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Isenberg BM, Becker KD, Wu E, Park HS, Chu W, Keenan-Miller D, Chorpita BF. Toward Efficient, Sustainable, and Scalable Methods of Treatment Characterization: An Investigation of Coding Clinical Practice from Chart Notes. Adm Policy Ment Health 2024; 51:103-122. [PMID: 38032421 DOI: 10.1007/s10488-023-01316-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE Chart notes provide a low-cost data source that could help characterize what occurs in treatment with sufficient precision to improve management of care. This study assessed the interrater reliability of treatment content coded from chart notes and evaluated its concordance with content coded from transcribed treatment sessions. METHOD Fifty randomly selected and digitally recorded treatment events were transcribed and coded for practice content. Independent coders then applied the same code system to chart notes for these same treatment events. ANALYSIS We measured reliability and concordance of practice occurrence and extensiveness at two levels of specificity: practices (full procedures) and steps (subcomponents of those procedures). RESULTS For chart notes, practices had moderate interrater reliability (M k = 0.50, M ICC = 0.56) and steps had moderate (M ICC = 0.74) to substantial interrater reliability (M k = 0.78). On average, 2.54 practices and 5.64 steps were coded per chart note and 4.53 practices and 13.10 steps per transcript. Across sources, ratings for 64% of practices and 41% of steps correlated significantly, with those with significant correlations generally demonstrating moderate concordance (practice M r = 0.48; step M r = 0.47). Forty one percent of practices and 34% of steps from transcripts were also identified in the corresponding chart notes. CONCLUSION Chart notes provide an accessible data source for evaluating treatment content, with different levels of specificity posing tradeoffs for validity and reliability, which in turn may have implications for chart note interfaces, training, and new metrics to support accurate, reliable, and efficient measurement of clinical practice.
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Affiliation(s)
- Benjamin M Isenberg
- Department of Psychology, University of California Los Angeles, Franz Hall, Los Angeles, CA, 90095, United States of America
| | - Kimberly D Becker
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, SC, 29208, United States of America
| | - Eleanor Wu
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, SC, 29208, United States of America
| | - Hyun Seon Park
- Department of Psychology, University of California Los Angeles, Franz Hall, Los Angeles, CA, 90095, United States of America
| | - Wendy Chu
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, SC, 29208, United States of America
| | - Danielle Keenan-Miller
- Department of Psychology, University of California Los Angeles, Franz Hall, Los Angeles, CA, 90095, United States of America
| | - Bruce F Chorpita
- Department of Psychology, University of California Los Angeles, Franz Hall, Los Angeles, CA, 90095, United States of America.
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Wood MD, Smith JL, Healey H, Görges M, Lokker C. Enhanced recovery support for people with eating disorders during the COVID-19 pandemic: quality improvement using a web-based, stepped-care programme in Canada. BMJ Open Qual 2023; 12:e002366. [PMID: 37935516 PMCID: PMC10632883 DOI: 10.1136/bmjoq-2023-002366] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Throughout the COVID-19 pandemic, the number of individuals struggling with eating disorders (EDs) increased substantially. Body Brave (a not-for-profit) created and implemented a web-based stepped-care Recovery Support Programme (RSP) to improve access to community-based ED services. This quality improvement study describes the RSP and assesses its ability to deliver timely access to treatment and platform engagement. METHODS We conducted a retrospective cohort study comparing access to, and use of Body Brave services 6 months before and 12 months after implementation of the RSP platform (using 6-month increments for two postimplementation periods). Primary programme quality measures included registration requests, number of participants onboarded and time to access services; secondary measures included use of RSP action plans, attendance for recovery sessions and workshops, number of participants accessing treatment and text-based patient experience data. RESULTS A substantial increase in registration requests was observed during the first postimplementation period compared with the preimplementation period (176.5 vs 85.5; p=0.028). When compared with the preimplementation period, the second postimplementation observed a significantly larger percentage of successfully onboarded participants (76.6 vs 37.9; p<0.01) and a reduction in the number of days to access services (2 days vs 31 days; p<0.01). Although participant feedback rates were low, many users found the RSP helpful, easy to access, user-friendly and were satisfied overall. Users provided suggestions for improvement (eg, a platform instructional video, offer multiple times of day for live sessions and drop-in hours). CONCLUSIONS Although clinical benefit needs to be assessed, our findings demonstrate that the RSP enabled participants to quickly onboard and access initial services and have informed subsequent improvements. Understanding initial programme effects and usage will help assess the feasibility of adapting and expanding the RSP across Canada to address the urgent need for low-barrier, patient-centred ED care.
