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Shakya P, Deb KS, Ganesh R, Datta A, Verma R, Chadda R. Telepsychiatry in post-pandemic India: A mixed methods exploration of patient perspectives and preferences toward telemedicine versus in-person consultations. Gen Hosp Psychiatry 2025; 93:89-99. [PMID: 39893866 DOI: 10.1016/j.genhosppsych.2025.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 12/29/2024] [Accepted: 01/08/2025] [Indexed: 02/04/2025]
Abstract
BACKGROUND Telepsychiatry saw wide acceptance during the COVID-19 pandemic, when traditional healthcare facilities were inaccessible. Post-pandemic, however, user preferences for the service remain uncertain. This study explores user perceptions of telepsychiatry, particularly focusing on those who discontinued its use, to identify factors influencing service satisfaction and barriers to continued use. METHODOLOGY A mixed methods study was conducted on interviews with 165 patients who had utilised telepsychiatry services at a tertiary care teaching hospital in north India. Quantitative data were collected on telepsychiatry dropout rates, and bivariate analyses identified differences between continuing users and discontinuers. Qualitative data were gathered via semi-structured interviews, thematically analysed, and coded to examine personal, illness-related, and socio-environmental determinants of service choice. RESULTS Analysis revealed a telepsychiatry dropout rate of 56.4 %, once physical OPDs became operational. Eight major themes - convenience, cost & time, therapeutic relationship, technological difficulty, service limitation, treatment outcome and privacy, affected telepsychiatry usage. Patients valued telepsychiatry for its convenience and time savings, while challenges such as brief consultations, frequent changes in doctors, and lack of privacy at home or work, prevented continued use. Technological barriers, especially for elderly and rural patients, and higher medication costs at local pharmacies were significant deterrents. CONCLUSION Telepsychiatry service use is dependent on a dynamic interplay between clinical condition, resource availability with user, service quality and available alternatives. Addressing these challenges remain crucial for integrating telepsychiatry into primary healthcare and ensuring its long-term sustainability.
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Affiliation(s)
| | | | - Ragul Ganesh
- Department of Psychiatry, JIPMER, Pondicherry, India
| | - Arnab Datta
- Department of Psychiatry, AIIMS New Delhi, India
| | - Rohit Verma
- Department of Psychiatry, AIIMS New Delhi, India
| | - Rakesh Chadda
- Department of Psychiatry, Amrita Institute of Medical Sciences, Faridabad, India; Department of Psychiatry, National Drug Dependence Treatment Centre, AIIMS, New Delhi, India
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Park N, Rouvere J, Chase E, Blanchard BE, Kaysen DL, Hendrickson RC, Fortney JC, Cerimele JM. Associations among sleep quality, cognitive processing therapy, and posttraumatic stress disorder symptoms in a primary care setting. J Trauma Stress 2025. [PMID: 39935094 DOI: 10.1002/jts.23132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Revised: 11/15/2024] [Accepted: 12/10/2024] [Indexed: 02/13/2025]
Abstract
Evidence describing the association between sleep quality and trauma-focused therapy is mixed. This secondary analysis of a primary care sample examined whether (a) baseline sleep quality moderated posttraumatic stress disorder (PTSD) symptom severity over time across groups receiving different doses of cognitive processing therapy (CPT) and (b) sleep quality improved over time with CPT. Participants were 227 adults who screened positive for PTSD and were participating in a clinical trial comparing two models of PTSD treatment delivery in primary care. The Pittsburgh Sleep Quality Index (PSQI) and PTSD Checklist for DSM-5 (PCL-5) were used to assess sleep disturbance and PTSD symptom severity, respectively. Multiple linear regression was used to assess whether baseline PSQI scores moderated 12-month PCL-5 scores across CPT dosage groups (0 sessions: 51.1%, 1-7 sessions: 31.7%; ≥ 8 sessions [adequate dose]: 17.2%) and whether PSQI scores differed by group at 12-month follow-up. Post hoc analyses examined changes in PCL-5 sleep disturbance items. Baseline sleep disturbance did not moderate the effect of CPT on PTSD severity among participants with an adequate CPT dose, p > .112. Sleep quality improved with adequate dose, B = -2.63, SE = 0.75, p < .001. Differences in change scores across groups for PCL-5 Item 2, F(2, 435) = 11.34, and Item 20, H(2) = 32.04, indicated that participants with an adequate CPT dose had greater reductions in trauma-related sleep symptoms than those who received 0-7 sessions, ps < .001. Residual post-CPT sleep impairment despite adequate PTSD improvement warrants further interventions.
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Affiliation(s)
- Nicola Park
- Department of Neurology (Sleep Medicine), University of California San Francisco, San Francisco, California, USA
| | - Julien Rouvere
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Erin Chase
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Brittany E Blanchard
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Debra L Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Rebecca C Hendrickson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
- VISN 20 Northwest Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, Washington, USA
| | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Joseph M Cerimele
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Paniagua-Avila A, Branas C, Susser E, Fort MP, Shelton R, Trigueros L, Camara B, Costigan E, Demis L, Florence A, Flores M, Miller-Suchet L, Paredes-Montero A, Rodrigues M, Kane J. Integrated programs for common mental illnesses within primary care and community settings in Latin America: a scoping review of components and implementation strategies. LANCET REGIONAL HEALTH. AMERICAS 2025; 41:100931. [PMID: 39717430 PMCID: PMC11665371 DOI: 10.1016/j.lana.2024.100931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 10/15/2024] [Accepted: 10/17/2024] [Indexed: 12/25/2024]
Abstract
Integrated programs for common mental illnesses are evidence-informed practices yet to be routinely implemented in Latin America. It synthesizes the literature on integrated programs for common mental illnesses (anxiety, depression, and posttraumatic stress disorder) in Latin American primary care and community settings. It maps program components (the 'what') to the collaborative care model core components and implementation strategies (the 'how') to the Expert Recommendations for Implementing Change (ERIC) taxonomy. Results from 18 programs across six countries (Belize, Brazil, Chile, Colombia, Mexico, Peru) show wide heterogeneity in component and strategy combinations. Overall, provider-level components and strategies were more common than family- or community-level ones. 'Team-based care' was the most commonly reported component, and 'family/user engagement' the least. The most common implementation strategy was 'supporting clinicians,' while 'changing infrastructure' was the least. Programs commonly addressed depression and only four followed experimental designs. We found limited evidence on the potential mechanisms of integrated program components and strategies.
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Affiliation(s)
- Alejandra Paniagua-Avila
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA
- Asociación para la Salud Mental FUNDAMENTAL, Guatemala City, Guatemala
| | - Charles Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Meredith P. Fort
- Colorado School of Public Health, University of Colorado Denver, Denver, CO, USA
- Centro de INCAP -Instituto de Nutrición de Centroamérica y Panamá- para la Investigación y Prevención de Enfermedades Crónicas (CIIPEC), Guatemala City, Guatemala
| | - Rachel Shelton
- Department Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | | | - Barbara Camara
- New York Psychiatric Institute, Columbia University Irving Medical Center, New York City, NY, USA
| | - Elen Costigan
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, NY, USA
- Médicos Sin Fronteras Latinoamérica, Mexico City, Mexico
| | - Lina Demis
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Ana Florence
- Department of Psychiatry, Columbia University, New York City, NY, USA
- Faculdade de Ciencias e Letras, Universidade Estadual de Sao Paulo, Sao Paulo, Brazil
| | - Maria Flores
- Hospital de Salud Mental Dr. Federico Mora, Guatemala City, Guatemala
| | | | | | - Mariana Rodrigues
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City, NY, USA
- Departamento de Psicologia, Centro Universitário UNA, Brazil
| | - Jeremy Kane
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA
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Blanchard BE, Bluett EJ, Johnson M, Zimberoff A, Fortney JC. Trauma exposure correlates among patients receiving care in federally qualified health centers. J Trauma Stress 2024; 37:864-876. [PMID: 38743483 DOI: 10.1002/jts.23055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 05/16/2024]
Abstract
Over 80% of adults in the general population experience trauma. Rates of patients with posttraumatic stress disorder (PTSD) are high in primary care settings and are likely to be even higher in federally qualified health centers (FQHCs). Trauma exposure has been linked to psychiatric symptoms and physical health comorbidities, though little research has focused on FQHC patients. This study addresses this by examining clinical and sociodemographic correlates of specific trauma types among FQHC patients. We analyzed secondary data from patients who screened positive for PTSD and were receiving health care in FQHCs in a clinical trial (N = 978). Individuals who did versus did not experience a specific trauma type were compared using between-group tests. In the sample, 91.3% of participants were exposed to a DSM-5 Criterion A traumatic event, with 79.6% experiencing two or more trauma types. Witnessing a life-threatening event (57.3%) and physical assault (55.7%) were the most common traumatic experiences. Physical health comorbidities and worse physical health functioning were associated with a higher likelihood of exposure to all trauma types, with effect sizes larger than PTSD, ds = 0.78-1.35. Depressive and anxiety symptoms were also associated with a higher likelihood of experiencing nearly all trauma types to a lesser magnitude. People of color, OR = 2.45, and individuals experiencing financial inequities, OR = 1.73, had higher odds of experiencing serious accidents as well as other trauma types. The findings highlight the need for trauma-informed care, including routine trauma and PTSD screening, for FQHC patients.
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Affiliation(s)
- Brittany E Blanchard
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ellen J Bluett
- Family Medicine Residency of Western Montana, University of Montana, Missoula, Montana, USA
| | - Morgan Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
- Veterans Affairs (VA) Health Systems Research Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
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Xie A, Hsu YJ, Speed TJ, Saunders J, Nguyen J, Khasawneh A, Kim S, A Marstellar J, M McDonald E, Shechter R, N Hanna M. The use of telemedicine for perioperative pain management during the COVID-19 pandemic. J Telemed Telecare 2024; 30:1607-1617. [PMID: 36974433 PMCID: PMC10051007 DOI: 10.1177/1357633x231162399] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 02/21/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Using a human factors engineering approach, the Johns Hopkins Personalized Pain Program adopted telemedicine for perioperative pain management in response to the COVID-19 pandemic. This study examines the impact of telemedicine adoption on the quality and outcomes of perioperative pain management. METHODS A mixed-methods study with a convergent parallel design was conducted. From June 2017 to December 2021, 902 patients participated in the Personalized Pain Program. Quantitative data on daily opioid consumption, pain severity and interference, physical and mental health status, and patient satisfaction and engagement were continuously collected with all patients using chart review and patient surveys. Beginning 23 March 2020, the Personalized Pain Program transitioned to telemedicine. A pre-post quasi-experimental design was used to examine the impact of telemedicine. In addition, qualitative interviews were conducted with 3 clinicians and 17 patients to explore their experience with telemedicine visits. RESULTS The monthly number of new patients seen in the Personalized Pain Program did not significantly change before and after telemedicine adoption. Compared to patients having in-person visits before the pandemic, patients having telemedicine visits during the pandemic achieved comparable improvements in daily opioid consumption, pain severity and interference, and physical health status. While telemedicine helped overcome many challenges faced by the patients, the limitations of telemedicine were also discussed. CONCLUSION The COVID-19 pandemic stimulated the use of telemedicine. To facilitate telemedicine adoption beyond the pandemic, future research is needed to examine best practices for telemedicine adoption and provide additional evidence on the effectiveness of telemedicine.
