 18 to 45 years who experienced >1 live birth pregnancy between 2011 and 2014 (n = 45,362). Pre-pregnancy, pregnancy, and postpartum periods were defined over consecutive 40-week intervals. The non-perinatal cohort consisted of age-matched women with no pregnancies during the same period (n = 139,705). A reference 40-week interval was defined from the individual's birthdate in the year they entered the cohort. Rate ratios of diagnosed mental disorders were adjusted (aRR) for demographic factors, parity, and mental health history. RESULTS Within the perinatal cohort, pregnancy was associated with a lower rate of diagnosed mood or anxiety disorder, substance use disorder, and suicide attempt relative to pre-pregnancy (aRR range, 0.22-0.82). Pregnancy also had lower rates of all outcomes compared with the postpartum period (aRR, 0.44-0.87). Postpartum had a higher rate of psychotic disorder compared with pre-pregnancy (aRR, 1.61; 95% CI, 1.17-2.21), but a lower rate of mood or anxiety disorder and suicide attempt. Compared with non-perinatal women, pregnancy was associated with lower rates of all outcomes (aRR range, 0.25-0.87). CONCLUSIONS Compared with a non-perinatal period, the rate of a diagnosed mental disorder is lower during pregnancy but begins to rise in the postpartum period, highlighting an important period for early identification and rapid access to intervention.
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Affiliation(s)
- Natalie P Mota
- 1 Departments of Clinical Health Psychology and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mariette Chartier
- 2 Department of Community Health Sciences, University of Manitoba.,3 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Okechukwu Ekuma
- 3 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Yao Nie
- 3 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Jennifer M Hensel
- 4 Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Simone Vigod
- 5 Department of Psychiatry, Women's College Hospital and Research Institute, Institute for Clinical Evaluative Sciences, the University of Toronto, Toronto, Ontario, Canada
| | - James M Bolton
- 6 Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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18
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Hensel JM, Chartier MJ, Ekuma O, MacWilliam L, Mota N, Tachere RO, McDougall C, Bolton JM. Risk and associated factors for a future schizophrenia diagnosis after an index diagnosis of unspecified psychotic disorder: A population-based study. J Psychiatr Res 2019; 114:105-112. [PMID: 31059990 DOI: 10.1016/j.jpsychires.2019.04.019] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 11/26/2022]
Abstract
A significant minority of unspecified psychosis presentations progress to schizophrenia. Clinical risk factors can inform targeted referral to specialized treatment programs, but few population studies have examined this. In this study, we used health administrative data for a population-based cohort from Manitoba, Canada to characterize the risk and identify vulnerable subgroups for a future diagnosis of schizophrenia after a diagnosis of unspecified psychotic disorder. Individuals aged 13-60 years with an inpatient or outpatient diagnosis of unspecified psychotic disorder between April 1, 2007 and March 31, 2012, and without any prior diagnosis of schizophrenia or related disorder, were identified (N = 3, 289). The primary outcome was a diagnosis of schizophrenia recorded after the index diagnosis of unspecified psychotic disorder and before March 31, 2015. Adjusted hazard ratios were computed controlling for age, sex, urbanicity, income, prior diagnosis of unspecified psychotic disorder, provider making the diagnosis, prior 12-month psychiatric hospitalization, and prior 12-month diagnoses of mood, anxiety, substance use, or personality disorders, and substance-induced psychosis. A classification tree identified vulnerable subgroups. The cumulative risk of a future diagnosis of schizophrenia was 26% during the follow-up period (mean 4.5 years), with a mean time to diagnosis of 2.0 years. The most vulnerable subgroup was diagnosed by a psychiatrist, younger than 27 years, without a mood or anxiety disorder, male, and residing in a low-income neighborhood; the rate of a subsequent schizophrenia diagnosis was 61.2%. These results support that identification of specific sociodemographic and clinical factors can help clinicians counsel and intervene with those at highest risk.
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Affiliation(s)
- Jennifer M Hensel
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, Manitoba, R3E 3N4, Canada.
| | - Mariette J Chartier
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, 408 - 727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, 408 - 727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Leonard MacWilliam
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, 408 - 727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Ave, Winnipeg, Manitoba, R3E 3N4, Canada
| | - Richard O Tachere
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, Manitoba, R3E 3N4, Canada
| | - Chelsey McDougall
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, 408 - 727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, Manitoba, R3E 3N4, Canada; Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, 408 - 727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada; Department of Community Health Sciences, University of Manitoba, S113, 750 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0W3, Canada
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19
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Hensel JM, Shaw J, Ivers NM, Desveaux L, Vigod SN, Cohen A, Onabajo N, Agarwal P, Mukerji G, Yang R, Nguyen M, Bouck Z, Wong I, Jeffs L, Jamieson T, Bhatia RS. A Web-Based Mental Health Platform for Individuals Seeking Specialized Mental Health Care Services: Multicenter Pragmatic Randomized Controlled Trial. J Med Internet Res 2019; 21:e10838. [PMID: 31165710 PMCID: PMC6684216 DOI: 10.2196/10838] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 04/26/2019] [Accepted: 04/26/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Web-based self-directed mental health applications are rapidly emerging to address health service gaps and unmet needs for information and support. OBJECTIVE The aim of this study was to determine if a multicomponent, moderated Web-based mental health application could benefit individuals with mental health symptoms severe enough to warrant specialized mental health care. METHODS A multicenter, pragmatic randomized controlled trial was conducted across several outpatient mental health programs affiliated with 3 hospital programs in Ontario, Canada. Individuals referred to or receiving treatment, aged 16 years or older, with access to the internet and an email address, and having the ability to navigate a Web-based mental health application were eligible. A total of 812 participants were randomized 2:1 to receive immediate (immediate treatment group, ITG) or delayed (delayed treatment group, DTG) access for 3 months to the Big White Wall (BWW), a multicomponent Web-based mental health intervention based in the United Kingdom and New Zealand. The primary outcome was the total score on the Recovery Assessment Scale, revised (RAS-r) which measures mental health recovery. Secondary outcomes were total scores on the Patient Health Questionnaire-9 item (PHQ-9), the Generalized Anxiety Disorder Questionnaire-7 item (GAD-7), the EuroQOL 5-dimension quality of life questionnaire (EQ-5D-5L), and the Community Integration Questionnaire. An exploratory analysis examined the association between actual BWW use (categorized into quartiles) and outcomes among study completers. RESULTS Intervention participants achieved small, statistically significant increases in adjusted RAS-r score (4.97 points, 95% CI 2.90 to 7.05), and decreases in PHQ-9 score (-1.83 points, 95% CI -2.85 to -0.82) and GAD-7 score (-1.55 points, 95% CI -2.42 to -0.70). Follow-up was achieved for 55% (446/812) at 3 months, 48% (260/542) of ITG participants and 69% (186/270) of DTG participants. Only 58% (312/542) of ITG participants logged on more than once. Some higher BWW user groups had significantly greater improvements in PHQ-9 and GAD-7 relative to the lowest use group. CONCLUSIONS The Web-based application may be beneficial; however, many participants did not engage in an ongoing way. This has implications for patient selection and engagement as well as delivery and funding structures for similar Web-based interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT02896894; https://clinicaltrials.gov/ct2/show/NCT02896894 (Archived by WebCite at http://www.webcitation.org/78LIpnuRO).