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Affiliation(s)
- Michael D Wood
- Department of Anesthesiology Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
- Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Hannah Healey
- Department of Health and Rehabilitation Sciences, Health Professional Education, Western University, London, Ontario, Canada
| | - Matthias Görges
- Department of Anesthesiology Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
- Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Cynthia Lokker
- Department of Health Research, Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Cordero DA. The COVID-19 Pandemic Memoir: Lessons for Future Challenges. Disaster Med Public Health Prep 2023; 17:e453. [PMID: 37605985 DOI: 10.1017/dmp.2023.124] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Dalmacito A Cordero
- Department of Theology and Religious Education (DTRE), De La Salle University, 1004 Taft Avenue, Manila, Philippines
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Mousavizadeh SN, Jandaghian Bidgoli MA. Recovery-Oriented Practices in Community-based Mental Health Services: A Systematic Review. Iran J Psychiatry 2023; 18:332-351. [PMID: 37575606 PMCID: PMC10422940 DOI: 10.18502/ijps.v18i3.13013] [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] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 08/15/2023]
Abstract
Objective: New initiatives are needed to manage patients with mental health problems in the community. Among the core principal ideals of any healthcare system is transition from traditional services to community-based practices. The aim of this study was to assess community-based and recovery-oriented practices and interventions for individuals with mental health problems. Method : MESH keywords, including "mental health recovery", "rehabilitation", "aftercare", "community psychiatry", and "mental health service" were searched in scientific databases such as Medline, EMBASE, PsychInfo, CINAHL, and Cochrane up to July 2022. A snowball search was also conducted on eligible studies. The methodological quality of the studies was determined by Kmet standard criteria. Results: The systematic review included 32 studies, all of which demonstrated a moderate to high promising effect for community-based and recovery-oriented practices or programs on patients with severe mental illness. These practices could help patients to find suitable jobs, avoid isolation and stigma, improve communication skills, increase awareness of problems, and foster independence. The study also highlighted the pivotal role of nurses, artistic and sports activities, electronic (E)-mental health, home visits, psychoeducation, and special recovery programs. Conclusion: Community-based and recovery-oriented practices should be used as an effective means of normalizing the lives of psychiatric patients. In essence, by cultivating hope and empowering these patients, many of the concerns of health systems can be eradicated.
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Affiliation(s)
- Seyedeh Narjes Mousavizadeh
- Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Khalid K, Jamaluddin R, Ismail MS. Enhancing employment outcome among stable psychiatric patients: lesson learnt on innovative model of work inclusion. BMJ Open Qual 2023; 12:bmjoq-2022-002139. [PMID: 37277216 DOI: 10.1136/bmjoq-2022-002139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/28/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Poor employment rate among psychiatric patients is poorly discussed. PURPOSE To share our strategies in boosting employment rate among stable psychiatric patients and discuss the lessons learnt. PARTICULAR FOCUS Multifaceted strategies were remodelled to ensure a three-dimensional optimisation: (1) strengthening clinical service to ensure stable disease and appropriate patient selection through battery of assessments, (2) provision of psychosocial support to boost self-esteem and foster discipline among patients through encouragement, guidance and regular monitoring by the multidisciplinary community mental health team and (3) encourage willingness and confidence among stakeholders and local market to host job opportunities to stable mental health patients. OVERVIEW The yearly employment rate among our stable psychiatric patients under supported employment programme from 2020 to 2021 was 28.6% (2/7) and 30.0% (3/10), respectively. A qualitative survey found the main hindrance to recruitment were employers' scepticism on work performance, while poor work retention was due to patients' lack of specific skill set and discipline to adhere to routine. We restructured our supported employment programme by adding the role of community mental health facility to foster discipline and routine for 6 months prior to referral to a job coach. Until June 2022, two out of five patients managed to secure job positions (40.0%). Despite our efforts to improve employment with the instituted remedial strategy, we still fail to reach the minimum standard set by ministry. Future plan will focus on tailoring individual interests to a specific set of skills that match industrial expectation prior to seeking employment. Additionally, enhancing public education using social media may foster better inclusion of psychiatric patients and social acceptance.