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Affiliation(s)
- Anping Xie
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yea-Jen Hsu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Traci J Speed
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jamia Saunders
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Jaclyn Nguyen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amro Khasawneh
- Department of Industrial Engineering, School of Engineering, Mercer University, Macon, GA, USA
| | - Samuel Kim
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jill A Marstellar
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eileen M McDonald
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ronen Shechter
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marie N Hanna
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Fortney JC, Ratzliff AD, Blanchard BE, Ferro L, Rouvere J, Chase E, Duncan MH, Merrill JO, Simpson T, Williams EC, Austin EJ, Curran GM, Schoenbaum M, Heagerty PJ, Saxon AJ. Collaborating to heal addiction and mental health in primary care (CHAMP): A protocol for a hybrid type 2a trial. Contemp Clin Trials 2024; 146:107700. [PMID: 39322115 PMCID: PMC11584174 DOI: 10.1016/j.cct.2024.107700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 08/23/2024] [Accepted: 09/21/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND The gold-standard treatment for opioid use disorder (OUD) is medication for OUD (MOUD). However, less than a quarter of people with OUD initiate MOUD. Expanding the Collaborative Care Model (CoCM) to include primary care patients with OUD could improve access to and initiation of MOUD. This paper presents the methods and baseline sample characteristics of a Hybrid Type 2a trial comparing the effectiveness of CoCM for OUD and co-occurring mental health symptoms (MHS) to CoCM for MHS only. METHOD 42 primary care clinics were cluster randomized and 254 primary care patients with OUD and elevated MHS were enrolled. Recruitment was terminated early by the Data and Safety Monitoring Board for futility. Participants completed research assessments at baseline, 3 months, and 6 months. The multiple primary outcomes were past-month number of days of nonmedical opioid use and SF12 Mental Health Component Summary (MCS) scores. RESULTS MCS scores were over a standard deviation below the national mean (M = 34.5). Nearly half (47.6 %) of participants had previously overdosed in their lifetimes. Three quarters (76.0 %) were already being prescribed MOUD at baseline, only 30.4 % reported non-medical use of opioids, and only 33.9 % reported being bothered by opioid cravings. CONCLUSION The unexpectedly high proportion of enrollees already prescribed MOUD at baseline indicates that most patients were in the maintenance rather than acute phase of treatment. Challenges identifying and enrolling patients in the acute phase of OUD treatment implies that intervention effectiveness will depend on its success preventing the discontinuation of MOUD rather than initiating MOUD.
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Affiliation(s)
- John C Fortney
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America; Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, United States of America; Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle, WA, United States of America.
| | - Anna D Ratzliff
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America; Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, United States of America
| | - Brittany E Blanchard
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Lori Ferro
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Julien Rouvere
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Erin Chase
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Mark H Duncan
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Joseph O Merrill
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Tracy Simpson
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound, Seattle, WA, United States of America
| | - Emily C Williams
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle, WA, United States of America; Department of Health Systems and Population Health, School of Public Health University of Washington, Seattle, WA, United States of America
| | - Elizabeth J Austin
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle, WA, United States of America; Department of Health Systems and Population Health, School of Public Health University of Washington, Seattle, WA, United States of America
| | - Geoffrey M Curran
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Department of Veterans Affairs, Health Services Research and Development, Center for Mental Healthcare and Outcomes Research, Little Rock, AR, USA
| | | | - Patrick J Heagerty
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Andrew J Saxon
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound, Seattle, WA, United States of America
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Ross DC, McCallum N, Truuvert AK, Butt A, Behdinan T, Rojas D, Soklaridis S, Vigod S. The development and evaluation of a virtual, asynchronous, trauma-focused treatment program for adult survivors of childhood interpersonal trauma. J Ment Health 2024; 33:566-575. [PMID: 38572918 DOI: 10.1080/09638237.2024.2332797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/05/2023] [Indexed: 04/05/2024]
Abstract
BACKGROUND The long-term mental and physical health implications of childhood interpersonal trauma on adult survivors is immense, however, there is a lack of available trauma-focused treatment services that are widely accessible. This study, utilizing a user-centered design process, sought feedback on the initial design and development of a novel, self-paced psychoeducation and skills-based treatment intervention for this population. AIMS To explore the views and perspectives of adult survivors of childhood interpersonal trauma on the first two modules of an asynchronous trauma-focused treatment program. METHODS Fourteen participants from our outpatient hospital service who completed the modules consented to provide feedback on their user experience. A thematic analysis of the three focus groups was conducted. RESULTS Four major themes emerged from the focus groups: (1) technology utilization, (2) module content, (3) asynchronous delivery, and (4) opportunity for interactivity. Participants noted the convenience of the platform and the use of multimedia content to increase engagement and did not find the modules to be emotionally overwhelming. CONCLUSIONS Our research findings suggest that an asynchronous virtual intervention for childhood interpersonal trauma survivors may be a safe and acceptable way to provide a stabilization-focused intervention on a wider scale.
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Affiliation(s)
- Dana C Ross
- Women's College Hospital and Research Institute, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nancy McCallum
- Women's College Hospital and Research Institute, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Annie K Truuvert
- Women's College Hospital and Research Institute, Toronto, ON, Canada
| | - Aysha Butt
- Women's College Hospital and Research Institute, Toronto, ON, Canada
| | - Tina Behdinan
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David Rojas
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, University of Toronto, Toronto, ON, Canada
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - Simone Vigod
- Women's College Hospital and Research Institute, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Haun MW, Tönnies J, Hartmann M, Wildenauer A, Wensing M, Szecsenyi J, Feißt M, Pohl M, Vomhof M, Icks A, Friederich HC. Model of integrated mental health video consultations for people with depression or anxiety in primary care (PROVIDE-C): assessor masked, multicentre, randomised controlled trial. BMJ 2024; 386:e079921. [PMID: 39322237 PMCID: PMC11423708 DOI: 10.1136/bmj-2024-079921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2024] [Indexed: 09/27/2024]
Abstract
OBJECTIVE To evaluate whether an integrated mental health video consultation approach (PROVIDE model) can improve symptoms compared with usual care in adults with depression and anxiety disorders attending primary care. DESIGN Assessor masked, multicentre, randomised controlled trial (PROVIDE-C). SETTING In 29 primary care practices in Germany, working remotely online from one trial hub. PARTICIPANTS 376 adults (18-81 years) who presented to their general practitioner (GP) with depression or anxiety, or both. INTERVENTION Participants were randomised (1:1) to receive the PROVIDE model (n=187) or usual care (n=189). Usual care was provided by GPs through interventions such as brief counselling and psychotropic medication prescriptions and may or may not have included referrals to mental health specialists. The PROVIDE model comprised transdiagnostic treatment provided through five real-time video sessions between the patient at the primary care practice and a mental health specialist at an offsite location. MAIN OUTCOME MEASURES The primary outcome was the absolute change in the mean severity of depressive and anxiety symptoms measured using the patient health questionnaire anxiety and depression scale (PHQ-ADS) at six months, in the intention-to-treat population. Secondary outcomes, measured at six and 12 months, included PHQ-ADS subscores, psychological distress related to somatic symptoms, recovery, health related quality of life, quality and patient centredness of chronic illness care, and adverse events. RESULTS Between 24 March 2020 and 23 November 2021, 376 patients were randomised into treatment groups. Mean age was 45 years (standard deviation (SD) 14), 63% of the participants were female, and mean PHQ-ADS-score was 26 points (SD 7.6). Compared with usual care, the PROVIDE intervention led to improvements in severity of depressive and anxiety symptom (adjusted mean change difference in the PHQ-ADS score -2.4 points (95% confidence interval -4.5 to -0.4), P=0.02) at six months. The effects were sustained at 12 months (-2.9 (-5.0 to -0.7), P<0.01). No serious adverse events were reported in either group. CONCLUSIONS Through relatively low intensity treatment, the PROVIDE model led to a decrease in depressive and anxiety symptoms with small effects in the short and long term. Depression and anxiety disorders are prevalent and therefore the small effect might cumulatively impact on population health in this population. TRIAL REGISTRATION ClinicalTrials.gov NCT04316572.
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Affiliation(s)
- Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, Heidelberg, Germany
- German Center for Mental Health (DZPG), Partner Site Mannheim-Heidelberg-Ulm, Germany
| | - Justus Tönnies
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, Heidelberg, Germany
- German Center for Mental Health (DZPG), Partner Site Mannheim-Heidelberg-Ulm, Germany
| | - Alina Wildenauer
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Germany
| | - Manuel Feißt
- Institute of Medical Biometry (IMBI), Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Germany
| | - Moritz Pohl
- Institute of Medical Biometry (IMBI), Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Germany
| | - Markus Vomhof
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, Heidelberg, Germany
- German Center for Mental Health (DZPG), Partner Site Mannheim-Heidelberg-Ulm, Germany
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Fortney JC, Kaysen DL, Engel CC, Cerimele JM, Nolan JP, Chase E, Blanchard BE, Hauge S, Bechtel J, Moore DL, Taylor A, Acierno R, Nagel N, Sripada RK, Painter JT, DeBeer BB, Bluett E, Teo AR, Morland LA, Heagerty PJ. Sequenced Treatment Effectiveness for Posttraumatic Stress (STEPS) Trial: A protocol for a pragmatic comparative effectiveness trial with baseline results. Contemp Clin Trials 2024; 144:107606. [PMID: 38866094 DOI: 10.1016/j.cct.2024.107606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/16/2024] [Accepted: 06/09/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND There have only been two efficacy trials reporting a head-to-head comparison of medications and psychotherapy for PTSD, and neither was conducted in primary care. Therefore, this protocol paper describes a pragmatic trial that compares outcomes of primary care patients randomized to initially receive a brief trauma-focused psychotherapy or a choice of three antidepressants. In addition, because there are few trials examining the effectiveness of subsequent treatments for patients not responding to the initial treatment, this pragmatic trial also compares the outcomes of those switching or augmenting treatments. METHOD Patients screening positive for PTSD (n = 700) were recruited from the primary care clinics of 7 Federally Qualified Health Centers (FQHC) and 8 Department of Veterans Affairs (VA) Medical Centers and randomized in the ratio 1:1:2 to one of three treatment sequences: 1) selective serotonin reuptake inhibitor (SSRI) followed by augmentation with Written Exposure Therapy (WET), 2) SSRI followed by a switch to serotonin-norepinephrine reuptake inhibitor (SNRI), or 3) WET followed by a switch to SSRI. Participants complete surveys at baseline, 4 months, and 8 months. The primary outcome is PTSD symptom severity as measured by the PTSD Checklist (PCL-5). RESULTS Average PCL-5 scores (M = 52.8, SD = 11.1) indicated considerable severity. The most common bothersome traumatic event for VA enrollees was combat (47.8%), and for FQHC enrollees was other (28.2%), followed by sexual assault (23.4%), and child abuse (19.8%). Only 22.4% were taking an antidepressant at baseline. CONCLUSION Results will help healthcare systems and clinicians make decisions about which treatments to offer to patients.