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Affiliation(s)
- Jennifer M Hensel
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada.,Women's College Research Institute, Toronto, ON, Canada
| | - James Shaw
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada
| | - Noah M Ivers
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Laura Desveaux
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Simone N Vigod
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ashley Cohen
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Nike Onabajo
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada
| | - Payal Agarwal
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Geetha Mukerji
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rebecca Yang
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada
| | - Megan Nguyen
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada
| | - Zachary Bouck
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada
| | - Ivy Wong
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada
| | - Lianne Jeffs
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Trevor Jamieson
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - R Sacha Bhatia
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Yang R, Vigod SN, Hensel JM. Optional Web-Based Videoconferencing Added to Office-Based Care for Women Receiving Psychotherapy During the Postpartum Period: Pilot Randomized Controlled Trial. J Med Internet Res 2019; 21:e13172. [PMID: 31199291 PMCID: PMC6592391 DOI: 10.2196/13172] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/11/2019] [Accepted: 04/07/2019] [Indexed: 12/13/2022] Open
Abstract
Background Depression and anxiety during the postpartum period are common, with psychotherapy often being the preferred method of treatment. However, psychological, physical, and social barriers prevent women from receiving appropriate and timely psychotherapy. The option of receiving psychotherapy through videoconferencing (VC) during the postpartum period presents an opportunity for more accessible and flexible care. Objective The aim of this study was to assess the feasibility, acceptability, and preliminary effectiveness of optional VC added to usual office-based psychotherapy, with a psychotherapist during the postpartum period. Methods We conducted a pilot randomized controlled trial with 1:1 randomization to office-based care (treatment as usual; TAU) or office-based care with the option of VC (treatment as usual plus videoconferencing; TAU-VC) for psychotherapy during the postpartum period. We assessed the ability to recruit and retain postpartum women into the study from an urban perinatal mental health program offering postpartum psychotherapy, and we evaluated the uptake, acceptability, and satisfaction with VC as an addition to in-person psychotherapy. We also compared therapy attendance using therapist logs and symptoms between treatment groups. Symptoms were assessed at baseline and 3 months postrandomization with the Edinburgh Postnatal Depression Scale, Generalized Anxiety Disorder 7-item, and Parental Stress Scale. Furthermore, 3-month scores were compared between groups with intention-to-treat linear mixed-effects models controlling for baseline score. Results We enrolled 38 participants into the study, with 19 participants in each treatment group. Attendance data were available for all participants, with follow-up symptom measures available for 25 out of 38 participants (66%). Among the 19 TAU-VC participants, 14 participants (74%) utilized VC at least once. Most participants were highly satisfied with the VC option, and they reported average savings of Can $26 and 2.5 hours in travel and childcare expenses and time per appointment. There were no significant differences between the 2 groups for psychotherapy attendance or symptoms. Conclusions The option of VC appears to be an acceptable method of receiving psychotherapy for postpartum women, with benefits described in costs and time savings. On the basis of this small pilot sample, there were no significant differences in outcomes between office-based care with or without the option of VC. This study has demonstrated the feasibility of such a program in an urban center, which suggests that a larger study would be beneficial to provide evidence that is more conclusive.
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Affiliation(s)
- Rebecca Yang
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Simone N Vigod
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Psychiatry, Women's College Hospital, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jennifer M Hensel
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Psychiatry, Women's College Hospital, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
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Jeffs L, Jamieson T, Saragosa M, Mukerji G, Jain AK, Man R, Desveaux L, Shaw J, Agarwal P, Hensel JM, Maione M, Onabajo N, Nguyen M, Bhatia R. Uptake and Scalability of a Peritoneal Dialysis Virtual Care Solution: Qualitative Study. JMIR Hum Factors 2019; 6:e9720. [PMID: 30990460 PMCID: PMC6488957 DOI: 10.2196/humanfactors.9720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/27/2017] [Revised: 11/29/2018] [Accepted: 01/06/2019] [Indexed: 02/06/2023] Open
Abstract
Background Early research in the area of virtual care solutions with peritoneal dialysis (PD) patients has focused on evaluating the outcomes and impact of these solutions. There has been less attention focused on understanding the factors influencing the uptake, usability, and scalability of virtual care for chronic kidney disease (CKD) patients receiving PD at home. Objective In this context, a study was undertaken to (1) assess and understand the factors influencing the uptake of a virtual care solution and (2) provide recommendations for the scalability of a virtual care solution aimed at enhancing CKD patients’ outcomes and experiences. Methods This study used a qualitative design with semistructured interviews and a thematic analysis approach. A total of 25 stakeholders—6 patients and 3 caregivers, 6 health care providers, 2 vendors, and 8 health system decision makers—participated in this study. Results The following three primary mechanisms emerged to influence the usability of the virtual care solution: (1) receiving hands-on training and ongoing communication from a supportive team, (2) adapting to meet user needs and embedding them into workflow, and (3) being influenced by patient and caregiver characteristics. Further, two overarching recommendations were developed for considerations around scalability: (1) co-design locally, embed into the daily workflow, and deploy over time and (2) share the benefits and build the case. Conclusions Study findings can be used by key stakeholders in their future efforts to enhance the implementation, uptake, and scalability of virtual care solutions for CKD and managing PD at home.
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Affiliation(s)
- Lianne Jeffs
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Trevor Jamieson
- St. Michael's Hospital, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Marianne Saragosa
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Geetha Mukerji
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Arsh K Jain
- London Health Sciences Centre, London, ON, Canada
| | - Rachel Man
- London Health Sciences Centre, London, ON, Canada
| | - Laura Desveaux
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - James Shaw
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Payal Agarwal
- 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
| | - Jennifer M Hensel
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | | | - Nike Onabajo
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Megan Nguyen
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - R Bhatia
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
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Hensel JM, Shaw J, Ivers NM, Desveaux L, Vigod SN, Bouck Z, Onabajo N, Agarwal P, Mukerji G, Yang R, Nguyen M, Jeffs L, Jamieson T, Bhatia RS. Extending access to a web-based mental health intervention: who wants more, what happens to use over time, and is it helpful? Results of a concealed, randomized controlled extension study. BMC Psychiatry 2019; 19:39. [PMID: 30678676 PMCID: PMC6345062 DOI: 10.1186/s12888-019-2030-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/30/2018] [Accepted: 01/16/2019] [Indexed: 01/08/2023] Open
Abstract
Background Web-based mental health applications may be beneficial, but adoption is often low leaving optimal implementation and payment models unclear. This study examined which users were interested in extended access to a web-based application beyond an initial 3-month trial period and evaluated if an additional 3 months of access was beneficial. Methods This study was a concealed extension of a multi-center, pragmatic randomized controlled trial that assessed the benefit of 3 months of access to the Big White Wall (BWW), an anonymous web-based moderated, multi-component mental health application offering self-directed activities and peer support. Trial participants were 16 years of age or older, recruited from hospital-affiliated mental health programs. Participants who received access to the intervention in the main trial and completed 3-month outcome assessments were offered participation. We compared those who were and were not interested in an extension of the intervention, and re-randomized consenting participants 1:1 to receive extended access or not over the subsequent 3 months. Use of the intervention was monitored in the extension group and outcomes were measured at 3 months after re-randomization in both groups. The primary outcome was mental health recovery as assessed by total score on the Recovery Assessment Scale (RAS-r), as in the main trial. Linear mixed models were used to examine the time by group interaction to assess for differences in responses over the 3-month extension study. Results Of 233 main trial participants who responded, 119 (51.1%) indicated an interest in receiving extended BWW access. Those who were interested had significantly higher baseline anxiety symptoms compared to those who were not interested. Of the 119, 112 were re-randomized (55 to extended access, 57 to discontinuation). Only 21 of the 55 extended access participants (38.2%) used the intervention during the extension period. Change in RAS-r scores over time was not significantly different between groups (time by group, F(1,77) = 1.02; P = .31). Conclusions Only half of eligible participants were interested in extended access to the intervention with decreasing use over time, and no evidence of added benefit. These findings have implications for implementation and payment models for this type of web-based mental health intervention. Trial registration Clinicaltrials.govNCT02896894. Registered retrospectively on September 12, 2016.