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Affiliation(s)
- Karniza Khalid
- Clinical Research Centre, Hospital Tuanku Fauziah, Ministry of Health Malaysia, Kangar, Malaysia
- Specialised Diagnostic Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Ruzita Jamaluddin
- Department of Psychiatry and Mental Health, Hospital Tuanku Fauziah, Ministry of Health Malaysia, Kangar, Malaysia
| | - Mohd Safiee Ismail
- Director's Office, Hospital Tuanku Fauziah, Ministry of Health Malaysia, Kangar, Malaysia
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Tiksnadi BB, Triani N, Fihaya FY, Turu' Allo IJ, Iskandar S, Putri DAE. Validation of Hospital Anxiety and Depression Scale in an Indonesian population: a scale adaptation study. Fam Med Community Health 2023; 11:fmch-2022-001775. [PMID: 37277187 DOI: 10.1136/fmch-2022-001775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE This study aims to adapt the English-language Hospital Anxiety and Depression Scale (HADS) to the Indonesian language and evaluate the validity and reliability of the adapted version (ie, HADS-Indonesia). DESIGN A cross-sectional study was conducted between June and November 2018. First, a translation and back-translation process was conducted by a committee consisting of the researchers, a psychiatrist, a methodology consultant and two translators. Face and convergent validity and test-retest reliability evaluations were conducted. Next, structural validity and internal consistency analyses were performed. An intraclass correlation coefficient (ICC) test evaluated the scale's test-retest reliability. A Spearman's rank correlation coefficient was calculated to evaluate the correlation between HADS-Indonesia and Zung's Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) for convergent validity evidence. Next, a structural validity analysis using exploratory factor analysis (EFA) and an internal consistency evaluation based on Cronbach's alpha was conducted. SETTING This study was conducted in three villages in Jatinangor subdistrict, Sumedang Regency, West Java province, Indonesia; the villages were chosen based on their profiles. PARTICIPANTS A total of 200 participants (male: n=91, 45.50% and female: n=109, 54.50%), with a mean age of 42.41 (14.25) years, were enrolled in this study using a convenience sampling method. The inclusion criteria were age ≥18 years old with basic Indonesian language literacy. RESULTS The overall HADS-Indonesia's ICC value was 0.98. There was a significant positive correlation between HADS-Indonesia's anxiety subscale and Zung's SAS (rs=0.45, p=0.030) and between the depression subscale of HADS-Indonesia and Zung's SDS (rs=0.58, p<0.001). The Kaiser-Meyer-Olkin statistics (KMO) (KMO=0.89) and Bartlett's test of sphericity (χ2(91, N=200)=1052.38, p<0.001)) indicated an adequate number of samples for EFA. All items' commonality was >0.40 and the average inter-item correlation was 0.36. EFA yielded a 2-factor solution explaining 50.80% (40.40%+10.40%) of the total variance. All items from the original HADS were retained, including its original subscales. The adapted HADS-Anxiety subscale consisted of seven items (alpha=0.85), and the HADS-Depression subscale consisted of seven items (alpha=0.80). CONCLUSIONS HADS-Indonesia is a valid and reliable instrument for use in the general population of Indonesia. However, further studies are warranted to provide more sophisticated validity and reliability evidence.