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Affiliation(s)
- John C Fortney
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA; VA Health Systems Research, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, WA, USA.
| | - Debra L Kaysen
- Departments of Psychiatry and Behavioral Sciences and Public Mental Health & Population Sciences, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Charles C Engel
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA; VA Health Systems Research, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, WA, USA
| | - Joseph M Cerimele
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA; VA Health Systems Research, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, WA, USA
| | | | - Erin Chase
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Brittany E Blanchard
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Stephanie Hauge
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Jared Bechtel
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Danna L Moore
- School of Economic Sciences, Washington State University, Pullman, WA, USA
| | - Ashley Taylor
- Primary Care Behavioral Health, VA Bedford Healthcare System, Bedford, MA, USA
| | - Ron Acierno
- Ralph H. Johnson VA Healthcare System, USA; Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Nancy Nagel
- Primary Care Mental Health Integration, Cincinnati VA Medical Center, Cincinnati, OH, USA
| | - Rebecca K Sripada
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jacob T Painter
- Health Systems Research Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA; College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bryann B DeBeer
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Denver, CO, USA; VA Rocky Mountain Mental Illness, Research, Education, and Clinical Center for Suicide Prevention, Denver, CO, USA
| | - Ellen Bluett
- University of Montana, Family Medicine Residency
| | - Alan R Teo
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA; Center to Improve Veteran Involvement in Care, Health Systems Research, VA Portland Health Care System, Portland, OR, USA
| | - Leslie A Morland
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Patrick J Heagerty
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
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Totten AM, Womack DM, Griffin JC, McDonagh MS, Davis-O'Reilly C, Blazina I, Grusing S, Elder N. Telehealth-guided provider-to-provider communication to improve rural health: A systematic review. J Telemed Telecare 2024; 30:1209-1229. [PMID: 36567431 PMCID: PMC11389081 DOI: 10.1177/1357633x221139892] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Telehealth may address healthcare disparities for rural populations. This systematic review assesses the use, effectiveness, and implementation of telehealth-supported provider-to-provider collaboration to improve rural healthcare. METHODS We searched Ovid MEDLINE®, CINAHL®, EMBASE, and Cochrane CENTRAL from 1 January 2010 to 12 October 2021 for trials and observational studies of rural provider-to-provider telehealth. Abstracts and full text were dual-reviewed. We assessed the risk of bias for individual studies and strength of evidence for studies with similar outcomes. RESULTS Seven studies of rural uptake of provider-to-provider telehealth documented increases over time but variability across geographic regions. In 97 effectiveness studies, outcomes were similar with rural provider-to-provider telehealth versus without for inpatient consultations, neonatal care, outpatient depression and diabetes, and emergency care. Better or similar results were reported for changes in rural clinician behavior, knowledge, confidence, and self-efficacy. Evidence was insufficient for other clinical uses and outcomes. Sixty-seven (67) evaluation and qualitative studies identified barriers and facilitators to implementing rural provider-to-provider telehealth. Success was linked to well-functioning technology, sufficient resources, and adequate payment. Barriers included lack of understanding of rural context and resources. Methodologic weaknesses of studies included less rigorous study designs and small samples. DISCUSSION Rural provider-to-provider telehealth produces similar or better results versus care without telehealth. Barriers to rural provider-to-provider telehealth implementation are common to practice change but include some specific to rural adaptation and adoption. Evidence gaps are partially due to studies that do not address differences in the groups compared or do not include sufficient sample sizes.
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Affiliation(s)
| | - Dana M Womack
- Oregon Health & Science University, Portland, OR, USA
| | | | | | | | - Ian Blazina
- Oregon Health & Science University, Portland, OR, USA
| | - Sara Grusing
- Oregon Health & Science University, Portland, OR, USA
| | - Nancy Elder
- Oregon Health & Science University, Portland, OR, USA
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11
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Chinnis S, Robidoux H, Harrold SA, Lauerer J. Advancing Behavioral Health Equity Through Telehealth and Remote Training of Newly Certified Psychiatric-Mental Health Nurse Practitioners. J Psychosoc Nurs Ment Health Serv 2024; 62:19-24. [PMID: 38451116 DOI: 10.3928/02793695-20240229-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
PURPOSE Rural communities are disproportionately impacted by acute shortages of mental health providers. This problem, combined with complex behavioral health conditions, elicited the need for a university-based, remote telepsychiatric traineeship for newly board certified psychiatric-mental health nurse practitioners (PMHNPs). METHOD The Psychiatric Advanced Practice Registered Nurse TechNology Enhanced Residency (PARTNER) Program was developed to advance behavioral health equity by increasing state-wide access to care, removing geographical barriers, and enhancing PMHNP workforce readiness by strengthening trainees' ability to manage complex behavioral health conditions. RESULTS In a southeastern state over a period of 3 years, six PMHNPs cumulatively provided behavioral health services to 1,195 patients, managed >118 diagnoses, and completed 3,535 visits, with 95.6% of visits comprising provision of care to patients residing in rural areas. CONCLUSION Care was provided through the implementation of a collaborative-interdisciplinary-care model provided by route of telehealth and comprising a partnership between PMHNPs and patients' primary care providers. The training program enhanced providers' clinical proficiency, improved patient outcomes, and increased the number of skilled providers trained to manage patients with complex behavioral health conditions. [Journal of Psychosocial Nursing and Mental Health Services, 62(8), 19-24.].
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Resnik J, Miller CJ, Roth CE, Burns K, Bovin MJ. A Systematic Review of the Department of Veterans Affairs Mental Health-Care Access Interventions for Veterans With PTSD. Mil Med 2024; 189:1303-1311. [PMID: 37837200 DOI: 10.1093/milmed/usad376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 08/23/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Access to mental health care has been a priority area for the U.S. Department of Veterans Affairs (DVA) for decades. Access for veterans with PTSD is essential because untreated PTSD is associated with numerous adverse outcomes. Although interventions have been developed to improve access to DVA mental health care, the impact of these interventions on access for veterans with untreated PTSD has not been examined comprehensively, limiting guidance on appropriate implementation. MATERIALS AND METHODS We conducted a systematic review of PubMed and PTSDpubs between May 2019 and January 2022 to identify DVA access interventions for veterans with PTSD not engaged in DVA mental health care. We identified 17 interventions and 29 manuscripts reporting quantitative access outcomes. We categorized interventions into four major categories: Primary care mental health integration, other national initiatives, telemental health, and direct outreach. We evaluated five outcome domains: Binary attendance, number of sessions attended, wait time, number of patients seen, and care initiation. We assessed the risk of bias using the Cochrane Collaboration criteria. RESULTS Across articles, binary attendance generally improved, whereas the impact on the number of sessions attended was equivocal. Overall, the number of patients seen increased compared to control participants and retrospective data. The few articles that examined care initiation had mixed results. Only one article examined the impact on wait time. CONCLUSIONS Access interventions for veterans with PTSD demonstrated varied success across interventions and outcomes. The national initiatives-particularly primary care mental health integration -were successful across several outcomes; telemental health demonstrated promise in improving access; and the success of direct outreach varied across interventions. Confidence in these findings is tempered by potential bias among studies. Limited literature on how these interventions impact relevant preattendance barriers, along with incomplete data on how many perform nationally, suggests that additional work is needed to ensure that these interventions increase access for veterans with PTSD nationwide.
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Affiliation(s)
- Jack Resnik
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA 02130, USA
| | - Christopher J Miller
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Clara E Roth
- VA Boston Healthcare System, National Center for PTSD (116B-2), Boston, MA 02130, USA
- Boston VA Research Institute (BVARI), Boston, MA 02130, USA
| | - Katharine Burns
- VA Boston Healthcare System, National Center for PTSD (116B-2), Boston, MA 02130, USA
- Emmanuel College, Boston, MA 02115, USA
| | - Michelle J Bovin
- VA Boston Healthcare System, National Center for PTSD (116B-2), Boston, MA 02130, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
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Reilly S, Hobson-Merrett C, Gibbons B, Jones B, Richards D, Plappert H, Gibson J, Green M, Gask L, Huxley PJ, Druss BG, Planner CL. Collaborative care approaches for people with severe mental illness. Cochrane Database Syst Rev 2024; 5:CD009531. [PMID: 38712709 PMCID: PMC11075124 DOI: 10.1002/14651858.cd009531.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND Collaborative care for severe mental illness (SMI) is a community-based intervention that promotes interdisciplinary working across primary and secondary care. Collaborative care interventions aim to improve the physical and/or mental health care of individuals with SMI. This is an update of a 2013 Cochrane review, based on new searches of the literature, which includes an additional seven studies. OBJECTIVES To assess the effectiveness of collaborative care approaches in comparison with standard care (or other non-collaborative care interventions) for people with diagnoses of SMI who are living in the community. SEARCH METHODS We searched the Cochrane Schizophrenia Study-Based Register of Trials (10 February 2021). We searched the Cochrane Common Mental Disorders (CCMD) controlled trials register (all available years to 6 June 2016). Subsequent searches on Ovid MEDLINE, Embase and PsycINFO together with the Cochrane Central Register of Controlled Trials (with an overlap) were run on 17 December 2021. SELECTION CRITERIA Randomised controlled trials (RCTs) where interventions described as 'collaborative care' were compared with 'standard care' for adults (18+ years) living in the community with a diagnosis of SMI. SMI was defined as schizophrenia, other types of schizophrenia-like psychosis or bipolar affective disorder. The primary outcomes of interest were: quality of life, mental state and psychiatric admissions at 12 months follow-up. DATA COLLECTION AND ANALYSIS Pairs of authors independently extracted data. We assessed the quality and certainty of the evidence using RoB 2 (for the primary outcomes) and GRADE. We compared treatment effects between collaborative care and standard care. We divided outcomes into short-term (up to six months), medium-term (seven to 12 months) and long-term (over 12 months). For dichotomous data we calculated the risk ratio (RR) and for continuous data we calculated the standardised mean difference (SMD), with 95% confidence intervals (CIs). We used random-effects meta-analyses due to substantial levels of heterogeneity across trials. We created a summary of findings table using GRADEpro. MAIN RESULTS Eight RCTs (1165 participants) are included in this review. Two met the criteria for type A collaborative care (intervention comprised of the four core components). The remaining six met the criteria for type B (described as collaborative care by the trialists, but not comprised of the four core components). The composition and purpose of the interventions varied across studies. For most outcomes there was low- or very low-certainty evidence. We found three studies that assessed the quality of life of participants at 12 months. Quality of life was measured using the SF-12 and the WHOQOL-BREF and the mean endpoint mental health component scores were reported at 12 months. Very low-certainty evidence did not show a difference in quality of life (mental health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.03, 95% CI -0.26 to 0.32; 3 RCTs, 227 participants). Very low-certainty evidence did not show a difference in quality of life (physical health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.08, 95% CI -0.18 to 0.33; 3 RCTs, 237 participants). Furthermore, in the medium term (at 12 months) low-certainty evidence did not show a difference between collaborative care and standard care in mental state (binary) (RR 0.99, 95% CI 0.77 to 1.28; 1 RCT, 253 participants) or in the risk of being admitted to a psychiatric hospital at 12 months (RR 5.15, 95% CI 0.67 to 39.57; 1 RCT, 253 participants). One study indicated an improvement in disability (proxy for social functioning) at 12 months in the collaborative care arm compared to usual care (RR 1.38, 95% CI 0.97 to 1.95; 1 RCT, 253 participants); we deemed this low-certainty evidence. Personal recovery and satisfaction/experience of care outcomes were not reported in any of the included studies. The data from one study indicated that the collaborative care treatment was more expensive than standard care (mean difference (MD) international dollars (Int$) 493.00, 95% CI 345.41 to 640.59) in the short term. Another study found the collaborative care intervention to be slightly less expensive at three years. AUTHORS' CONCLUSIONS This review does not provide evidence to indicate that collaborative care is more effective than standard care in the medium term (at 12 months) in relation to our primary outcomes (quality of life, mental state and psychiatric admissions). The evidence would be improved by better reporting, higher-quality RCTs and the assessment of underlying mechanisms of collaborative care. We advise caution in utilising the information in this review to assess the effectiveness of collaborative care.