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Affiliation(s)
- Jennifer M Hensel
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada. .,Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, Ontario, Canada. .,Women's College Research Institute, Toronto, Ontario, Canada. .,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - James Shaw
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada.,Women's College Research Institute, Toronto, Ontario, Canada
| | - Noah M Ivers
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada.,Women's College Research Institute, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Women's College Hospital and University of Toronto, Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Laura Desveaux
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada.,Women's College Research Institute, Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Simone N Vigod
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada.,Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Zachary Bouck
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
| | - Nike Onabajo
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
| | - Payal Agarwal
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
| | - Geetha Mukerji
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Yang
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
| | - Megan Nguyen
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
| | - Lianne Jeffs
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Trevor Jamieson
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - R Sacha Bhatia
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada.,Women's College Research Institute, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Agarwal P, Mukerji G, Desveaux L, Ivers NM, Bhattacharyya O, Hensel JM, Shaw J, Bouck Z, Jamieson T, Onabajo N, Cooper M, Marani H, Jeffs L, Bhatia RS. Mobile App for Improved Self-Management of Type 2 Diabetes: Multicenter Pragmatic Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e10321. [PMID: 30632972 PMCID: PMC6329896 DOI: 10.2196/10321] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 09/08/2018] [Accepted: 09/14/2018] [Indexed: 01/19/2023] Open
Abstract
Background As the increasing prevalence of type 2 diabetes mellitus has put pressure on health systems to appropriately manage these patients, there have been a growing number of mobile apps designed to improve the self-management of diabetes. One such app, BlueStar, has been shown to significantly reduce hemoglobin A1c (HbA1c) levels in small studies and is the first app in the United States to receive Food and Drug Administration approval as a mobile prescription therapy. However, the impact of the app across real-world population among different clinical sites and health systems remains unclear. Objective The primary objective of this study was to conduct a pragmatic randomized controlled trial of the BlueStar mobile app to determine if app usage leads to improved HbA1c levels among diverse participants in real-life clinical contexts. We hypothesized that this mobile app would improve self-management and HbA1c levels compared with controls. Methods The study consisted of a multicenter pragmatic randomized controlled trial. Overall, 110 participants randomized to the immediate treatment group (ITG) received the intervention for 6 months, and 113 participants randomized to the wait-list control (WLC) group received usual care for the first 3 months and then received the intervention for 3 months. The primary outcome was glucose control measured by HbA1c levels at 3 months. Secondary outcomes assessed intervention impact on patient self-management, experience of care, and self-reported health utilization using validated scales, including the Problem Areas in Diabetes, the Summary of Diabetes Self-Care Activities, and the EuroQol-5D. Intervention usage data were collected directly from the app. Results The results of an analysis of covariance controlling for baseline HbA1c levels did not show evidence of intervention impact on HbA1c levels at 3 months (mean difference [ITG−WLC] −0.42, 95% CI −1.05 to 0.21; P=.19). Similarly, there was no intervention effect on secondary outcomes measuring diabetes self-efficacy, quality of life, and health care utilization behaviors. An exploratory analysis of 57 ITG participants investigating the impact of app usage on HbA1c levels showed that each additional day of app use corresponded with a 0.016-point decrease in participants’ 3-month HbA1c levels (95% CI −0.03 to −0.003). App usage varied significantly by site, as participants from 1 site logged in to the app a median of 36 days over 14 weeks (interquartile range [IQR] 10.5-124); those at another site used the app significantly less (median 9; IQR 6-51). Conclusions The results showed no difference between intervention and control arms for the primary clinical outcome of glycemic control measured by HbA1c levels. Although there was low usage of the app among participants, results indicate contextual factors, particularly site, had a significant impact on overall usage. Future research into the patient and site-specific factors that increase app utilization are needed. Trial Registration Clinicaltrials.gov NCT02813343; https://clinicaltrials.gov/ct2/show/NCT02813343 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT02813343)
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Affiliation(s)
- Payal Agarwal
- Women's College Hospital 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
| | - Geetha Mukerji
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Laura Desveaux
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Noah M Ivers
- Women's College Hospital 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.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Onil Bhattacharyya
- Women's College Hospital 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.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Jennifer M Hensel
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - James Shaw
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Zachary Bouck
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Trevor Jamieson
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of General Internal Medicine, St Michael's Hospital, Toronto, ON, Canada
| | - Nike Onabajo
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Madeline Cooper
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Husayn Marani
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Lianne Jeffs
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - R Sacha Bhatia
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
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Abstract
PURPOSE OF REVIEW This review summarizes digital health solutions being used for Indigenous mental well-being, with emphasis on available evidence and examples reported in the literature. We also describe our own local experience with a rural telemental health service for Indigenous youth and discuss the unique opportunities and challenges. RECENT FINDINGS Digital health solutions can be grouped into three main categories: (1) remote access to specialists, (2) building and supporting local capacity, and (3) patient-directed interventions. Limited evidence exists for the majority of digital solutions specifically in Indigenous contexts, although examples and pilot projects have been described. Telemental health has the strongest evidence, along with a growing evidence for web-based applications, largely led by Australia. Other digital approaches remain areas of promise requiring additional study. Co-design and service integration and respect for Indigenous history and ideologies are essential for success. While the use of digital health solutions for Indigenous mental well-being holds promise, there is a limited evidence base for most of them. Future efforts to expand the use of digital solutions in this population should adhere to best practices for the delivery of Indigenous health services.
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Affiliation(s)
- Jennifer M. Hensel
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, MB Canada
| | - Katherine Ellard
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, MB Canada
| | - Mark Koltek
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, MB Canada
| | - Gabrielle Wilson
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, MB Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, MB Canada
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Jeffs L, Jamieson T, Saragosa M, Mukerji G, Jain AK, Man R, Desveaux L, Shaw J, Agarwal P, Hensel JM, Maione M, Nguyen M, Onabajo N, Bhatia RS. Improving safety and efficiency in care: multi-stakeholders' perceptions associated with a peritoneal dialysis virtual care solution. Patient Prefer Adherence 2018; 12:2623-2629. [PMID: 30587934 PMCID: PMC6294168 DOI: 10.2147/ppa.s181604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although there is a growing body of literature on the outcomes and impacts of remote home management with peritoneal dialysis (PD) patients, less is understood how this virtual care solution impacts the quality and efficiency of the healthcare system care. In this context, a study was undertaken to understand the perceptions of patients and their caregivers, healthcare providers, health system decision makers, and vendors associated with a remote monitoring and tracking solution aimed at enhancing the outcomes and experiences of chronic kidney disease (CKD) patients receiving PD at home. METHODS A qualitative design using semi-structured interviews with 25 stakeholders was used in this study. Narrative data were analyzed by a thematic analysis approach. RESULTS The following two themes emerged from the data: (1) leveraging data to monitor and intervene to keep patients safe and (2) increasing efficiencies and having control over supplies. DISCUSSION Our study findings elucidated the ability of patients (and in some cases, caregivers) to monitor and trend their data and order and track directly on-line their dialysis supplies were key to their active participation in managing their CKD and keeping them safe at home. Their active participation and functionality of the virtual care solution also led to enhanced efficiencies (eg, process faster, easier, convenient, time savings) for both patients and healthcare providers. CONCLUSION The virtual care solution showed promising signs of a patient-centric approach and may serve as a blueprint for other virtual care solutions for chronic disease management.
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Affiliation(s)
- Lianne Jeffs
- Sinai Health System, Toronto, ON M5G 1X5, Canada,
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON M5G 1WB, Canada,
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1B2, Canada,
| | - Trevor Jamieson
- Department of Medicine, University of Toronto, Division of General Internal Medicine, St Michael's Hospital, Women's College Hospital, Toronto, ON M5G 1WB, Canada
- Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, Toronto, ON M5S 1B2, Canada
| | - Marianne Saragosa
- Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, Toronto, ON M5S 1B2, Canada
| | - Geetha Mukerji
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1B2, Canada,
- Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, Toronto, ON M5S 1B2, Canada
- Women's College Hospital, Toronto, ON M5S 1B2, Canada
| | - Arsh K Jain
- London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Rachel Man
- London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Laura Desveaux
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1B2, Canada,
- Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, Toronto, ON M5S 1B2, Canada
| | - James Shaw
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1B2, Canada,
- Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, Toronto, ON M5S 1B2, Canada
| | - Payal Agarwal
- Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, Toronto, ON M5S 1B2, Canada
- Department of Family and Community Medicine, Women's College Hospital, University of Toronto, Toronto, ON M5S 1B2, Canada
| | - Jennifer M Hensel
- Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, Toronto, ON M5S 1B2, Canada
- Department of Psychiatry, University of Toronto, Women's College Hospital, Women's College Research Institute, Women's College Hospital, Toronto, ON M5S 1B2, Canada
| | - Maria Maione
- St Michael's Hospital, Toronto, ON M5G 1WB, Canada
| | - Megan Nguyen
- Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, Toronto, ON M5S 1B2, Canada
| | - Nike Onabajo
- Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, Toronto, ON M5S 1B2, Canada
| | - R Sacha Bhatia
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1B2, Canada,
- Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, Toronto, ON M5S 1B2, Canada
- University Health Network, Toronto, ON M5S 1B2, Canada
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Hensel JM, Taylor VH, Fung K, Yang R, Vigod SN. Acute Care Use for Ambulatory Care-Sensitive Conditions in High-Cost Users of Medical Care with Mental Illness and Addictions. Can J Psychiatry 2018; 63:816-825. [PMID: 29347834 PMCID: PMC6309042 DOI: 10.1177/0706743717752880] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The role of mental illness and addiction in acute care use for chronic medical conditions that are sensitive to ambulatory care management requires focussed attention. This study examines how mental illness or addiction affects risk for repeat hospitalization and/or emergency department use for ambulatory care-sensitive conditions (ACSCs) among high-cost users of medical care. METHOD A retrospective, population-based cohort study using data from Ontario, Canada. Among the top 10% of medical care users ranked by cost, we determined rates of any and repeat care use (hospitalizations and emergency department [ED] visits) between April 1, 2011, and March 31, 2012, for 14 consensus established ACSCs and compared them between those with and without diagnosed mental illness or addiction during the 2 years prior. Risk ratios were adjusted (aRR) for age, sex, residence, and income quintile. RESULTS Among 314,936 high-cost users, 35.9% had a mental illness or addiction. Compared to those without, individuals with mental illness or addiction were more likely to have an ED visit or hospitalization for any ACSC (22.8% vs. 19.6%; aRR, 1.21; 95% confidence interval [CI], 1.20-1.23). They were also more likely to have repeat ED visits or hospitalizations for the same ACSC (6.2% vs. 4.4% of those without; aRR, 1.48; 95% CI, 1.44-1.53). These associations were stronger in stratifications by mental illness diagnostic subgroup, particularly for those with a major mental illness. CONCLUSIONS The presence of mental illness and addiction among high-cost users of medical services may represent an unmet need for quality ambulatory and primary care.