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Affiliation(s)
- Badai Bhatara Tiksnadi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran / Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Nurlita Triani
- Department of Psychiatry, Faculty of Medicine, Universitas Padjadjaran / Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Faris Yuflih Fihaya
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran / Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Iswandy Janetputra Turu' Allo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran / Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Shelly Iskandar
- Department of Psychiatry, Faculty of Medicine, Universitas Padjadjaran / Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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Estrada-Zambrano N, Martinez-Ferreira C, Reyes-Figueroa J. [CLINICAL AND FUNCTIONAL OUTCOMES IN DAY HOSPITALS IN TIMES OF COVID-19]. Rev Colomb Psiquiatr 2022:S0034-7450(22)00136-6. [PMID: 36590102 PMCID: PMC9790863 DOI: 10.1016/j.rcp.2022.12.001] [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] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 12/02/2022] [Indexed: 12/27/2022]
Abstract
Objective - Mental health services have been clearly affected by the pandemic and its restrictions. In our day hospital units users attended on fewer days, group therapy was drastically reduced, the number of users in groups was limited and individual and group teletherapy was initiated. This study evaluates the impact of these changes on clinical and functional outcomes.Methods - This is a descriptive study prospectively comparing two cohorts of users: those admitted and discharged from our day hospitals before or during the pandemic. All users received a multidisciplinary assessment at admission and discharge including clinician and user-rated scales on psychopathology, daily living skills, quality of life and caregiver burdens. Improvement in both groups was compared.Results - Both cohorts were homogenous at admission. Length of admission was not different for the two groups, but users admitted during the pandemic attended the day hospital on significantly fewer days. Improvement observed in most scales was equivalent in both groups, suggesting a similar evolution of both cohorts.Conclusions - Despite the reduction in assistance days and group therapeutic interventions no major changes were found in the outcomes of both groups. This study shows that careful adaptations and availability, even in critical situations, can result in equally effective treatments. Further research is essential to determine which of these adaptations should be maintained beyond the pandemic.
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Affiliation(s)
- Núria Estrada-Zambrano
- Clinical psychology specialist. Hospital Universitari Institut Pere Mata. Hospital de Dia, Calle Rebolledo 3, 43004 Tarragona, Spain
| | - Catarina Martinez-Ferreira
- Occupational therapy degree. Hospital Universitari Institut Pere Mata. Hospital de Dia, Calle Rebolledo 3, 43004 Tarragona, Spain
| | - Julio Reyes-Figueroa
- Medicine degree, specialist in psychiatry. Hospital Universitari Institut Pere Mata. Hospital de Dia, Calle Rebolledo 3, 43004 Tarragona, Spain
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Rains LS, Dalton-Locke C, Landau S, Needle JJ, Johnson S. Variations in the uptake of telemental health technologies in community and crisis mental health services during the early pandemic: a survey of mental health professionals in the UK. BMC Psychiatry 2022; 22:776. [PMID: 36494646 PMCID: PMC9733196 DOI: 10.1186/s12888-022-04385-1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND One of the many challenges faced by mental health services during the COVID-19 pandemic was how to deliver care during lockdown. In community and crisis services, this often meant rapidly adopting or expanding the use of telemental health technologies, including phone and video calls. The aim of this study is to explore variations in use and report staff views of such technologies during the early stages of the pandemic. The primary analysis compared rates of use between professions, demographic groups, genders, regions, and crisis and community services. METHODS We used data from an online survey conducted by the Mental Health Policy Research Unit in Spring 2020 regarding the impact of the pandemic on mental healthcare in the United Kingdom. We included quantitative data from all professional groups working in community or crisis services providing care to working age adults, including general and specialist services. Our outcome of interest was the percentage of clients whom clinicians primarily interacted with via videocall. We also collected demographics and professional characteristics such as the type of mental health service respondents worked in. In addition, we explored respondents' views and experiences of telemental health as a medium for providing care. RESULTS 978 participants were included in the primary analysis (834 provided outcome data for community services, 193 for crisis services). In community services, virtually all staff reported stopping some or all face-to-face appointments following the onset of the pandemic, with a large majority using video or phone call appointments where possible instead. Telemental health use was higher in community than in crisis services, and amongst professionals who mainly provided psychotherapy or peer support than in other groups. There was also evidence of use being lower in regions in Northern England, Scotland, and Wales than elsewhere. There was no evidence of an association with staff gender, age, or ethnicity. Staff were generally positive about telemental health and intended to make more use of technologies following the pandemic. However, significant barriers to its use were also reported, often involving skills and available infrastructure. CONCLUSIONS Despite its rapid implementation, telemental health was viewed positively by clinicians who saw it as an effective alternative to face-to-face appointments in some contexts, including during the pandemic. However, adoption of the technology also has the potential to exacerbate existing or create new inequalities without effective management of training and infrastructure needs.