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Affiliation(s)
- Siobhan Reilly
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Charley Hobson-Merrett
- Primary Care Plymouth, University of Plymouth, Plymouth, UK
- National Institute for Health Research Applied Research Collaboration South West Peninsula, Plymouth, UK
| | | | - Ben Jones
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Debra Richards
- Primary Care Plymouth, University of Plymouth, Plymouth, UK
| | - Humera Plappert
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | | | - Maria Green
- Pennine Health Care NHS Foundation Trust, Bury, UK
| | - Linda Gask
- Health Sciences Research Group, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter J Huxley
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Benjamin G Druss
- Department of Health Policy and Management, Emory University, Atlanta, USA
| | - Claire L Planner
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
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Witzeman KA, Lieberman A, Beckman EJ, Ross KV, Coons HL. Integrated Care for Persons With Persistent Gynecologic Conditions. Clin Obstet Gynecol 2024; 67:247-261. [PMID: 38281176 DOI: 10.1097/grf.0000000000000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Persons with persistent gynecologic conditions frequently cope with complex biopsychosocial challenges and benefit from integrated behavioral health evaluation and treatment within gynecologic practices. Integrated care refers to the provision of behavioral health services within a health care setting which contributes to improved patient, provider, and practice outcomes, however, has not been commonly provided in traditional gynecologic practices. Several models of integrated behavioral health are reviewed. Each model holds specific applications in primary and specialty gynecology settings and may enhance the gynecologic patient experience. This article reviews current research supporting integrated care and describes implementation, funding, and evaluation to improve patient outcomes.
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Affiliation(s)
- Kathryn A Witzeman
- Department of Women's Health and Gynecology, University of Colorado School of Medicine, Rifle, Colorado
| | - Alison Lieberman
- Department of Integrated Behavioral Health, Denver Health Medical Center
| | - Elizabeth Joy Beckman
- Department of Integrated Behavioral Health and Department of Psychiatry, University of Colorado School of Medicine, Denver
| | - Kaitlin V Ross
- Department of Psychiatry, Colorado Center for Women's Behavioral Health and Wellness, University of Colorado School of Medicine/Anschutz Medical Campus, Aurora, Colorado
| | - Helen L Coons
- Women's Mental Health Associates & Health Psychology Solutions, Denver, Colorado
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Meredith LS, Wong EC, Marx BP, Han B, Korn AR, Tobin JN, Cassells A, Williamson S, Franco M, Overa CC, Holder T, Lin TJ, Sloan DM. Design of a hybrid implementation effectiveness cluster randomized controlled trial of delivering written exposure therapy for PTSD in underserved primary care settings. Contemp Clin Trials 2024; 138:107435. [PMID: 38211725 PMCID: PMC11146292 DOI: 10.1016/j.cct.2024.107435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/28/2023] [Accepted: 01/07/2024] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Posttraumatic stress disorder (PTSD) results in substantial costs to society. Prevalence of PTSD among adults is high, especially among those presenting to primary care settings. Evidence-based psychotherapies (EBPs) for PTSD are available but dissemination and implementation within primary care settings is challenging. Building Experience for Treating Trauma and Enhancing Resilience (BETTER) examines the effectiveness of integrating Written Exposure Therapy (WET) within primary care collaborative care management (CoCM). WET is a brief exposure-based treatment that has the potential to address many challenges of delivering PTSD EBPs within primary care settings. METHODS The study is a hybrid implementation effectiveness cluster-randomized controlled trial in which 12 Federally Qualified Health Centers (FQHCs) will be randomized to either CoCM plus WET (CoCM+WET) or CoCM only with 60 patients within each FQHC. The primary aim is to evaluate the effectiveness of CoCM+WET to improve PTSD and depression symptom severity. Secondary treatment outcomes are mental and physical health functioning. The second study aim is to examine implementation of WET within FQHCs using FQHC process data and staff interviews pre- and post-intervention. Exploratory aims are to examine potential moderators and mediators of the intervention. Assessments occur at baseline, and 3- and 12-month follow-up. CONCLUSION The study has the potential to impact practice and improve clinical and public health outcomes. By establishing the effectiveness and feasibility of delivering a brief trauma-focused EBP embedded within CoCM in primary care, the study aims to improve PTSD outcomes for underserved patients. TRIAL REGISTRATION (Clinicaltrials.govNCT05330442).
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Affiliation(s)
- Lisa S Meredith
- RAND Corporation, Santa Monica, CA, United States of America; VA HSR&D Center for Healthcare Innovation, Implementation & Policy, Sepulveda, CA, United States of America.
| | - Eunice C Wong
- RAND Corporation, Santa Monica, CA, United States of America
| | - Brian P Marx
- National Center for PTSD, Behavioral Science Division at VA Boston Healthcare, Boston, MA, United States of America; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | - Bing Han
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, United States of America
| | - Ariella R Korn
- RAND Corporation, Boston, MA 02116, United States of America
| | - Jonathan N Tobin
- Clinical Directors Network (CDN), New York, NY, United States of America; The Rockefeller University Center for Clinical and Translational Science, New York, NY, United States of America
| | - Andrea Cassells
- Clinical Directors Network (CDN), New York, NY, United States of America
| | | | - Meghan Franco
- Pardee RAND Graduate School, Santa Monica, CA, United States of America
| | - Cleo Clarize Overa
- Clinical Directors Network (CDN), New York, NY, United States of America
| | - Tameir Holder
- Clinical Directors Network (CDN), New York, NY, United States of America
| | - T J Lin
- Clinical Directors Network (CDN), New York, NY, United States of America
| | - Denise M Sloan
- National Center for PTSD, Behavioral Science Division at VA Boston Healthcare, Boston, MA, United States of America; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
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Teng Y, Niu J, Liu Y, Wang H, Chen J, Kong Y, Wang L, Lian B, Wang W, Sun H, Yue K. Ketamine alleviates fear memory and spatial cognition deficits in a PTSD rat model via the BDNF signaling pathway of the hippocampus and amygdala. Behav Brain Res 2024; 459:114792. [PMID: 38048914 DOI: 10.1016/j.bbr.2023.114792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is associated with traumatic stress experiences. This condition can be accompanied by learning and cognitive deficits. Studies have demonstrated that ketamine can rapidly and significantly alleviate symptoms in patients with chronic PTSD. Nonetheless, the effects of ketamine on neurocognitive impairment and its mechanism of action in PTSD remain unclear. METHODS In this study, different concentrations of ketamine (5, 10, 15, and 20 mg/kg, i.p.) were evaluated in rat models of single prolonged stress and electrophonic shock (SPS&S). Expression levels of brain-derived neurotrophic factor (BDNF) and post-synaptic density-95 (PSD-95) in the hippocampus (HIP) and amygdala (AMG) were determined by Western blot analysis and immunohistochemistry. RESULTS The data showed that rats subjected to SPS&S exhibited significant PTSD-like cognitive impairment. The effect of ketamine on SPS&S-induced neurocognitive function showed a U-shaped dose effect in rats. A single administration of ketamine at a dosage of 10-15 mg/kg resulted in significant changes in behavioral outcomes. These manifestations of improvement in cognitive function and molecular changes were reversed at high doses (15-20 mg/kg). CONCLUSION Overall, ketamine reversed SPS&S-induced fear and spatial memory impairment and the down-regulation of BDNF and BDNF-related PSD-95 signaling in the HIP and AMG. A dose equal to 15 mg/kg rapidly reversed the behavioral and molecular changes and promoted the amelioration of cognitive dysfunction. The enhanced association of BDNF signaling with PSD-95 effects could be involved in the therapeutic efficiency of ketamine for PTSD.
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Affiliation(s)
- Yue Teng
- School of Psychology, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong 261053, PR China
| | - JiaYao Niu
- School of Clinical Medicine, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong 261053, PR China
| | - Yang Liu
- School of Psychology, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong 261053, PR China
| | - Han Wang
- School of Psychology, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong 261053, PR China
| | - JinHong Chen
- School of Continuing Education, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong 261053, PR China
| | - YuJia Kong
- School of Public Health, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong 261053, PR China
| | - Ling Wang
- Clinical Competency Training Center, Medical experiment and training center, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong 261053, PR China
| | - Bo Lian
- Department of Bioscience and Technology, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong 261053, PR China
| | - WeiWen Wang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100864, PR China
| | - HongWei Sun
- School of Psychology, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong 261053, PR China.
| | - KuiTao Yue
- The Medical imaging Center, Affiliated Hospital of Weifang Medical University, 2428# Yuhe Road, Weifang, Shandong 261053, PR China.
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Cho CH, Lee HJ, Kim YK. Telepsychiatry in the Treatment of Major Depressive Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1456:333-356. [PMID: 39261437 DOI: 10.1007/978-981-97-4402-2_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
This chapter explores the transformative role of telepsychiatry in managing major depressive disorders (MDD). Traversing geographical barriers and reducing stigma, this innovative branch of telemedicine leverages digital platforms to deliver effective psychiatric care. We investigate the evolution of telepsychiatry, examining its diverse interventions such as videoconferencing-based psychotherapy, medication management, and mobile applications. While offering significant advantages like increased accessibility, cost-effectiveness, and improved patient engagement, challenges in telepsychiatry include technological barriers, privacy concerns, ethical and legal considerations, and digital literacy gaps. Looking forward, emerging technologies like virtual reality, artificial intelligence, and precision medicine hold immense potential to personalize and enhance treatment effectiveness. Recognizing its limitations and advocating for equitable access, this chapter underscores telepsychiatry's power to revolutionize MDD treatment, making quality mental healthcare a reality for all.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea.
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Tsao PA, Fann JR, Nevedal AL, Bloor LE, Krein SL, Caram ME. A Positive Distress Screen…Now What? An Updated Call for Integrated Psychosocial Care. J Clin Oncol 2023; 41:4837-4841. [PMID: 37441747 PMCID: PMC10617941 DOI: 10.1200/jco.22.02719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/03/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023] Open
Abstract
How can we move collaborative care from evidence-based practice to everyday practice for those living with cancer and distress?
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Affiliation(s)
- Phoebe A. Tsao
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Veterans Affairs Health Services Research & Development, Center for Clinical Management & Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Jesse R. Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
- Department of Psychosocial Oncology, Fred Hutchinson Cancer Center, Seattle, WA
| | - Andrea L. Nevedal
- Veterans Affairs Health Services Research & Development, Center for Clinical Management & Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Lindsey E. Bloor
- Department of Psychiatry, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Sarah L. Krein
- Veterans Affairs Health Services Research & Development, Center for Clinical Management & Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Megan E.V. Caram
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Veterans Affairs Health Services Research & Development, Center for Clinical Management & Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
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19
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Fortney JC, Rajan S, Chen JA, Campbell SB, Nolan JP, Wong E, Sayre G, Petrova V, Simons CE, Reisinger HS, Schnurr PP. A mixed-methods evaluation of why an implementation trial failed to engage veterans with posttraumatic stress disorder in trauma-focused psychotherapy. J Trauma Stress 2023; 36:762-771. [PMID: 37370238 DOI: 10.1002/jts.22946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 06/29/2023]
Abstract
An effectiveness trial found that telemedicine collaborative care for posttraumatic stress disorder (PTSD) significantly increased engagement in trauma-focused psychotherapy (TFP) and improved PTSD symptoms. However, in a subsequent implementation trial, very few veterans enrolled in collaborative care initiated TFP. We conducted a mixed-methods evaluation to determine why veterans did not initiate TFP in the implementation trial. After conducting chart reviews of 1,071 veterans with PTSD enrolled in collaborative care, patients were categorized into four mutually exclusive TFP groups: TFP not discussed; TFP discussed, declined; TFP discussed, did not decline; and TFP initiated. We conducted semistructured interviews with 43 unique patients and 58 unique providers (i.e., care managers and mental health specialists). Almost half (48.6%) of the veterans had no documentation of discussing TFP with their care manager; another 28.9% discussed it but declined. Most veterans (77.1%) had an encounter with a mental health specialist, 36.8% of whom never discussed TFP, and 35.7% of whom discussed it but declined. Providers reported that many veterans were not able, willing, or ready to engage in TFP and that non-trauma-focused therapies were better aligned with their treatment goals. Veterans gave numerous reasons for not initiating TFP, including having bad prior experiences with TFP and wanting to avoid thinking about past traumatic experiences. Commonly cited reasons for noninitiation were providers never discussing TFP with veterans and veterans declining TFP after discussing it with their provider. Interventions, such as shared decision-making tools, may be needed to engage providers and patients in informed discussions about TFP.