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Affiliation(s)
- Jennifer M Hensel
- Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, Ontario.,Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, Ontario
| | - Valerie H Taylor
- Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, Ontario
| | - Kinwah Fung
- Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Rebecca Yang
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, Ontario
| | - Simone N Vigod
- Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, Ontario.,Institute for Clinical Evaluative Sciences, Toronto, Ontario
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Hensel JM, Yang R, Rai M, Taylor VH. Optimizing Electronic Consultation Between Primary Care Providers and Psychiatrists: Mixed-Methods Study. J Med Internet Res 2018; 20:e124. [PMID: 29625949 PMCID: PMC5910533 DOI: 10.2196/jmir.8943] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 09/11/2017] [Revised: 12/06/2017] [Accepted: 12/27/2017] [Indexed: 11/20/2022] Open
Abstract
Background The use of electronic consultation (e-consult) between primary care providers (PCPs) and psychiatrists has potential, given the high prevalence of mental health issues in primary care and problematic access to specialist care. Utilization and uptake, however, appears to be lower than would be expected. Objective This study aimed to examine actual utilization of e-consult between PCPs and psychiatrists and investigate the perceptions of PCPs about this form of psychiatric advice to inform how to optimize the utility and thereby the uptake of this service. Methods In this mixed-methods study, we conducted a chart review of psychiatry e-consults (N=37) over 2 platforms during early implementation in Ontario, Canada, as well as 3 group interviews and 1 individual interview with PCPs (N=10) with variable experience levels and from a range of practice settings. The chart review assessed response times and referral content including the type of request, referral attachments, and consultant responses. Interviews explored the perceptions of the PCPs about the uses and barriers of psychiatry e-consult. Thematic content analysis of interview data identified common themes as well as themes unique to different provider profiles (eg, experienced PCPs vs new PCPs and rural vs urban practice). On the basis of interpretation of the quantitative and qualitative findings, we developed recommendations for the optimization of psychiatry e-consultation services. Results During the study period, psychiatry e-consults comprised 3.66% (49/1339) of all e-consults submitted on the studied platforms. Among the e-consults reviewed, different psychiatric diagnoses were represented: 70% of requests (26/37) queried about medication safety or side effects, whereas 59% (22/37) asked about psychiatric symptom management. Moreover, 81% (30/37) of e-consults were answered within 24 hours, and 65% (24/37) were addressed in a single exchange. Themes from the interview data included psychiatry having a complexity that differentiates it from other specialties and may limit the utility of e-consult, other than for psychopharmacology advice. Variability in awareness exists in the way e-consultation could be used in psychiatry, with new PCPs feeling unsure about the appropriateness of a question. In general, new PCPs and PCPs practicing in rural areas were more receptive to psychiatry e-consult. PCPs viewed e-consult as an opportunity to collaborate and desired that it be integrated with other available services. Recommendations include the need for appropriate specialist staffing to address a wide range of requests, adequate education to referrers regarding the use of psychiatry e-consult, and the need to integrate psychiatry e-consult with other geographically relevant services, given the complexity of psychiatric issues. Conclusions E-consult is a viable and timely way for PCPs to get much-needed psychiatric advice. For optimizing its utility and uptake, e-consult needs to be integrated into reliable care pathways with adequate referrer and consultant preparation.
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Affiliation(s)
- Jennifer M Hensel
- Women's College Hospital Institute for Healthcare Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Psychiatry, Women's College Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rebecca Yang
- Women's College Hospital Institute for Healthcare Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Minnie Rai
- Women's College Hospital Institute for Healthcare Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Women's College Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Hensel JM, Taylor VH, Fung K, de Oliveira C, Vigod SN. Unique Characteristics of High-Cost Users of Medical Care With Comorbid Mental Illness or Addiction in a Population-Based Cohort. Psychosomatics 2017; 59:135-143. [PMID: 29157683 DOI: 10.1016/j.psym.2017.10.005] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To understand whether high-cost users of medical care with and without comorbid mental illness or addiction differ in terms of their sociodemographic and health characteristics. Unique characteristics would warrant different considerations for interventions and service design aimed at reducing unnecessary health care utilization and associated costs. METHODS From the top 10% of Ontarians ranked by total medical care costs during fiscal year 2011/2012 (N = 314,936), prior 2-year mental illness or addiction diagnoses were determined from administrative data. Sociodemographics, medical illness characteristics, medical costs, and utilization were compared between those high-cost users of medical care with and without comorbid mental illness or addiction. Odds of being a frequent user of inpatient (≥3 admissions) and emergency (≥5 visits) services were compared between groups, adjusting for age, sex, socioeconomic status and medical illness characteristics. RESULTS High-cost users of medical care with comorbid mental illness or addiction were younger, had a lower socioeconomic status, had greater historical medical morbidity, and had higher total medical care costs (mean excess of $2,031/user) than those without. They were more likely to be frequent users of inpatient (12.8% vs 10.2%; adjusted OR, 1.14; 95% CI: 1.12-1.17) and emergency (8.4% vs 4.8%; adjusted OR, 1.55; 95% CI: 1.50-1.59) services. Effect sizes were larger in major mood, psychotic, and substance use disorder subgroups. CONCLUSIONS High-cost medical care users with mental illness or addiction have unique characteristics with respect to sociodemographics and service utilization patterns to consider in interventions and policies for this patient group.