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Affiliation(s)
- Luke Sheridan Rains
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, UK.
| | - Christian Dalton-Locke
- grid.83440.3b0000000121901201Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, UK
| | - Sabine Landau
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Justin J. Needle
- grid.4464.20000 0001 2161 2573Centre for Health Services Research, School of Health Sciences, City, University of London, London, UK
| | - Sonia Johnson
- grid.83440.3b0000000121901201Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, UK ,grid.450564.60000 0000 8609 9937Camden and Islington NHS Foundation Trust, London, UK
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Starks SL, Kelly EL, Castillo EG, Meldrum ML, Bourgois P, Braslow JT. Client Outreach in Los Angeles County's Assisted Outpatient Treatment Program: Strategies and Barriers to Engagement. Res Soc Work Pract 2022; 32:839-854. [PMID: 36081900 PMCID: PMC9447859 DOI: 10.1177/1049731520949918] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose Assisted Outpatient Treatment (AOT) programs can compel treatment-refusing individuals to participate in mental health treatment via civil court order. In California's AOT programs, individuals first must be offered 30 days of outreach services and can accept services voluntarily. This study examines the use of outreach strategies in an AOT program with the potential for voluntary or involuntary enrollment. Methods Outreach staff completed a survey in which they reported and rated outreach strategies and barriers to treatment for 487 AOT-referred individuals. Results Outreach staff reported using a broad array of strategies to persuade and engage clients. Supportive and persuasive strategies were most common. More coercive strategies, including court order, were used when needed. More clients enrolled voluntarily (39.4%) than involuntarily (7.2%). Conclusions Outreach, coupled with the strategic used of potential court involvement, can lead to voluntary enrollment of treatment-refusing individuals with many, often severe, barriers to engaging in outpatient treatment.
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Affiliation(s)
- Sarah L. Starks
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
| | - Erin L. Kelly
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Enrico G. Castillo
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
- Los Angeles County Department of Mental Health
| | - Marcia L. Meldrum
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
| | - Philippe Bourgois
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
| | - Joel T. Braslow
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
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Wilson AB, Phillips J, Parisi A, Ishler KJ, Villodas M, Francis A. Patterns in Medicaid Coverage and Service Utilization Among People with Serious Mental Illnesses. Community Ment Health J 2022; 58:729-39. [PMID: 34448985 DOI: 10.1007/s10597-021-00878-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
Disruptions in Medicaid adversely affect service use and outcomes among individuals with serious mental illnesses (SMI). A retrospective longitudinal study examined Medicaid coverage and service utilization patterns among individuals with SMI (N = 8358) from 2007 to 2010. Only 36% of participants were continuously enrolled in Medicaid and 20% experienced multiple enrollment disruptions. Mental health diagnosis did not predict continuous coverage; however, individuals with schizophrenia were 19% more likely to have multiple coverage disruptions than those with depression (b = - 0.21; p < 0.01). Single and multiple coverage disruptions were associated with decreased rates of outpatient service days utilized (IRR = 0.77 and 0.65, respectively, p < 0.001) and decreased odds of not using acute care services (OR 0.26 and 0.19, respectively, p < 0.001). Future research should explore mechanisms underlying Medicaid stability and develop interventions that facilitate insurance stability and service utilization.
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11
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Jannati N, Farokhzadian J, Ahmadian L. The Experience of Healthcare Professionals Providing Mental Health Services to Mothers with Postpartum Depression: A qualitative study. Sultan Qaboos Univ Med J 2021; 21:554-562. [PMID: 34888074 PMCID: PMC8631231 DOI: 10.18295/squmj.4.2021.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/02/2020] [Accepted: 10/27/2020] [Indexed: 11/27/2022] Open
Abstract
Objectives This study aimed to describe the experience of healthcare professionals in
providing mental health services to women with postpartum depression
(PPD). Methods In this qualitative study, data were collected through semi-structured
interviews with five physicians, five midwives and five psychologists from
14 urban healthcare centres in Kerman, Iran, from April 2019 to September
2019. Purposeful sampling was used to select the participants. Data were
qualitatively analysed using a content analysis approach. Results Data analysis revealed the main theme of the study: ‘the long way
ahead for comprehensive, integrated and responsive mental health
services’. This theme included four categories: ‘postpartum
depression challenges’, ‘social and personal
factors’, ‘structural challenges’ and ‘need
for change in mental health services’. The participants described
that depression diagnosis is difficult due to insufficient knowledge among
healthcare providers and the hidden signs of PPD. They also described how
different factors such as economic and cultural factors, personality traits,
a community’s lack of knowledge, negative attitude towards
depression and limited family support might cause depression. Moreover,
providing mental health services involves certain challenges, such as
limited human resources, insufficient financial resources and incomplete or
inefficient policy-making. Conclusion Although measures have been taken to provide mental health services, there
are many challenges regarding providing mental health services to mothers.