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Affiliation(s)
- John C Fortney
- VA Health Services Research and Development, Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Suparna Rajan
- VA Health Services Research and Development, Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Jessica A Chen
- VA Health Services Research and Development, Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Sarah B Campbell
- VA Health Services Research and Development, Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - John P Nolan
- Independent researcher, El Dorado, Arkansas, USA
| | - Edwin Wong
- VA Health Services Research and Development, Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - George Sayre
- VA Health Services Research and Development, Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Valentina Petrova
- VA Health Services Research and Development, Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Carol E Simons
- VA Health Services Research and Development, Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Heather S Reisinger
- VA Health Services Research and Development, Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Paula P Schnurr
- National Center for PTSD, VA Medical Center, White River Junction, Vermont, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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20
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Brunt TJ, Gale-Grant O. Telepsychiatry: what clinicians need to know about digital mental healthcare. BJPSYCH ADVANCES 2023; 29:230-238. [PMID: 37521104 PMCID: PMC10374879 DOI: 10.1192/bja.2022.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/05/2022] [Accepted: 05/27/2022] [Indexed: 12/31/2022]
Abstract
The COVID-19 pandemic has rapidly accelerated the use of online and remote mental healthcare provision. The immediate need to transform services has not allowed for thorough examination of the literature supporting remote delivery of psychiatric care. In this article we review the history of telepsychiatry, the rationale for continuing to offer services remotely and the limitations of psychiatry without in-person care. Focusing on randomised controlled trials we find that evidence for the efficacy of remotely delivered psychiatric care compared with in-person treatment is of low quality and limited scope but does not demonstrate clear superiority of one care delivery method over the other.
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Affiliation(s)
- Thomas J. Brunt
- Psychiatry core trainee at South London and Maudsley NHS Foundation Trust, London, UK, with an interest in telehealth and the use of technology in healthcare
| | - Oliver Gale-Grant
- Conducts research in the MRC Centre for Neurodevelopmental Disorders and Department of Forensic and Neurodevelopmental Science at King's College London, London, UK, focusing on computational modelling of brain development
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21
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Achtyes ED, Glenn T, Monteith S, Geddes JR, Whybrow PC, Martini J, Bauer M. Telepsychiatry in an Era of Digital Mental Health Startups. Curr Psychiatry Rep 2023; 25:263-272. [PMID: 37166622 PMCID: PMC10172730 DOI: 10.1007/s11920-023-01425-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE OF REVIEW Telepsychiatry practiced by psychiatrists is evidence-based, regulated, private, and effective in diverse settings. The use of telemedicine has grown since the COVID-19 pandemic as people routinely obtain more healthcare services online. At the same time, there has been a rapid increase in the number of digital mental health startups that offer various services including online therapy and access to prescription medications. These digital mental health firms advertise directly to the consumer primarily through digital advertising. The purpose of this narrative review is to contrast traditional telepsychiatry and the digital mental health market related to online therapy. RECENT FINDINGS In contrast to standard telepsychiatry, most of the digital mental health startups are unregulated, have unproven efficacy, and raise concerns related to self-diagnosis, self-medicating, and inappropriate prescribing. The role of digital mental health firms for people with serious mental illness has not been determined. There are inadequate privacy controls for the digital mental health firms, including for online therapy. We live in an age where there is widespread admiration for technology entrepreneurs and increasing emphasis on the role of the patient as a consumer. Yet, the business practices of digital mental health startups may compromise patient safety for profits. There is a need to address issues with the digital mental health startups and to educate patients about the differences between standard medical care and digital mental health products.
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Affiliation(s)
- Eric D Achtyes
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, CA, USA
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Julia Martini
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Dresden, Germany
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Pourat N, Padilla-Frausto DI, Chen X, Lim D, Osterweil D, Batra RA. The Impact of a Primary Care Telepsychiatry Program on Outcomes of Managed Care Older Adults. J Am Med Dir Assoc 2023; 24:119-124.e4. [PMID: 36356654 DOI: 10.1016/j.jamda.2022.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The goal of this study was to assess the outcomes of a primary-based telepsychiatry intervention program for older managed care enrollees with depression/anxiety and with limited access to in-person psychiatric care. DESIGN A pre-post design was used to examine service use (n = 218) and severity of depression (n = 204). Enrollment, claims, and depression and anxiety score data were obtained from the medical group. The implementation process and self-reported outcomes were examined. SETTING AND PARTICIPANTS The program was funded by the Senior Care Action Network (SCAN) group and implemented by a large medical group serving older adults who were identified as needing outpatient psychiatric care, including those with psychiatric hospitalizations, depression/anxiety disorders, comorbid substance use disorders, or other multiple comorbidities. METHODS Poisson regressions were used to examine changes in predicted rates of outpatient services, emergency department visits, and hospitalizations up to 24 months prior and 24 months following the first telepsychiatry visit. Changes in predicted severity of depression up to 2 quarters prior and 3 quarters following the first telepsychiatry visit were examined. RESULTS The number of outpatient services declined significantly by 0.24 per patient per 6-month time frame following the first telepsychiatry visit. The number of emergency department visits and hospitalizations also declined after the first visit (0.07 and 0.03 per patient per 6-month time frame, respectively). Depression severity scores also declined in the quarters following the first visit (1.52). The medical group reported improvements in both wait time for appointments and no-show rates with the integration of telepsychiatry in primary care. CONCLUSIONS AND IMPLICATIONS The telepsychiatry program lowered service use, depression severity, and increased better access to psychiatry care. The findings highlight the potential benefits of sustaining and expanding the telepsychiatry program by SCAN and other plans facing a limited supply of psychiatrists.
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Affiliation(s)
- Nadereh Pourat
- University of California Los Angeles, Center for Health Policy Research, Los Angeles, CA, USA; Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.
| | | | - Xiao Chen
- University of California Los Angeles, Center for Health Policy Research, Los Angeles, CA, USA
| | - Dominic Lim
- Senior Care Action Network (SCAN) Health Group, Long Beach, CA, USA
| | - Dan Osterweil
- Senior Care Action Network (SCAN) Health Group, Long Beach, CA, USA; Division of Geriatric Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Romilla A Batra
- Senior Care Action Network (SCAN) Health Group, Long Beach, CA, USA
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23
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DeLaCruz-Jiron EJ, Hahn LM, Donahue AL, Shore JH. Telemental Health for the Homeless Population: Lessons Learned when Leveraging Care. Curr Psychiatry Rep 2023; 25:1-6. [PMID: 36480149 PMCID: PMC9734763 DOI: 10.1007/s11920-022-01400-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The purpose of this paper is to review key lessons when using telehealth within the context of mental health and homelessness. We examine technological and bandwidth issues the homeless population might face when getting telehealth services, discuss clinical process adaption needed for working remotely, and highlight the lessons learned when leveraging mental health services to homeless patients across telehealth platforms. RECENT FINDINGS Homelessness is associated with chronic, mental health disparities and access to mental health services is often less accessible among communities with unstable housing. Telehealth provides "OnDemand" treatment options while removing specific barriers found with in-person health care such as transportation, overwhelmed mental health facilities, i.e., appointment availability, and office hour limitations while reducing costs for both providers and patients. We provide two case examples to demonstrate successful delivery of telemental health services to homeless patients and review lessons learned when leveraging care.
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Affiliation(s)
| | - Lauren M. Hahn
- Access Management Services LLC, 11100 East Bethany Drive, Aurora, CO 80014 USA
| | - Amy L. Donahue
- Access Management Services LLC, 11100 East Bethany Drive, Aurora, CO 80014 USA
| | - Jay H. Shore
- Access Management Services LLC, 11100 East Bethany Drive, Aurora, CO 80014 USA ,Department of Psychiatry and Family Medicine, School of Medicine and Centers for American Indian and Alaska Native Health Colorado School of Public Health, Anschutz Medical Campus, Aurora, USA
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24
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Hilty DM, Serhal E, Crawford A. A Telehealth and Telepsychiatry Economic Cost Analysis Framework: Scoping Review. Telemed J E Health 2023; 29:23-37. [PMID: 35639444 DOI: 10.1089/tmj.2022.0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Introduction: Despite a good evidence base for telepsychiatry (TP), economic cost analyses are infrequent and vary in quality. Methods: A scoping review was conducted based on the research question, "From the perspective of an economic cost analysis for telehealth and telepsychiatry, what are the most meaningful ways to ensure a study/intervention improved clinical care, provided value to participants, had population level impact, and is sustainable?" The search in seven databases focused on keywords in four concept areas: (1) economic cost analysis, (2) evaluation, (3) telehealth and telepsychiatry, and (4) quantifiable health status outcomes. The authors reviewed the full-text articles based on the inclusion (Medical Subject Headings [MeSH] of the keywords) and exclusion criteria. Results: Of a total of 2,585 potential references, a total of 99 articles met the inclusion criteria. The evaluation of telehealth and TP has focused on access, quality, patient outcomes, feasibility, effectiveness, outcomes, and cost. Cost-effectiveness, cost-benefit, and other analytic models are more common with telehealth than TP studies, and these studies show favorable clinical, quality of life, and economic impact. A standard framework for economic cost analysis should include: an economist for planning, implementation, and evaluation; a tool kit or guideline; comprehensive analysis (e.g., cost-effectiveness or cost-benefit) with an incremental cost-effectiveness ratio; measures for health, quality of life, and utility outcomes for populations; methods to convert outcomes into economic benefits (e.g., monetary, quality of adjusted life year); broad perspective (e.g., societal perspective); sensitivity analysis for uncertainty in modeling; and adjustments for differential timing (e.g., discounting and future costs). Conclusions: Technology assessment and economic cost analysis-such as effectiveness and implementation science approaches-contribute to clinical, training, research, and other organizational missions. More research is needed with a framework that enables comparisons across studies and meta-analyses.