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Affiliation(s)
- Jennifer M Hensel
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; Women's College Research Institute, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Valerie H Taylor
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; Women's College Research Institute, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Kinwah Fung
- Women's College Research Institute, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Claire de Oliveira
- Institute for Clinical Evaluative Sciences, Toronto, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada
| | - Simone N Vigod
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; Women's College Research Institute, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Desveaux L, Agarwal P, Shaw J, Hensel JM, Mukerji G, Onabajo N, Marani H, Jamieson T, Bhattacharyya O, Martin D, Mamdani M, Jeffs L, Wodchis WP, Ivers NM, Bhatia RS. A randomized wait-list control trial to evaluate the impact of a mobile application to improve self-management of individuals with type 2 diabetes: a study protocol. BMC Med Inform Decis Mak 2016; 16:144. [PMID: 27842539 PMCID: PMC5109669 DOI: 10.1186/s12911-016-0381-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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] [Received: 08/13/2016] [Accepted: 10/28/2016] [Indexed: 11/30/2022] Open
Abstract
Background Management of diabetes through improved glycemic control and risk factor modification can help prevent long-term complications. Much diabetes management is self-management, in which healthcare providers play a supporting role. Well-designed e-Health solutions targeting behavior change can improve a range of measures, including glycemic control, perceived health, and a reduction in hospitalizations. Methods The primary objective of this study is to evaluate if a mobile application designed to improve self-management among patients with type 2 diabetes (T2DM) improves glycemic control compared to usual care. The secondary objectives are to determine the effects on patient experience and health system costs; evaluate how and why the intervention worked as observed; and gain insight into considerations for system-wide scale-up. This pragmatic, randomized, wait-list-control trial will recruit adult participants from three Diabetes Education Programs in Ontario, Canada. The primary outcome is glycemic control (measured by HbA1c). Secondary outcomes include patient-reported outcomes and patient-reported experience measures, health system utilization, and intervention usability. The primary outcome will be analyzed using an ANCOVA, with continuous secondary outcomes analyzed using Poisson regression. Direct observations will be conducted of the implementation and application-specific training sessions provided to each site. Semi-structured interviews will be conducted with participants, healthcare providers, organizational leaders, and system stakeholders as part of the embedded process evaluation. Thematic analysis will be applied to the qualitative data in order to describe the relationships between (a) key contextual factors, (b) the mechanisms by which they effect the implementation of the intervention, and (c) the impact on the outcomes of the intervention, according to the principles of Realist Evaluation. Discussion The use of mobile health and virtual tools is on the rise in health care, but the evidence of their effectiveness is mixed and their evaluation is often lacking key contextual data. Results from this study will provide much needed information about the clinical and cost-effectiveness of a mobile application to improve diabetes self-management. The process evaluation will provide valuable insight into the contextual factors that influence the application effectiveness, which will inform the potential for adoption and scale. Trial registration Clinicaltrials.gov NCT02813343. Registered on 24 June 2016 (retrospectively registered). Trial Sponsor: Ontario Telemedicine Network
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Affiliation(s)
- Laura Desveaux
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, ON, M5S 1B2, Canada.,Women's College Research Institute, Women's College Hospital, 76 Grenville Ave, Toronto, ON, Canada
| | - Payal Agarwal
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, ON, M5S 1B2, Canada
| | - Jay Shaw
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, ON, M5S 1B2, Canada.,Women's College Research Institute, Women's College Hospital, 76 Grenville Ave, Toronto, ON, Canada.,Insititue for Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, ON, Canada
| | - Jennifer M Hensel
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, ON, M5S 1B2, Canada.,Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, ON, Canada
| | - Geetha Mukerji
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, ON, M5S 1B2, Canada.,Insititue for Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nike Onabajo
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, ON, M5S 1B2, Canada
| | - Husayn Marani
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, ON, M5S 1B2, Canada
| | - Trevor Jamieson
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, ON, M5S 1B2, Canada.,Division of General Internal Medicine, St. Michael's Hospital, 209 Victoria St, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Onil Bhattacharyya
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, ON, M5S 1B2, Canada.,Women's College Research Institute, Women's College Hospital, 76 Grenville Ave, Toronto, ON, Canada.,Department of Family and Community Medicine, Women's College Hospital and University of Toronto, 76 Grenville Ave, Toronto, ON, Canada
| | - Danielle Martin
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, ON, M5S 1B2, Canada.,Department of Family and Community Medicine, Women's College Hospital and University of Toronto, 76 Grenville Ave, Toronto, ON, Canada
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training, St. Michael's Hospital, 209 Victoria St, Toronto, ON, Canada
| | - Lianne Jeffs
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, Canada
| | - Walter P Wodchis
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, Canada.,Insititue for Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, ON, Canada.,Toronto Rehabilitation Institute, 550 University Avenue, Toronto, ON, Canada
| | - Noah M Ivers
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, ON, M5S 1B2, Canada.,Women's College Research Institute, Women's College Hospital, 76 Grenville Ave, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, Canada.,Insititue for Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, ON, Canada.,Department of Family and Community Medicine, Women's College Hospital and University of Toronto, 76 Grenville Ave, Toronto, ON, Canada
| | - R Sacha Bhatia
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave, Toronto, ON, M5S 1B2, Canada. .,Women's College Research Institute, Women's College Hospital, 76 Grenville Ave, Toronto, ON, Canada. .,Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Hensel JM, Shaw J, Jeffs L, Ivers NM, Desveaux L, Cohen A, Agarwal P, Wodchis WP, Tepper J, Larsen D, McGahan A, Cram P, Mukerji G, Mamdani M, Yang R, Wong I, Onabajo N, Jamieson T, Bhatia RS. A pragmatic randomized control trial and realist evaluation on the implementation and effectiveness of an internet application to support self-management among individuals seeking specialized mental health care: a study protocol. BMC Psychiatry 2016; 16:350. [PMID: 27756281 PMCID: PMC5069942 DOI: 10.1186/s12888-016-1057-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 09/09/2016] [Accepted: 09/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental illness is a substantial and rising contributor to the global burden of disease. Access to and utilization of mental health care, however, is limited by structural barriers such as specialist availability, time, out-of-pocket costs, and attitudinal barriers including stigma. Innovative solutions like virtual care are rapidly entering the health care domain. The advancement and adoption of virtual care for mental health, however, often occurs in the absence of rigorous evaluation and adequate planning for sustainability and spread. METHODS A pragmatic randomized controlled trial with a nested comparative effectiveness arm, and concurrent realist process evaluation to examine acceptability, effectiveness, and cost-effectiveness of the Big White Wall (BWW) online platform for mental health self-management and peer support among individuals aged 16 and older who are accessing mental health services in Ontario, Canada. Participants will be randomized to 3 months of BWW or treatment as usual. At the end of the 3 months, participants in the intervention group will have the opportunity to opt-in to an intervention extension arm. Those who opt-in will be randomized to receive an additional 3 months of BWW or no additional intervention. The primary outcome is recovery at 3 months as measured by the Recovery Assessment Scale-revised (RAS-r). Secondary outcomes include symptoms of depression and anxiety measured with the Personal Health Questionnaire-9 item (PHQ-9) and the Generalized Anxiety Disorder Questionnaire-7 item (GAD-7) respectively, quality of life measured with the EQ-5D-5L, and community integration assessed with the Community Integration Questionnaire. Cost-effectiveness evaluations will account for the cost of the intervention and direct health care costs. Qualitative interviews with participants and stakeholders will be conducted throughout. DISCUSSION Understanding the impact of virtual strategies, such as BWW, on patient outcomes and experience, and health system costs is essential for informing whether and how health system decision-makers can support these strategies system-wide. This requires clear evidence of effectiveness and an understanding of how the intervention works, for whom, and under what circumstances. This study will produce such effectiveness data for BWW, while simultaneously exploring the characteristics and experiences of users for whom this and similar online interventions could be helpful. TRIAL REGISTRATION Clinicaltrials.gov NCT02896894 . Registered on 31 August 2016 (retrospectively registered).