Therefore, serious measures should be taken to improve mental health
services and re-define the existing measures. Informing the community,
empowering the healthcare providers and attempting to change the
community’s attitudes and beliefs can affect the mental healthcare
of women with depression.
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Affiliation(s)
| | - Jamileh Farokhzadian
- Nursing Research Center, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Leila Ahmadian
- Neuroscience Research Center, Institute of Neuropharmacology
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Dos Santos Treichel CA, Bakolis I, Onocko-Campos RT. Determinants of timely access to Specialized Mental Health Services and maintenance of a link with primary care: a cross-sectional study. Int J Ment Health Syst 2021; 15:84. [PMID: 34863218 PMCID: PMC8645081 DOI: 10.1186/s13033-021-00507-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although access to specialized services is one of the main components of the study of paths to mental health care worldwide, the factors related to the continuity of the patient’s link with Primary Care after admission to a Specialized Mental Health Services still need to be explored in greater depth. Thus, this study aimed to evaluate the determinants of timely access to Specialized Mental Health Services (outcome 1) and maintenance of a link with Primary Care after patients’ admission (outcome 2). Methods This is a cross-sectional study, conducted with 341 users of Specialized Mental Health Services at outpatient and community level in a medium-sized city in Brazil between August and November 2019. Associations between the outcomes and the other variables were explored with the use of Poisson regression models with robust variance estimators. Results Factors positively associated with timely access were the diagnosis of psychosis or psychoactive substance misuse. The inversely associated factors with this outcome were higher income, having their need for mental health care identified in an appointment for general complaints, having been referred to the current service by Primary Care, having attended the current service for up to 3 years and delay until the first appointment (in a previous service). Regarding the maintenance of a link with Primary Care, factors positively associated were being referred to the current service by Primary Care or private service and receiving visits from Community Health Agents. The inversely associated factors with this outcome were male sex, being employed, having a diagnosis of psychosis or psychoactive substance misuse, and a greater perception of social support. Conclusions In addition to individual factors, factors related to the organization of services and the referral between them stood out in influencing both the access and maintenance of the patients’ link with Primary Care. Thus, this study reinforces the idea that integration between Primary Care and Specialized Mental Health Services should be strengthened, both to reduce waiting times for between-service referrals and benefit of care continuity.
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Affiliation(s)
- Carlos Alberto Dos Santos Treichel
- Department of Collective Health, School of Medical Sciences, University of Campinas, St. Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz., Campinas, SP, Zip code 13083-887, Brazil.
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rosana Teresa Onocko-Campos
- Department of Collective Health, School of Medical Sciences, University of Campinas, St. Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz., Campinas, SP, Zip code 13083-887, Brazil
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13
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Cervantes PE, Matheis M, Estabillo J, Seag DEM, Nelson KL, Peth-Pierce R, Hoagwood KE, Horwitz SM. Trends Over a Decade in NIH Funding for Autism Spectrum Disorder Services Research. J Autism Dev Disord 2020; 51:2751-2763. [PMID: 33040269 DOI: 10.1007/s10803-020-04746-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 12/15/2022]
Abstract
Investments in autism spectrum disorder (ASD) research, guided by the Interagency Autism Coordinating Committee (IACC), have focused disproportionately on etiology over a well-established stakeholder priority area: research to improve accessibility and quality of community-based services. This study analyzed National Institutes of Health ASD services research funding from 2008 to 2018 to examine funding patterns, evaluate the impact of IACC objectives, and identify future directions. Approximately 9% of total funds were allocated to services research. This investment remained relatively stable across time and lacked diversity across domains (e.g., area of focus, ages sampled, implementation strategies used). While advancements were observed, including increased prevalence of projects focused on adult samples and on dissemination/implementation and prevention areas, greater investment in service research is critically needed.