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Affiliation(s)
- Donald M Hilty
- Northern California Veterans Administration Health Care System, Mather, California, USA
- Department of Psychiatry & Behavioral Sciences, UC Davis, Sacramento, California, USA
| | - Eva Serhal
- ECHO Ontario Mental Health and ECHO Ontario Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Allison Crawford
- ECHO Ontario Mental Health and ECHO Ontario Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
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25
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Furdock RJ, Feldman B, Sinkler M, Connelly M, Hoffa M, Simpson M, Hendrickson SB, Vallier HA. Factors influencing participation in psychosocial programming among orthopaedic trauma patients with PTSD. Injury 2022; 53:4000-4004. [PMID: 36184361 DOI: 10.1016/j.injury.2022.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Post Traumatic Stress Disorder (PTSD) commonly occurs following acute trauma. Post-injury outcomes are negatively impacted by PTSD. Trauma Recovery Services (TRS) programming was developed at our institution in 2013 to provide psychosocial programming that increases patient satisfaction with care and ability to return to work and decreases PTSD symptoms. We sought to identify factors that influence patients' decision to participate in programming. METHODS Over a 3-year period at a single, urban level 1 trauma center, 172 patients over the age of 18 screened positive for PTSD on the validated PTSD checklist for DSM-5 (PCL-5) screening tool. Demographic, socioeconomic, injury, and medical comorbidity information was collected. Variables were initially compared in a univariate manner via Chi-squared, Fisher exact, t-test, or Mann-Whitney U, as appropriate. Variables that had a p-value <0.2 on univariate analysis were entered into a backward stepwise logistic regression model to identify independent predictors of participation in TRS programming. RESULTS Mean age was 37.8 years. 70.1% of patients were male. The most common mechanisms of injury were gunshot wound (33.7%), motor vehicle crash (19.0%), and burn. 33.5% of patients participated in TRS programming. Nine predictors had p<.2 on univariate analysis and were entered into the stepwise regression model. Four predictors remained in the final model. Patients with private insurance (RR=2.2, p=.038), high school diploma or greater (RR=1.53, p=.002; Table 1), and PCL-5 score greater than 50 were more likely to participate in TRS programming (RR=1.42, p=.046). Patients who live 20 or more minutes away by car from TRS were less likely to participate in programming (RR=0.47, p=.065). DISCUSSION Patients with more severe PTSD, higher levels of education, and private insurance were more likely to participate in TRS programming. Participation in TRS and similar psychosocial programs may be improved by minimizing the participant's potential commute to the program location.
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Affiliation(s)
- Ryan J Furdock
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Blake Feldman
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Margaret Sinkler
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Madison Connelly
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Matthew Hoffa
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Megen Simpson
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Sarah B Hendrickson
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Heather A Vallier
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA.
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26
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Dickens GL, Al Maqbali M, Blay N, Hallett N, Ion R, Lingwood L, Schoultz M, Tabvuma T. Randomized controlled trials of mental health nurse-delivered interventions: A systematic review. J Psychiatr Ment Health Nurs 2022; 30:341-360. [PMID: 36271871 DOI: 10.1111/jpm.12881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/27/2022] [Accepted: 10/18/2022] [Indexed: 11/30/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Well conducted randomized controlled trials provide the highest level of evidence of effectiveness of healthcare interventions, including those delivered by mental health nurses. Trials have been conducted over the years but there has not been a comprehensive review since 2005, and never one including studies conducted outside the UK. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper provides a comprehensive overview of results from randomized controlled trials of mental health nurse-delivered interventions conducted in the UK, Ireland, US, Australia, New Zealand, or Canada and reported 2005 to 2020. It highlights that the trial evidence is limited and offers only partial evidence for interventions that are central to mental health nursing practice. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Much mental health nursing practice is not supported by the highest level trial evidence. Mental health nurses need to carefully select evidence on which to base their practice both from the mental health nursing literature and beyond. Mental health nurses and other stakeholders should demand greater investment in trials to strengthen the evidence base. ABSTRACT INTRODUCTION: Nurses are the largest professional disciplinary group working in mental health services and have been involved in numerous trials of nursing-specific and multidisciplinary interventions. Systematic appraisal of relevant research findings is rare. AIM To review trials from the core Anglosphere (UK, US, Canada, Ireland, Australia, New Zealand) published from 2005 to 2020. METHOD A systematic review reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Comprehensive electronic database searches were conducted. Eligible studies were randomized controlled trials of mental health nurse-delivered interventions conducted in relevant countries. The risk of bias was independently assessed. Synthesis involved integration of descriptive statistics of standardized metrics and study bias. RESULTS Outcomes from 348 between-group comparisons were extracted from K = 51 studies (N = 11,266 participants), Standardized effect sizes for 68 (39 very small/small, 29 moderate/large) statistically significant outcomes from 30 studies were calculable. All moderate/large effect sizes were at risk of bias. DISCUSSION Trial evidence of effective mental health nurse-delivered interventions is limited. Many studies produced few or no measurable benefits; none demonstrated improvements related to personal recovery. IMPLICATIONS FOR PRACTICE Mental health nurses should look beyond gold standard RCT evidence, and to evidence-based interventions that have not been trialled with mental health nurse delivery.
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Affiliation(s)
- Geoffrey L Dickens
- Department of Nursing Midwifery & Health, Northumbria University, Newcastle-Upon-Tyne, UK
| | - Mohammed Al Maqbali
- Department of Nursing Midwifery & Health, Northumbria University, Newcastle-Upon-Tyne, UK
| | - Nicole Blay
- Centre for Applied Nursing Research, Ingham Institute for Medical Research, Liverpool, New South Wales, Australia.,Western Sydney University, Penrith, New South Wales, Australia
| | - Nutmeg Hallett
- The School of Nursing, College of Medical and Dental Sciences, Birmingham, UK
| | - Robin Ion
- School of Health & Life Sciences, Paisley Campus, University of the West of Scotland, Paisley, UK
| | - Louise Lingwood
- Department of Nursing Midwifery & Health, Northumbria University, Newcastle-Upon-Tyne, UK
| | - Mariyana Schoultz
- Department of Nursing Midwifery & Health, Northumbria University, Newcastle-Upon-Tyne, UK
| | - Tracy Tabvuma
- South Western Sydney Local Health District Mental Health Service, Campbelltown Hospital, Campbelltown, New South Wales, Australia
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27
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Tzeng YH, Yin WH, Lin KC, Wei J, Liou HR, Sung HJ, Lang HC. Factors Associated With the Utilization of Outpatient Virtual Clinics: Retrospective Observational Study Using Multilevel Analysis. J Med Internet Res 2022; 24:e40288. [PMID: 35917486 PMCID: PMC9377537 DOI: 10.2196/40288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background Although the COVID-19 pandemic has accelerated the adoption of telemedicine and virtual consultations worldwide, complex factors that may affect the use of virtual clinics are still unclear. Objective This study aims to identify factors associated with the utilization of virtual clinics in the experience of virtual clinic service implementation in Taiwan. Methods We retrospectively analyzed a total of 187,742 outpatient visits (176,815, 94.2%, in-person visits and 10,927, 5.8%, virtual visits) completed at a large general hospital in Taipei City from May 19 to July 31, 2021, after rapid implementation of virtual outpatient clinic visits due to the COVID-19 pandemic. Data of patients’ demographic characteristics, disease type, physicians’ features, and specialties/departments were collected, and physicians’ opinions regarding virtual clinics were surveyed and evaluated using a 5-point Likert scale. Multilevel analysis was conducted to determine the factors associated with the utilization of virtual clinics. Results Patient-/visit-, physician-, and department-level factors accounted for 67.5%, 11.1%, and 21.4% of the total variance in the utilization of virtual clinics, respectively. Female sex (odds ratio [OR] 1.27, 95% CI 1.22-1.33, P<.001); residing at a greater distance away from the hospital (OR 2.36, 95% CI 2.15-2.58 if distance>50 km, P<.001; OR 3.95, 95% CI 3.11-5.02 if extensive travel required, P<.001); reimbursement by the National Health Insurance (NHI; OR 7.29, 95% CI 5.71-9.30, P<.001); seeking care for a major chronic disease (OR 1.33, 95% CI 1.24-1.42, P<.001); the physician’s positive attitude toward virtual clinics (OR 1.50, 95% CI 1.16-1.93, P=.002); and visits within certain departments, including the heart center, psychiatry, and internal medicine (OR 2.55, 95% CI 1.46-4.46, P=.004), were positively associated with the utilization of virtual clinics. The patient’s age, the physician’s age, and the physician’s sex were not associated with the utilization of virtual clinics in our study. Conclusions Our results show that in addition to previously demonstrated patient-level factors that may influence telemedicine use, including the patient’s sex and distance from the hospital, factors at the visit level (insurance type, disease type), physician level (physician’s attitude toward virtual clinics), and department level also contribute to the utilization of virtual clinics. Although there was a more than 300-fold increase in the number of virtual visits during the pandemic compared with the prepandemic period, the majority (176,815/187,742, 94.2%) of the outpatient visits were still in-person visits during the study period. Therefore, it is of great importance to understand the factors impacting the utilization of virtual clinics to accelerate the implementation of telemedicine. The findings of our study may help direct policymaking for expanding the use of virtual clinics, especially in countries struggling with the development and promotion of telemedicine virtual clinic services.
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Affiliation(s)
- Yun-Hsuan Tzeng
- Health Management Center, Cheng Hsin General Hospital, Taipei, TW.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, TW
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, TW.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, TW
| | - Kuan-Chia Lin
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei, TW.,Community Medicine Research Center, National Yang Ming Chiao Tung University, Taipei, TW
| | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital, Taipei, TW
| | - Hao-Ren Liou
- Health Management Center, Cheng Hsin General Hospital, Taipei, TW
| | - Hung-Ju Sung
- Health Management Center, Cheng Hsin General Hospital, Taipei, TW
| | - Hui-Chu Lang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitou Dist., Taipei, TW
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Farrell D, Fadeeva A, Zat Z, Knibbs L, Miller P, Barron I, Matthess H, Matthess C, Gazit N, Kiernan MD. A Stage 1 Pilot Cohort Exploring the Use of EMDR Therapy as a Videoconference Psychotherapy During COVID-19 With Frontline Mental Health Workers: A Proof of Concept Study Utilising a Virtual Blind 2 Therapist Protocol. Front Psychol 2022; 13:901855. [PMID: 35874361 PMCID: PMC9298740 DOI: 10.3389/fpsyg.2022.901855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/19/2022] [Indexed: 02/05/2023] Open
Abstract
Objective The COVID-19 pandemic has had a major impact on the delivery of psychological treatment. Due to social distancing requirements, the provision moved to videoconferencing psychotherapy (VCP). There is a paucity of empirical data supporting the efficacy of EMDR therapy as a VCP. This stage 1 pilot study tested an EMDR therapy scripted protocol, such as Virtual Blind 2 Therapist (VB2Tr), on frontline mental health workers as a VCP regarding fitness for purpose, distinctiveness, relevance, and efficiency. Methods A total of 24 participants were recruited for the study. The design included a one-session treatment intervention with pre, post, 1-month, and 6-month follow-up (FU) measurements. This treatment session used a “Blind 2 Therapist” EMDR therapy scripted protocol as videoconference psychotherapy that involves non-disclosure of traumatic memory. The research explored the treatment effect on the core characteristics of trauma memory, including subjective disturbance, belief systems, memory intensity (MI), vividness, and levels of emotionality. Additionally, the research explored participants’ experiences of adverse and benevolent childhood experiences (ACEs/BCEs) during their childhood. Results Regarding the four tests, namely, fitness for purpose, distinctiveness, relevance, and efficiency, results are favourably suggesting potential clinical benefits of using EMDR as videoconference psychotherapy. Although this is a proof-of-concept study showing positive results, no clinical population or control group was used. The purpose of the study is to explore the potential for scalability toward a larger clinical trial. The treatment intervention was achieved irrespective of either ACEs/BCEs during childhood. Conclusion The research tentatively supports the case for EMDR therapy as a credible treatment when used as video conference psychotherapy and in using the Blind 2 Therapist protocol. However, more research is needed to scale toward a clinical trial. Clinical Trial Registration Clinical Trial Registration:https://www.isrctn.com/ISRCTN12099530, identifier ISRCTN12099530.