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Affiliation(s)
- Jennifer M. Hensel
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, 76 Grenville St, Toronto, ON Canada ,Department of Psychiatry, Women’s College Hospital and University of Toronto, 76 Grenville St, Toronto, ON Canada ,Women’s College Research Institute, Women’s College Hospital, 76 Grenville St, Toronto, ON Canada
| | - Jay Shaw
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, 76 Grenville St, Toronto, ON Canada ,Women’s College Research Institute, Women’s College Hospital, 76 Grenville St, Toronto, ON Canada
| | - Lianne Jeffs
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON Canada
| | - Noah M. Ivers
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, 76 Grenville St, Toronto, ON Canada ,Women’s College Research Institute, Women’s College Hospital, 76 Grenville St, Toronto, ON Canada ,Department of Family and Community Medicine, Women’s College Hospital and University of Toronto, 76 Grenville St, Toronto, ON Canada ,Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON Canada
| | - Laura Desveaux
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, 76 Grenville St, Toronto, ON Canada ,Women’s College Research Institute, Women’s College Hospital, 76 Grenville St, Toronto, ON Canada
| | - Ashley Cohen
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON Canada
| | - Payal Agarwal
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, 76 Grenville St, Toronto, ON Canada
| | - Walter P. Wodchis
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON Canada ,Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON Canada
| | - Joshua Tepper
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON Canada ,Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON Canada
| | - Darren Larsen
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, 76 Grenville St, Toronto, ON Canada ,Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON Canada ,Women’s College Hospital Family Health Centre, 77 Grenville St, Toronto, ON Canada ,OntarioMD, 150 Bloor St, Toronto, ON Canada
| | - Anita McGahan
- Rotman School of Management, University of Toronto, 105 St. George St, Toronto, ON Canada
| | - Peter Cram
- Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, and University of Toronto, 600 University Ave, Toronto, ON Canada
| | - Geetha Mukerji
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, 76 Grenville St, Toronto, ON Canada ,Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON Canada ,Department of Medicine, University of Toronto, 1 King’s College Circle #3172, Toronto, ON Canada
| | - Muhammad Mamdani
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON Canada ,Li Ka Shing Centre for Healthcare Analytics Research and Training, St. Michael’s Hospital, 209 Victoria St, Toronto, ON Canada ,Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON Canada
| | - Rebecca Yang
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, 76 Grenville St, Toronto, ON Canada
| | - Ivy Wong
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, 76 Grenville St, Toronto, ON Canada
| | - Nike Onabajo
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, 76 Grenville St, Toronto, ON Canada
| | - Trevor Jamieson
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, 76 Grenville St, Toronto, ON Canada
| | - R. Sacha Bhatia
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, 76 Grenville St, Toronto, ON Canada ,Women’s College Research Institute, Women’s College Hospital, 76 Grenville St, Toronto, ON Canada ,Department of Medicine, University of Toronto, 1 King’s College Circle #3172, Toronto, ON Canada
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Rai M, Vigod SN, Hensel JM. Barriers to Office-Based Mental Health Care and Interest in E-Communication With Providers: A Survey Study. JMIR Ment Health 2016; 3:e35. [PMID: 27480108 PMCID: PMC4985609 DOI: 10.2196/mental.6068] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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] [Received: 06/02/2016] [Accepted: 07/06/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND With rising availability and use of Internet and mobile technology in society, the demand and need for its integration into health care is growing. Despite great potential within mental health care and growing uptake, there is still little evidence to guide how these tools should be integrated into traditional care, and for whom. OBJECTIVE To examine factors that might inform how e-communication should be implemented in our local outpatient mental health program, including barriers to traditional office-based care, patient preferences, and patient concerns. METHODS We conducted a survey in the waiting room of our outpatient mental health program located in an urban, academic ambulatory hospital. The survey assessed (1) age, mobile phone ownership, and general e-communication usage, (2) barriers to attending office-based appointments, (3) preferences for, and interest in, e-communication for mental health care, and (4) concerns about e-communication use for mental health care. We analyzed the data descriptively and examined associations between the presence of barriers, identifying as a social media user, and interest level in e-communication. RESULTS Respondents (N=68) were predominantly in the age range of 25-54 years. The rate of mobile phone ownership was 91% (62/68), and 59% (40/68) of respondents identified as social media users. There was very low existing use of e-communication between providers and patients, with high levels of interest endorsed by survey respondents. Respondents expressed an interest in using e-communication with their provider to share updates and get feedback, coordinate care, and get general information. In regression analysis, both a barrier to care and identifying as a social media user were significantly associated with e-communication interest (P=.03 and P=.003, respectively). E-communication interest was highest among people who both had a barrier to office-based care and were a social media user. Despite high interest, there were also many concerns including privacy and loss of in-person contact. CONCLUSIONS A high burden of barriers to attending office-based care paired with a high interest in e-communication supports the integration of e-communication within our outpatient services. There may be early adopters to target: those with identified barriers to office-based care and who are active on social media. There is also a need for caution and preservation of existing services for those who choose not to, or cannot, access e-services.
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Affiliation(s)
- Minnie Rai
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada
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Hensel JM, Taylor VH, Fung K, Vigod SN. Rates of Mental Illness and Addiction among High-Cost Users of Medical Services in Ontario. Can J Psychiatry 2016; 61:358-66. [PMID: 27254845 PMCID: PMC4872244 DOI: 10.1177/0706743716644764] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To quantify the burden of mental illness and addiction among high-costing users of medical services (HCUs) using population-level data from Ontario, and compare to a referent group of nonusers. METHOD We conducted a population-level cohort study using health administrative data from fiscal year 2011-2012 for all Ontarians with valid health insurance as of April 1, 2011 (N = 10,909,351). Individuals were grouped based on medical costs for hospital, emergency, home, complex continuing, and rehabilitation care in 2011-2012: top 1%, top 2% to 5%, top 6% to 50%, bottom 50%, and a zero-cost nonuser group. The rate of diagnosed psychotic, major mood, and substance use disorders in each group was compared to the zero-cost referent group with adjusted odds ratios (AORs) for age, sex, and socioeconomic status. A sensitivity analysis included anxiety and other disorders. RESULTS Mental illness and addiction rates increased across cost groups affecting 17.0% of the top 1% of users versus 5.7% of the zero-cost group (AOR, 3.70; 95% confidence interval [CI], 3.59 to 3.81). This finding was most pronounced for psychotic disorders (3.7% vs. 0.7%; AOR, 5.07; 95% CI, 4.77 to 5.38) and persisted for mood disorders (10.0% vs. 3.3%; AOR, 3.52; 95% CI, 3.39 to 3.66) and substance use disorders (7.0% vs. 2.3%; AOR, 3.82; 95% CI, 3.66 to 3.99). When anxiety and other disorders were included, the rate of mental illness was 39.3% in the top 1% compared to 21.3% (AOR, 2.39; 95% CI, 2.34 to 2.45). CONCLUSIONS A high burden of mental illness and addiction among HCUs warrants its consideration in the design and delivery of services targeting HCUs.
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Affiliation(s)
- Jennifer M Hensel
- Department of Psychiatry, Women's College Hospital, Toronto, Ontario Department of Psychiatry, University of Toronto, Toronto, Ontario Women's College Research Institute, Toronto, Ontario
| | - Valerie H Taylor
- Department of Psychiatry, Women's College Hospital, Toronto, Ontario Department of Psychiatry, University of Toronto, Toronto, Ontario Women's College Research Institute, Toronto, Ontario
| | - Kinwah Fung
- Women's College Research Institute, Toronto, Ontario Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Simone N Vigod
- Department of Psychiatry, Women's College Hospital, Toronto, Ontario Department of Psychiatry, University of Toronto, Toronto, Ontario Women's College Research Institute, Toronto, Ontario Institute for Clinical Evaluative Sciences, Toronto, Ontario
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Hensel JM, Banayan DJ, Cheng C, Langley J, Dewa CS. Client and key worker ratings of need in first-episode psychosis early intervention programmes. Early Interv Psychiatry 2016; 10:246-51. [PMID: 25112944 DOI: 10.1111/eip.12171] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 06/18/2014] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to fill a gap in the literature by examining agreement on need as rated by clients and their key workers from first-episode psychosis early intervention programmes. Compared with adult populations and more chronic courses of illness, these clients may have unique needs given the onset of their illness in adolescence or early adulthood. METHODS Needs agreement between clients and key workers was assessed using the Camberwell Assessment of Need in a sample of 188 client-key worker pairs recruited from six early intervention programmes in Ontario, Canada. Ratings were assessed with percentage agreement and prevalence-adjusted Cohen's kappa. RESULTS At the aggregate level, both clients and key workers rated a mean of 2.6 unmet needs. Compared with other diagnoses, key workers rated significantly more unmet need in clients with primary psychotic disorders. Agreement between individual client and key worker ratings was highest (adjusted κ > 0.85) in the domains of telephone, risk to others, child care and accommodation. Lowest agreement (adjusted κ < 0.4) was found in the domains of psychological distress, sexual expression, company, daytime activities and intimate relationships. CONCLUSIONS While congruence is present in concrete domains, there is substantial variability in how clients and their key workers perceive need in more personal areas. The initial focus of care may necessarily be on needs such as shelter, food and treatment; however, subsequent care should incorporate a shared assessment of need to support strong relationships with providers and ongoing engagement in treatment.