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Affiliation(s)
- Paige E Cervantes
- Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, NY, USA.
| | - Maya Matheis
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Jasper Estabillo
- Tarjan Center, Jane & Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | - Dana E M Seag
- Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, NY, USA
| | - Katherine L Nelson
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | | | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, NY, USA
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Takeuchi S, So R. Effect of a hospital-based multidisciplinary outreach service on readmission prevention for first-episode schizophrenia: A propensity score-matched cohort study. Asian J Psychiatr 2020; 52:102133. [PMID: 32361474 DOI: 10.1016/j.ajp.2020.102133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
Multidisciplinary outreach services are promising approaches in preventing relapse of people with first-episode schizophrenia. Previous studies have evaluated the effect of multidisciplinary outreach services on readmission prevention, but results were inconsistent. Therefore, we conducted a single-centre, retrospective, propensity score-matched cohort study to determine whether multidisciplinary outreach services for people with first-episode schizophrenia effectively prevent readmission in Japanese real-world settings. We adjusted potential confounding factors prospectively collected for another study. The primary outcome measure was days until readmission. We used data from 124 people with first-episode schizophrenia for matching and included 86 matched patients in the analyses; 43 patients with multidisciplinary outreach services and 43 without. The result showed that the percentage of patients not readmitted with and without multidisciplinary outreach services were 77% and 72% at 6 months, 63% and 67% at 12 months, and 53% and 67% at 18 months. Although not statistically significant, the risk of compulsory readmission was less in the group with multidisciplinary outreach services than in the group without. In conclusion, we failed to demonstrate that our hospital-based multidisciplinary outreach service had a significant effect on first-episode schizophrenia patients following their first hospitalisation. Improved treatment adherence in the group with multidisciplinary outreach services could be a reason for our insignificant readmission results. Larger real-world studies with detailed confounding data would be needed to confirm our results.
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Affiliation(s)
- Sayako Takeuchi
- Department of Psychiatry, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Ryuhei So
- Department of Psychiatry, Okayama Psychiatric Medical Center, Okayama, Japan.
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15
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Madoz-Gúrpide A, Ballesteros Martín JC, Leira Sanmartín M, García Yagüe E. [The Need of a New Integral Approach to the Care of Patient with Severe Mental Disorder Thirty Years after the Psychiatric Reform]. Rev Esp Salud Publica 2017; 91:e201701007. [PMID: 28098133] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/21/2016] [Indexed: 06/06/2023] Open
Abstract
More than thirty years have passed since the beginning of the psychiatric reform, a period of intense and relevant social, scientific and cultural changes which have directly impacted on mental disorders and their management. Improvement in psychopharmacological treatment, a new model of physician-patient relationship, patient´s empowerment as a key issue and the fight against social stigma related to mental health disorders, changes in clinical governance and health policy, the assistential burden derived from the treatment of less severe pathology in mental health community centers, improvements in teamwork and coordination with other resources involved… are some of the relevant changes which determine the scene of community-based mental health assistance. We think this is a right time to check the state of the community-based care programmes for severe mental disorders, and the role of mental health center. We propose to have a reflexion about two relevant topics: where we are and where we are heading.