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Affiliation(s)
- Derek Farrell
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Anastasia Fadeeva
- Northern Hub for Veteran and Military Families' Research, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Zeynep Zat
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Lorraine Knibbs
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Paul Miller
- Mirabilis Health Institute, Newtownabbey, United Kingdom
| | - Ian Barron
- Centre for International Education, College of Education, University of Massachusetts, Amherst, MA, United States
| | - Helga Matthess
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Cordula Matthess
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
| | | | - Matthew D Kiernan
- Northern Hub for Veteran and Military Families' Research, Northumbria University, Newcastle upon Tyne, United Kingdom
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Fortney JC, Rajan S, Reisinger HS, Moeckli J, Nolan JP, Wong ES, Rise P, Petrova VV, Sayre GG, Pyne JM, Grubaugh A, Simsek-Duran F, Grubbs KM, Morland LA, Felker B, Schnurr PP. Deploying a telemedicine collaborative care intervention for posttraumatic stress disorder in the U.S. Department of Veterans Affairs: A stepped wedge evaluation of an adaptive implementation strategy. Gen Hosp Psychiatry 2022; 77:109-117. [PMID: 35596963 DOI: 10.1016/j.genhosppsych.2022.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/08/2022] [Accepted: 03/23/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To address barriers to trauma-focused psychotherapy for veterans with posttraumatic stress disorder (PTSD), we compared two implementation strategies to promote the deployment of telemedicine collaborative care. METHOD We conducted a Hybrid Type III Effectiveness Implementation trial at six VA medical centers and their 12 affiliated Community Based Outpatient Clinics. The trial used a stepped wedge design and an adaptive implementation strategy that started with standard implementation, followed by enhanced implementation for VA medical centers that did not achieve the performance benchmark. Implementation outcomes for the 544 veterans sampled from the larger population targeted by the intervention were assessed from chart review (care management enrollment and receipt of trauma-focused psychotherapy) and telephone survey (perceived access and PTSD symptoms) after each implementation phase. The primary outcome was enrollment in care management. RESULTS There was no significant difference between standard implementation and enhanced implementation on any of the implementation outcomes. 41.6% of sampled veterans had a care manager encounter, but only 6.0% engaged in trauma-focused psychotherapy. CONCLUSIONS While telemedicine collaborative care was shown to be effective at engaging veterans in trauma-focused psychotherapy in a randomized controlled trial, neither standard nor enhanced implementation strategies were sufficient to support successful deployment into routine care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02737098.
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Affiliation(s)
- John C Fortney
- VA HSR&D Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States of America.
| | - Suparna Rajan
- VA HSR&D Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America
| | - Heather S Reisinger
- VA HSR&D Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, IA, United States of America; Department of Internal Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Jane Moeckli
- VA HSR&D Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, IA, United States of America
| | | | - Edwin S Wong
- VA HSR&D Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America; Department of Health and Systems and Population Health, University of Washington, Seattle, WA, United States of America
| | - Peter Rise
- VA HSR&D Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America
| | - Valentina V Petrova
- VA HSR&D Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America
| | - George G Sayre
- VA HSR&D Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America
| | - Jeffrey M Pyne
- VA HSR&D Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, United States of America; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Anouk Grubaugh
- VA HSR&D Charleston Health Equity and Rural Outreach Innovation Center, Charleston, SC, United States of America; Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States of America
| | - Fatma Simsek-Duran
- Iowa City VA Health Care System, IA, United States of America; Department of Psychiatry, University of Iowa, Iowa City, IA, United States of America
| | - Kathleen M Grubbs
- VA San Diego Healthcare System, San Diego, CA, United States of America; Department of Psychiatry, University of California-San Diego, San Diego, CA, United States of America
| | - Leslie A Morland
- VA San Diego Healthcare System, San Diego, CA, United States of America; Department of Psychiatry, University of California-San Diego, San Diego, CA, United States of America
| | - Bradford Felker
- VA HSR&D Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States of America
| | - Paula P Schnurr
- National Center for PTSD, VA Medical Center, White River Junction, VT, United States of America; Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
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Rhon DI, Fritz JM, Kerns RD, McGeary DD, Coleman BC, Farrokhi S, Burgess DJ, Goertz CM, Taylor SL, Hoffmann T. TIDieR-telehealth: precision in reporting of telehealth interventions used in clinical trials - unique considerations for the Template for the Intervention Description and Replication (TIDieR) checklist. BMC Med Res Methodol 2022; 22:161. [PMID: 35655144 PMCID: PMC9161193 DOI: 10.1186/s12874-022-01640-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/20/2022] [Indexed: 12/28/2022] Open
Abstract
Abstract
Background
Recent international health events have led to an increased proliferation of remotely delivered health interventions. Even with the pandemic seemingly coming under control, the experiences of the past year have fueled a growth in ideas and technology for increasing the scope of remote care delivery. Unfortunately, clinicians and health systems will have difficulty with the adoption and implementation of these interventions if ongoing and future clinical trials fail to report necessary details about execution, platforms, and infrastructure related to these interventions. The purpose was to develop guidance for reporting of telehealth interventions.
Methods
A working group from the US Pain Management Collaboratory developed guidance for complete reporting of telehealth interventions. The process went through 5-step process from conception to final checklist development with input for many stakeholders, to include all 11 primary investigators with trials in the Collaboratory.
Results
An extension focused on unique considerations relevant to telehealth interventions was developed for the Template for the Intervention Description and Replication (TIDieR) checklist.
Conclusion
The Telehealth Intervention guideline encourages use of the Template for the Intervention Description and Replication (TIDieR) checklist as a valuable tool (TIDieR-Telehealth) to improve the quality of research through a reporting guide of relevant interventions that will help maximize reproducibility and implementation.
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Morgan ER, Rivara FP, Ta M, Grossman DC, Jones K, Rowhani-Rahbar A. Incarceration and subsequent risk of suicide: A statewide cohort study. Suicide Life Threat Behav 2022; 52:467-477. [PMID: 35092087 DOI: 10.1111/sltb.12834] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/26/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Increasing suicide rates across the United States are disproportionate among populations most impacted by mass incarceration. We sought to determine if incarceration is associated with risk of suicide and firearm suicide after release from prison. METHODS Using a population-based Washington cohort from Department of Corrections and vital statistics administrative records 1990-2017, individuals were compared to the sex-, age-, and race-matched population of Washington using Poisson regression. Among previously incarcerated individuals, we included incarceration history characteristics to calculate sub-hazard ratios using Cox proportional-hazards models. RESULTS Of 140,281 individuals released from prison, 484 died by suicide. Suicide risk was 62% higher among previously incarcerated individuals compared with the general population (RR: 1.62; 95% CI: 1.46-1.79). Suicide risk was higher among individuals convicted of firearm-involved crimes (RR: 2.27; 95% CI: 1.79-2.89). Individuals released prior to age 18 had substantially higher risk of firearm suicide than those whose first release occurred between ages 18-24 (sHR: 11.91; 95% CI: 4.30-32.96). CONCLUSION Our findings highlight the need for improved mental health resources and lethal means safety in this population. Mental health and substance use treatment have been proposed as effective alternatives to incarceration-continuing to study their impacts may reveal additional benefits of reducing suicide.
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Affiliation(s)
- Erin Renee Morgan
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.,Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Frederick P Rivara
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Myduc Ta
- Assessment, Policy Development and Evaluation Unit, Public Health - Seattle & King County, Seattle, Washington, USA
| | - David C Grossman
- Kaiser Permanente Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Karl Jones
- Washington State Department of Corrections, Tumwater, Washington, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.,Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
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LaRocco-Cockburn A, Jakupcak M, Bauer AM, Bowen DJ, Bechtel J, Koconis N, Fortney JC. Care managers' experiences in a collaborative care program for the treatment of bipolar disorder and PTSD in underserved communities. Gen Hosp Psychiatry 2022; 76:16-24. [PMID: 35313202 DOI: 10.1016/j.genhosppsych.2022.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 02/17/2022] [Accepted: 03/03/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To understand care managers' experiences treating primary care patients with bipolar disorder and PTSD in a telepsychiatry collaborative care (TCC) program, as part of a large pragmatic trial. METHODS We conducted individual qualitative interviews with 12 care managers to evaluate barriers and facilitators to implementation of a previously completed TCC intervention for patients with bipolar disorder and/or PTSD. We used directed and conventional content analysis and Consolidated Framework for Implementation Research (CFIR) constructs to organize care manager experiences. RESULTS Participants described clinical and medication management support from telepsychiatrists and satisfaction with the TCC model as facilitators of success for patients with bipolar disorder and PTSD in underserved communities. Participants also described onboarding of primary care providers and clinic leadership as keys to successful team-care and credited satisfaction with providing Behavioral Activation as essential to sustained delivery of the psychotherapy component of TCC. CONCLUSIONS Participants described high satisfaction with TCC for patients with bipolar disorder and PTSD. Challenges included lack of clinic leadership and PCP engagement. Early and ongoing promotion of integrated care and prioritizing telepsychiatry consultation with patients, behavioral health professionals and PCPs, may improve patient care, provide ongoing training and improve workforce satisfaction.
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Affiliation(s)
- Anna LaRocco-Cockburn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America; LaRocco Counseling, PLLC, 2366 Eastlake Ave E, Suite 234, Seattle, WA 98102, United States of America.
| | - Matthew Jakupcak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America; Lyra Health, 287 Lorton Ave, Burlingame, CA 94010, United States of America.
| | - Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America.
| | - Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, Box 357120, Seattle, WA, United States of America.
| | - Jared Bechtel
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America.
| | - Natalie Koconis
- University of Washington, Institute for Public Health Genetics, in association with the Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America.
| | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America; Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Values-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America.
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Benudis A, Re'em Y, Kanellopoulos D, Moreno A, Zonana J. Patient and provider experiences of telemental health during the COVID-19 pandemic in a New York City academic medical center. Psychiatry Res 2022; 311:114496. [PMID: 35306378 PMCID: PMC8898588 DOI: 10.1016/j.psychres.2022.114496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 02/26/2022] [Accepted: 03/05/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We aimed to evaluate patient and provider experiences with telemental health (TMH) at an academic outpatient psychiatry department in New York City during the first wave of the COVID-19 pandemic. METHODS Patients and providers completed online surveys evaluating their experience with TMH during the first wave of the COVID-19 pandemic. Surveys were distributed to 1,178 patients and 287 providers from July 2020 through October 2020. RESULTS 42.5% of providers and 21% of patients responded to the survey. The majority of patient and provider respondents rated the quality of phone and video visits as "equally good" or "somewhat worse" than in-person visits, while the majority of respondents were "somewhat satisfied" or "very satisfied" with video visits. Patients and providers preferred a hybrid model for future care. Common barriers to TMH included privacy, technical difficulties, and wi-fi access. CONCLUSIONS Patients and providers appeared willing to exchange some degree of quality for satisfaction with TMH. This study did not demonstrate with statistical significance any specific patient populations that would benefit more or less from TMH, suggesting that TMH may be a successful model for diverse patient populations. Our results suggest that providers, payors, and regulators should facilitate hybrid care delivery models that incorporate TMH beyond the pandemic.