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Affiliation(s)
- Jennifer M Hensel
- Department of Psychiatry, Women's College Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - David J Banayan
- Department of Psychiatry and Behavioural Neuroscience, University of Chicago, Chicago, Illinois, USA
| | | | - John Langley
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Psychiatry, St.Michael's Hospital, Toronto, Canada
| | - Carolyn S Dewa
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Research on Employment and Workplace Health, Centre for Addiction and Mental Health, Toronto, Canada
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Hensel JM, Grosman Kaplan K, Anvari M, Taylor VH. The impact of history of exposure to abuse on outcomes after bariatric surgery: data from the Ontario Bariatric Registry. Surg Obes Relat Dis 2016; 12:1441-1446. [PMID: 27387698 DOI: 10.1016/j.soard.2016.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 03/12/2016] [Accepted: 03/15/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies worldwide have reported an increased prevalence of abuse histories among bariatric surgery candidates. The impact of abuse history on weight loss after surgery has not been examined in Canada. OBJECTIVES Determine the prevalence of abuse and its impact on postoperative outcomes in Ontario, Canada. SETTING Data from the Ontario Bariatric Registry. METHODS A retrospective cohort study of laparoscopic gastric bypass and sleeve gastrectomy surgeries from 2010 to 2014, for which any follow-up data were available (N = 6016). Weight loss outcomes at 3 months (n = 5147), 6 months (n = 4749), and 1 year (n = 4024) were compared between those with and without a self-reported history of any of emotional, physical or sexual abuse and those with and without a history of sexual abuse specifically. Mixed repeated measures models were adjusted for age, sex, type of surgery, and baseline body mass index. One-year postoperative occurrence of revisions or repairs, hospitalization, and death were also examined. RESULTS The prevalence of documented abuse was 21.5%. Emotional abuse was most common (13.1%), followed by sexual abuse (10.6%), then physical abuse (8.9%). There was no significant association between presence of abuse history and weight loss at any time point in repeated measures analyses. CONCLUSION Abuse histories are common in bariatric surgery candidates in Ontario, but at a lower prevalence than what has been reported elsewhere. History of abuse does not appear to affect weight loss out to 1 year postoperatively and may alert providers to offer additional support perioperatively and postoperatively, particularly in the setting of psychiatric co-morbidity.
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Affiliation(s)
- Jennifer M Hensel
- Department of Psychiatry, Women's College Hospital & University of Toronto, Toronto, Ontario, Canada.
| | | | - Mehran Anvari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Valerie H Taylor
- Department of Psychiatry, Women's College Hospital & University of Toronto, Toronto, Ontario, Canada
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Abstract
Revisions to the posttraumatic stress disorder (PTSD) diagnostic criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) clarify that secondary exposure can lead to the development of impairing symptoms requiring treatment. Historically known as secondary traumatic stress (STS), this reaction occurs through repeatedly hearing the details of traumatic events experienced by others. Professionals who work therapeutically with trauma victims may be at particular risk for this exposure. This meta-analysis of 38 published studies examines 17 risk factors for STS among professionals indirectly exposed to trauma through their therapeutic work with trauma victims. Small significant effect sizes were found for trauma caseload volume (r = .16), caseload frequency (r = .12), caseload ratio (r = .19), and having a personal trauma history (r = .19). Small negative effect sizes were found for work support (r = -.17) and social support (r = -.26). Demographic variables appear to be less implicated although more work is needed that examines the role of gender in the context of particular personal traumas. Caseload frequency and personal trauma effect sizes were moderated by year of publication. Future work should examine the measurement of STS and associated impairment, understudied risk factors, and effective interventions.
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Affiliation(s)
- Jennifer M Hensel
- Centre for Research on Employment and Workplace Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry at Women's College Hospital, Toronto, Ontario, Canada
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Hensel JM, Lunsky Y, Dewa CS. Exposure to aggressive behaviour and burnout in direct support providers: The role of positive work factors. Res Dev Disabil 2015; 36C:404-412. [PMID: 25462500 DOI: 10.1016/j.ridd.2014.10.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/19/2014] [Accepted: 10/23/2014] [Indexed: 06/04/2023]
Abstract
Many direct support providers (DSPs) are exposed to aggressive behaviour in their work supporting adults with developmental disabilities service recipients. This is a work environment factor that has been linked to job burnout. The objective of this study was to examine the impact of positive work factors on emotional exhaustion (EE) among DSPs who are exposed to aggressive behaviour. Survey responses from 671 DSPs who were working in community service settings for adults with developmental disabilities, and were exposed to aggressive behaviour at least monthly were examined. Hierarchical linear regression examined the direct contribution and moderating role of positive work factors (self-efficacy for dealing with aggression and work contributions) on EE measured with the Maslach Burnout Inventory-Human Services Survey, after controlling for demographics, occupational variables, exposure to aggression and negative emotional reactions to aggression. Results showed that younger age, more experience, more depression/anger emotions in response to aggression, lower self-efficacy and low positive work contributions were significantly associated with EE. Positive work motivation was a moderator of exposure to aggression and EE. When work motivations were low, DSPs were more negatively affected by higher exposure to aggression. These findings suggest that in addition to addressing the negative emotional reactions to the aggressive behaviour encountered at work, it is also important to foster positive work factors which may be protective against EE.
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Affiliation(s)
- Jennifer M Hensel
- Centre for Research on Employment and Workplace Health, Centre for Addiction and Mental Health, 33 Russell St., Toronto, Ontario, Canada M5S 2S1.
| | - Yona Lunsky
- Dual Diagnosis Service, Centre for Addiction and Mental Health, 1001 Queen St., Toronto, Ontario, Canada M6J 1H4.
| | - Carolyn S Dewa
- Centre for Research on Employment and Workplace Health, Centre for Addiction and Mental Health, 33 Russell St., Toronto, Ontario, Canada M5S 2S1.
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Hensel JM, Flint AJ. Addressing the Access Problem for Patients with Serious Mental Illness who Require Tertiary Medical Care. J Health Care Poor Underserved 2015; 26:35-48. [DOI: 10.1353/hpu.2015.0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hensel JM, Lunsky Y, Dewa CS. The mediating effect of severity of client aggression on burnout between hospital inpatient and community residential staff who support adults with intellectual disabilities. J Clin Nurs 2013; 23:1332-41. [PMID: 24128052 DOI: 10.1111/jocn.12387] [Citation(s) in RCA: 11] [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] [Accepted: 04/01/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To compare exposure to client aggressive behaviour, perceived self-efficacy in managing this behaviour and burnout between community residential group home and specialised hospital inpatient staff who provide care for adults with intellectual disabilities (ID). To assess the mediating role of aggression exposure on burnout in these two staff groups. BACKGROUND Aggressive behaviour is a common indication for admission to hospital so these staff typically experience more frequent and severe forms compared to staff working in the community. There have been mixed results in few studies examining burnout and perceived self-efficacy between these two groups. DESIGN This study used a demographically matched sample of cross-sectional survey data from community residential group home and hospital staff who care for adults with ID in Ontario, Canada. METHODS Exposure to aggression, perceived self-efficacy and burnout were compared for 42 matched pairs using descriptive statistics. A mediation analysis was used to examine the role of aggression severity in the relationship between care setting and burnout. RESULTS Hospital staff were exposed to more severe client aggression and scored higher in emotional exhaustion (EE). There were no differences in perceived self-efficacy. Severity of aggression was a partial mediator of the higher EE among hospital staff. CONCLUSIONS Exposure to more severe forms of client aggression among hospital staff contributes, at least in part, to them feeling more emotionally exhausted. This study contributes to further understanding exposure to aggression in these different settings and the impact it can have on emotional outcomes. RELEVANCE TO CLINICAL PRACTICE There may be a role for policy and resource development aimed at reducing aggression and preventing or managing the associated emotional consequences. This is particularly true in hospitals, where aggression is most severe.
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Affiliation(s)
- Jennifer M Hensel
- Centre for Research on Employment and Workplace Health, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Hensel JM, Lunsky Y, Dewa CS. Exposure to client aggression and burnout among community staff who support adults with intellectual disabilities in Ontario, Canada. J Intellect Disabil Res 2012; 56:910-915. [PMID: 21988339 DOI: 10.1111/j.1365-2788.2011.01493.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Studies have shown that staff who support adults with intellectual disabilities (ID) are exposed to challenging behaviour in their work including client aggression. Exposure to aggressive behaviour has been associated with staff stress and burnout. Study samples have been small however, and there has been very little data exploring this issue among North American staff. METHODS A cross-sectional survey which included demographics, measures of frequency and severity (including perceived severity and a standardised severity score) of exposure to client aggression and the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) was completed by 926 community staff who support adults with ID in Ontario, Canada. Relationships between demographic variables and exposure to aggression were examined with descriptive statistics. Pearson correlations were used to analyse exposure variables and MBI-HSS scores. RESULTS Nearly all staff reported being exposed to client aggression in the prior 6 months. Mean MBI-HSS scores were comparable to previously published data in similar populations with the exception of a higher score in the personal accomplishment domain. All measures of exposure to aggression were significantly positively correlated with MBI-HSS scores in the emotional exhaustion and depersonalisation dimensions of burnout. CONCLUSIONS The prevalence of burnout in this North American sample is comparable to what has been reported in similar populations in other locations, although these staff may have a higher sense of accomplishment with regard to their work. Findings from this large sample support the evidence that exposure to client aggression affects staff emotional well-being but is by no means the only important factor. Further study is needed to explore the differences and similarities reported here as well as other contributing factors which will guide the implementation of effective strategies to improve staff well-being.