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Affiliation(s)
- Agustín Madoz-Gúrpide
- Centro de Salud Mental San Blas. Hospital Universitario Ramón y Cajal. Madrid. España
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). Madrid. España
- Universidad de Alcalá de Henares. Alcalá de Henares. Madrid. España
| | - Juan Carlos Ballesteros Martín
- Centro de Salud Mental San Blas. Hospital Universitario Ramón y Cajal. Madrid. España
- Universidad de Alcalá de Henares. Alcalá de Henares. Madrid. España
| | - Mónica Leira Sanmartín
- Centro de Salud Mental Arganda del Rey. Hospital Universitario del Sureste. Madrid. España
| | - Ernesto García Yagüe
- Centro de Salud Mental San Blas. Hospital Universitario Ramón y Cajal. Madrid. España
- Universidad de Alcalá de Henares. Alcalá de Henares. Madrid. España
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Lessard L, Fournier L, Gauthier J, Morin D. Continuum of care for persons with common mental health disorders in Nunavik: a descriptive study. Int J Circumpolar Health 2015; 74:27186. [PMID: 25979200 PMCID: PMC4433488 DOI: 10.3402/ijch.v74.27186] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 04/03/2015] [Accepted: 04/05/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Changing Directions, Changing Lives, the Mental Health Strategy for Canada, prioritizes the development of coordinated continuums of care in mental health that will bridge the gap in services for Inuit populations. OBJECTIVE In order to target ways of improving the services provided in these contexts to individuals in Nunavik with depression or anxiety disorders, this research examines delays and disruptions in the continuum of care and clinical, individual and organizational characteristics possibly associated with their occurrences. DESIGN A total of 155 episodes of care involving a common mental disorder (CMD), incident or recurring, were documented using the clinical records of 79 frontline health and social services (FHSSs) users, aged 14 years and older, living in a community in Nunavik. Each episode of care was divided into 7 stages: (a) detection; (b) assessment; (c) intervention; (d) planning the first follow-up visit; (e) implementation of the first follow-up visit; (f) planning a second follow-up visit; (g) implementation of the second follow-up visit. Sequential analysis of these stages established delays for each one and helped identify when breaks occurred in the continuum of care. Logistic and linear regression analysis determined whether clinical, individual or organizational characteristics influenced the breaks and delays. RESULTS More than half (62%) the episodes of care were interrupted before the second follow-up. These breaks mostly occurred when planning and completing the first follow-up visit. Episodes of care were more likely to end early when they involved anxiety disorders or symptoms, limited FHSS teams and individuals over 21 years of age. The median delay for the first follow-up visit (30 days) exceeded guideline recommendations significantly (1-2 weeks). CONCLUSION Clinical primary care approaches for CMDs in Nunavik are currently more reactive than preventive. This suggests that recovery services for those affected are suboptimal.
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Affiliation(s)
- Lily Lessard
- Department of Nursing Sciences, Université du Québec à Rimouski, Levis and Rimouski, Canada
- Faculty of Nursing Sciences, Université Laval, Québec, Canada;
| | - Louise Fournier
- Faculty of Nursing Sciences, Université Laval, Québec, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, CRCHUM, Université de Montréal, Montreal, Canada
| | - Josée Gauthier
- Department of Nursing Sciences, Université du Québec à Rimouski, Levis and Rimouski, Canada
- Expert in Organization of Care and Services in Rural and Remote Areas, Health and Social Service System Analysis and Evaluation, Institut national de santé publique du Québec, Rimouski, Canada
| | - Diane Morin
- Faculty of Nursing Sciences, Université Laval, Québec, Canada
- Institut universitaire de recherche et de formation en soins, University of Lausanne, Lausanne, Switzerland
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Lockhart I, Orme M, Mitchell S. The efficacy of licensed-indication use of donepezil and memantine monotherapies for treating behavioural and psychological symptoms of dementia in patients with Alzheimer's disease: systematic review and meta-analysis. Dement Geriatr Cogn Dis Extra 2011; 1:212-27. [PMID: 22163246 PMCID: PMC3199891 DOI: 10.1159/000330032] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/AIMS Behavioural and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD) greatly increase caregiver burden. The abilities of donepezil and memantine to manage BPSD within their licensed indications in AD were compared. METHODS A systematic review, random effects meta-analysis and Bucher indirect comparison were conducted. RESULTS Six randomised controlled studies (4 donepezil and 2 memantine) reported use within the licensed indication and had Neuropsychiatric Inventory (NPI) data suitable for meta-analysis. BPSD showed significant improvement with donepezil compared with placebo [weighted mean difference (WMD) in NPI -3.51, 95% confidence interval (CI) -5.75, -1.27], whereas this was not the case for memantine (WMD -1.65, 95% CI -4.78, 1.49). WMD in NPI for donepezil versus memantine favoured donepezil but was not statistically significant (-1.86, 95% CI -5.71, 1.99; p = 0.34). CONCLUSION Within its licensed indication, donepezil is efficacious for the management of BPSD in AD compared with placebo.
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