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Affiliation(s)
- J M Hensel
- Centre for Research on Employment and Workplace Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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Hensel JM, Bender A, Bacchiochi J, Dewa CS. Factors associated with working status among workers assessed at a specialized worker's compensation board psychological trauma program. Am J Ind Med 2011; 54:552-9. [PMID: 21360724 DOI: 10.1002/ajim.20944] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND Psychological morbidity following trauma occurring in the workplace can impact return to work but few studies have investigated this. METHODS This study was a secondary analysis of administrative data from a specialized workers' compensation board psychological trauma program in Toronto, Canada. Unadjusted and adjusted logistic regression analyses were used to examine factors associated with working status at the time of assessment for workers referred within 1 year of traumatic event. RESULTS Having a disrupted marriage (OR = 3.06, 95% CI 1.14-8.20), sustaining a permanently impairing physical injury (OR = 2.76, 95% CI 1.01-7.55) and the presence of secondary psychiatric diagnoses (OR = 2.55, 95% CI 1.34-4.83) were significantly associated with not working at the time of assessment. When the analyses were subset to workers without permanently impairing physical injuries, only the presence of additional psychiatric diagnoses was significantly associated with not working (OR = 3.81, 95% CI 1.48-9.83). CONCLUSIONS Return to work after trauma can be a complicated and difficult to treat problem. Social supports, physical rehabilitation and treatment of complex mental health problems likely play a crucial role in improving outcomes.
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Affiliation(s)
- Jennifer M Hensel
- Work and Well-Being Research and Evaluation Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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Hensel JM, Ménard C, Chung PWM, Milosevic MF, Kirilova A, Moseley JL, Haider MA, Brock KK. Development of Multiorgan Finite Element-Based Prostate Deformation Model Enabling Registration of Endorectal Coil Magnetic Resonance Imaging for Radiotherapy Planning. Int J Radiat Oncol Biol Phys 2007; 68:1522-8. [PMID: 17674983 DOI: 10.1016/j.ijrobp.2007.04.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [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: 10/25/2006] [Revised: 04/03/2007] [Accepted: 04/03/2007] [Indexed: 11/25/2022]
Abstract
PURPOSE Endorectal coil (ERC) magnetic resonance imaging (MRI) provides superior visualization of the prostate compared with computed tomography at the expense of deformation. This study aimed to develop a multiorgan finite element deformable method, Morfeus, to accurately co-register these images for radiotherapy planning. METHODS Patients with prostate cancer underwent fiducial marker implantation and computed tomography simulation for radiotherapy planning. A series of axial MRI scans were acquired with and without an ERC. The prostate, bladder, rectum, and pubic bones were manually segmented and assigned linear elastic material properties. Morfeus mapped the surface of the bladder and rectum between two imaged states, calculating the deformation of the prostate through biomechanical properties. The accuracy of deformation was measured as fiducial marker error and residual surface deformation between the inferred and actual prostate. The deformation map was inverted to deform from 100 cm(3) to no coil. RESULTS The data from 19 patients were analyzed. Significant prostate deformation occurred with the ERC (mean intrapatient range, 0.88 +/- 0.25 cm). The mean vector error in fiducial marker position (n = 57) was 0.22 +/- 0.09 cm, and the mean vector residual surface deformation (n = 19) was 0.15 +/- 0.06 cm for deformation from no coil to 100-cm(3) ERC, with an image vector resolution of 0.22 cm. Accurately deformed MRI scans improved soft-tissue resolution of the anatomy for radiotherapy planning. CONCLUSIONS This method of multiorgan deformable registration enabled accurate co-registration of ERC-MRI scans with computed tomography treatment planning images. Superior structural detail was visible on ERC-MRI, which has potential for improving target delineation.
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Affiliation(s)
- Jennifer M Hensel
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON, Canada
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Hensel JM, Shandling M, Redelmeier DA. Rural medical students at urban medical schools: Too few and far between? Open Med 2007; 1:e13-7. [PMID: 20101285 PMCID: PMC2801916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 10/29/2006] [Accepted: 10/30/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rural regions of industrialized nations are experiencing a crisis in health care access, reflecting a high disease burden and a low physician supply. The maldistribution of physicians stems partly from the low rate of entry into medical school of applicants from rural backgrounds. METHODS We analyzed applicants to the University of Toronto medical school in 2005 (n = 2052) to test for possible institutional bias against rural applicants and possible applicant bias against the institution. The designation of rurality was assigned using the Statistics Canada classification of residential postal codes to detect residence in communities with a population of fewer than 10,000 people. RESULTS Consistent with past reports, rural applicants were under-represented (n = 93, 4.5% of applicants relative to 20% of baseline population). Rural applicants, on average, were equally competitive with urban applicants as measured by grades, test scores, and interviews. Rural applicants were just as likely as urban applicants to be offered admission (17% vs 14%, p = 0.43), indicating no large bias from the institution. Rural applicants, however, were more than twice as likely to decline the admission offer (69% vs 24%, p < 0.001), indicating a large bias against the institution. This discrepancy was not explained by financial disparity and was not confined to those applicants most likely to receive invitations to other schools. CONCLUSIONS Programs to increase physician supply in rural areas need to address students' concealed preferences that are established before enrolment. Medical schools, in particular, need to encourage more rural students to apply and to persuade those offered admission to accept.
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Shupak NM, Hensel JM, Cross-Mellor SK, Kavaliers M, Prato FS, Thomas AW. Analgesic and behavioral effects of a 100 μT specific pulsed extremely low frequency magnetic field on control and morphine treated CF-1 mice. Neurosci Lett 2004; 354:30-3. [PMID: 14698475 DOI: 10.1016/j.neulet.2003.09.063] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [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: 11/25/2022]
Abstract
Diverse studies have shown that magnetic fields can affect behavioral and physiological functions. Previously, we have shown that sinusoidal extremely low frequency magnetic fields and specific pulsed magnetic fields (Cnps) can produce alterations in the analgesia-related behavior of the land snail. Here, we have extended these studies to show an induction of analgesia in mice equivalent to a moderate dose of morphine (5 mg/kg), and the effect of both Cnp exposure and morphine injection on some open-field activity. Cnp exposure was found to prolong the response latency to a nociceptive thermal stimulus (hot plate). Cnp+morphine offset the increased movement activity found with morphine alone. These results suggest that pulsed magnetic fields can induce analgesic behavior in mice without the side effects often associated with opiates like morphine.
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Affiliation(s)
- Naomi M Shupak
- Bioelectromagnetics, Lawson Health Research Institute, Department of Nuclear Medicine, St. Joseph's Health Care, 268 Grosvenor Street, London, Ont. N6A 4V2, Canada
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Abstract
Abdominoplasty is a popular body-contouring procedure. In this study the authors review retrospectively 199 abdominoplasty patients during a 15-year period to identify factors that affect overall outcome. Patients included 190 women and 9 men. The complication rate was 32% with few major complications (1.4%). The revision rate was 43%, and was related to fine-tuning the aesthetic appearance. Patients were divided into four groups based on tobacco use and history of diabetes and hypertension. There was no significant difference in revision rates or major complications between the subgroups. Minor complication rates, however, were significantly higher in smokers and patients with diabetes and/or hypertension. Complication and revision rates in patients undergoing intra-abdominal procedures combined with abdominoplasty were not significantly different from those patients undergoing abdominoplasty alone. A patient survey revealed symptom improvement in 95% of patients. Eighty-six percent of patients were satisfied with their result, and 86% would recommend abdominoplasty to a friend. The authors conclude that abdominoplasty is a safe and satisfying procedure, whether performed alone or in conjunction with another procedure. Patients are pleased with the outcome and have improvement in their symptoms, with minimal health risk. There is, however, a significant incidence of minor complications, related primarily to wound healing. These complications are increased significantly in smokers and patients with diabetes and/or hypertension. Revision rates are not different significantly between the subgroups. When complications do occur or revisions are required, they are minor and managed easily in an office setting.
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Affiliation(s)
- J M Hensel
- Northeastern Ohio Universities College of Medicine, Rootstown, OH, USA
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