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Affiliation(s)
- Abigail Benudis
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
| | - Yochai Re'em
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Dora Kanellopoulos
- NewYork-Presbyterian Hospital/Westchester Behavioral Health Center, White Plains, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | | | - Jess Zonana
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
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Fortney JC, Carey EP, Rajan S, Rise PJ, Gunzburger EC, Felker BL. A Comparison of Patient-Reported Mental Health Outcomes for the Department of Veterans Affairs' Regional Telehealth and Community Care Programs. Health Serv Res 2022; 57:755-763. [PMID: 35467011 PMCID: PMC9264470 DOI: 10.1111/1475-6773.13993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives To compare patient‐reported outcomes for veterans with limited access to Department of Veterans Affairs (VA) mental health services referred to the Veterans Community Care Program (VCCP) or regional telehealth Clinical Resource Hubs‐Mental Health (CRH‐MH). Data Sources This national evaluation used secondary data from the VA Corporate Data Warehouse, chart review, and primary data collected by baseline survey between October 8, 2019 and May 27, 2020 and a 4‐month follow‐up survey. Study Design A quasi‐experimental longitudinal study design was used to sample 545 veterans with VCCP or CRH‐MH referrals for new treatment episodes. Patient‐reported outcomes included symptom severity, perceived access, utilization, and patient‐centeredness. Data Collection During the baseline and follow‐up surveys, all veterans were administered the Patient Health Questionnaire‐8 (PHQ‐8) to assess depression severity, and veterans with a provisional diagnosis of posttraumatic stress disorder (PTSD) were also administered the PTSD Checklist for DSM‐5 (PCL‐5) to assess PTSD symptom severity. The 4‐month follow‐up survey also asked about perceived access using the Perceived Access Inventory, the number of encounters, and patient‐centeredness of care using the Patient‐Centered Care portion of the Veterans Satisfaction Survey. Principal Findings Results indicated that compared to VCCP consults, veterans with CRH‐MH consults reported 0.65 (CI95 = 0.51–0.83, p < 0.01) times the number of barriers to care, but a non‐significant lower number of encounters (−0.792, CI95 −2.221, 0.636, p = 0.28). There was no significant (p = 0.24) difference in satisfaction with patient‐centeredness, with both groups “agreeing” on average to positively worded questions. Veterans in both groups experienced little improvement in depression or PTSD symptom severity, and there were no clinically meaningful differences between groups. Conclusions Overall findings indicate that the CRH‐MH and VCCP generate similar patient‐reported outcomes. Future research should compare the quality and cost of care delivered by the VCCP and CRH‐MH programs.
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Affiliation(s)
- John C Fortney
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA.,Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
| | - Evan P Carey
- Department of Biostatistics & Informatics, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA.,Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Denver, Colorado, USA
| | - Suparna Rajan
- Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
| | - Peter J Rise
- Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
| | - Elise C Gunzburger
- Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Denver, Colorado, USA
| | - Bradford L Felker
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA.,Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
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Davis B, McDaniel CC, Wang CH, Garza KB. Mental Health and Psychotropic Stigma Among Student Pharmacists. Front Public Health 2022; 10:818034. [PMID: 35419335 PMCID: PMC8995784 DOI: 10.3389/fpubh.2022.818034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To gain a better understanding of student pharmacists' stigma toward mental health and psychotropic medications. Methods A cross-sectional study was conducted via paper and online surveys amongst all student pharmacists enrolled in a Doctor of Pharmacy program in the Southeastern United States (n = 501). The Perceived Devaluation and Discrimination (PDD) Scale was used to measure mental health stigma. The Beliefs about Medicines Questionnaire (BMQ) was modified to measure psychotropic stigma. MANOVAs were conducted to investigate relationships between student pharmacists' characteristics with mental health and psychotropic stigma. A paired t-test was used to determine if there was a difference between degree of mental health stigma and psychotropic stigma. Results A total of 390 participants completed the survey (65%). The sample was mostly female (67%), white (79%), and non-Hispanic (96%). Ages were predominantly within the 19–24-year range (80%), and the majority of respondents reported previous interactions with patients who have mental health conditions (55%) or patients on psychotropic medications (65%). Student personal preferences for mental health treatment were primarily psychologic (42%) or both psychologic and psychotropic (40%). Degree of psychotropic stigma was significantly greater than that of mental health stigma. A statistically significant association was found between student personal preference for treatment and the psychotropic stigma. No difference was found in degree of either type of stigma across cohorts. Conclusions Student pharmacists demonstrated both mental health and psychotropic stigmas. Future research should be performed to determine what effects these stigmas have on care of patients with mental health conditions.
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Affiliation(s)
- Brandy Davis
- Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, Auburn, AL, United States
| | - Cassidi C McDaniel
- Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, Auburn, AL, United States
| | - Chih-Hsuan Wang
- Educational Foundations, Leadership, and Technology, Auburn University, Auburn, AL, United States
| | - Kimberly B Garza
- Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, Auburn, AL, United States
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Ainslie M, Brunette MF, Capozzoli M. Treatment Interruptions and Telemedicine Utilization in Serious Mental Illness: Retrospective Longitudinal Claims Analysis. JMIR Ment Health 2022; 9:e33092. [PMID: 35311673 PMCID: PMC8981005 DOI: 10.2196/33092] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Avoiding interruptions and dropout in outpatient care can prevent mental illness symptom exacerbation and costly crisis services, such as emergency room visits and inpatient psychiatric hospitalization. During the COVID-19 pandemic, to attempt to maintain care continuity, telemedicine services were increasingly utilized, despite the lack of data on efficacy in patients with serious mental illness. Patients with serious mental illness are challenging to enroll and sustain in randomized controlled trials over time due to fluctuations in disease exacerbation. However, capturing and examining utilization and efficacy data in community mental health center (CMHC) patients with serious mental illness during the pandemic is a unique opportunity to inform future clinical and policy decision-making. OBJECTIVE We aimed to identify and describe the characteristics of CMHC patients with serious mental illness who experienced treatment interruptions and who utilized telemedicine during the pandemic. METHODS We conducted a retrospective observational study of treatment interruptions and telemedicine use during the period from December 2019 to June 2020 (compared to the period from December 2018 to June 2019) in New Hampshire CMHC patients. The study population included all Medicaid beneficiaries with serious mental illness engaged in treatment 3 months prior to the declaration of a state of emergency in response to the COVID-19 pandemic. We used chi-square tests of independence and logistic regression to explore associations between treatment interruptions and variables (gender, age, rurality, and diagnosis). Telemedicine utilization was categorized as low (<25%), medium (25%-75%), or high (>75%) use. RESULTS A total of 16,030 patients were identified. New Hampshire CMHCs demonstrated only a 4.9% increase in treatment interruptions compared with the year prior. Patients who were male (odds ratio [OR] 1.27, 95% CI 1.17-1.38; P<.001), under the age of 18 years (ages 0-12 years: OR 1.37, 95% CI 0.62-0.86, P<.001; aged 13-17 years: OR 1.49, 95% CI 0.57-0.79, P<.001), or among milder diagnostic categories, such as anxiety disorders (OR 3.77, 95% CI 3.04-4.68; P<.001) and posttraumatic stress disorder (OR 3.69, 95% CI 2.96-4.61; P<.001), were most likely to experience treatment interruptions. Patients who were female (OR 0.89, CI 0.65-0.74), 18 to 34 years old (OR 0.74, CI 0.70-0.79), or among milder diagnostic categories, such as anxiety disorder (OR 0.69, CI 0.65-0.74) or posttraumatic stress disorder (OR 0.77, CI 0.72-0.83), and with major depressive disorder (OR 0.73, CI 0.68-0.78) were less likely to be in the low telemedicine utilization group. CONCLUSIONS The integration of telemedicine supported care continuity for most CMHC patients; yet, retention varied by subpopulation, as did telemedicine utilization. The development of policies and clinical practice guidelines requires empirical evidence on the effectiveness and limitations of telemedicine in patients with serious mental illness.
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Affiliation(s)
- Marcy Ainslie
- Department of Nursing, University of New Hampshire, Durham, NH, United States
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Michelle Capozzoli
- Department of Mathematics & Statistics, University of New Hampshire, Durham, NH, United States
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Meredith LS, Wong E, Osilla KC, Sanders M, Tebeka MG, Han B, Williamson SL, Carton TW. Trauma-informed Collaborative Care for African American Primary Care Patients in Federally Qualified Health Centers: A Pilot Randomized Trial. Med Care 2022; 60:232-239. [PMID: 35157622 PMCID: PMC8867914 DOI: 10.1097/mlr.0000000000001681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND African Americans have nearly double the rate of posttraumatic stress disorder (PTSD) compared with other racial/ethnic groups. OBJECTIVE To understand whether trauma-informed collaborative care (TICC) is effective for improving PTSD among African Americans in New Orleans who receive their care in Federally Qualified Health Centers (FQHCs). DESIGN AND METHOD In this pilot randomized controlled trial, we assigned patients within a single site to either TICC or to enhanced usual care (EUC). We performed intent to treat analysis by nonparametric exact tests for small sample sizes. PARTICIPANTS We enrolled 42 patients from October 12, 2018, through July 2, 2019. Patients were eligible if they considered the clinic their usual source of care, had no obvious physical or cognitive obstacles that would prevent participation, were age 18 or over, self-identified as African American, and had a provisional diagnosis of PTSD. MEASURES Our primary outcome measures were PTSD measured as both a symptom score and a provisional diagnosis based on the PTSD Checklist for DSM-5 (PCL-5). KEY RESULTS Nine months following baseline, both PTSD symptom scores and provisional PTSD diagnosis rates decreased substantially more for patients in TICC than in EUC. The decreases were by 26 points in EUC and 36 points in TICC for symptoms (P=0.08) and 33% in EUC and 57% in TICC for diagnosis rates (P=0.27). We found no effects for mediator variables. CONCLUSIONS TICC shows promise for addressing PTSD in this population. A larger-scale trial is needed to fully assess the effectiveness of this approach in these settings.
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Affiliation(s)
- Lisa S. Meredith
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
- VA HSR&D Center for Healthcare Innovation, Implementation & Policy, 16111 Plummer St, North Hills, CA, USA
| | - Eunice Wong
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
| | | | - Margaret Sanders
- Louisiana Public Health Institute, 1515 Poydras Street, Suite 1200, New Orleans, LA, USA
| | | | - Bing Han
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
| | | | - Thomas W. Carton
- Louisiana Public Health Institute, 1515 Poydras Street, Suite 1200, New Orleans, LA, USA
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Moon K, Sobolev M, Kane JM. Digital and Mobile Health Technology in Collaborative Behavioral Health Care: Scoping Review. JMIR Ment Health 2022; 9:e30810. [PMID: 35171105 PMCID: PMC8892315 DOI: 10.2196/30810] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/08/2021] [Accepted: 10/20/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The collaborative care model (CoCM) is a well-established system of behavioral health care in primary care settings. There is potential for digital and mobile technology to augment the CoCM to improve access, scalability, efficiency, and clinical outcomes. OBJECTIVE This study aims to conduct a scoping review to synthesize the evidence available on digital and mobile health technology in collaborative care settings. METHODS This review included cohort and experimental studies of digital and mobile technologies used to augment the CoCM. Studies examining primary care without collaborative care were excluded. A literature search was conducted using 4 electronic databases (MEDLINE, Embase, Web of Science, and Google Scholar). The search results were screened in 2 stages (title and abstract screening, followed by full-text review) by 2 reviewers. RESULTS A total of 3982 nonduplicate reports were identified, of which 20 (0.5%) were included in the analysis. Most studies used a combination of novel technologies. The range of digital and mobile health technologies used included mobile apps, websites, web-based platforms, telephone-based interactive voice recordings, and mobile sensor data. None of the identified studies used social media or wearable devices. Studies that measured patient and provider satisfaction reported positive results, although some types of interventions increased provider workload, and engagement was variable. In studies where clinical outcomes were measured (7/20, 35%), there were no differences between groups, or the differences were modest. CONCLUSIONS The use of digital and mobile health technologies in CoCM is still limited. This study found that technology was most successful when it was integrated into the existing workflow without relying on patient or provider initiative. However, the effect of digital and mobile health on clinical outcomes in CoCM remains unclear and requires additional clinical trials.
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Affiliation(s)
- Khatiya Moon
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
| | - Michael Sobolev
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- Cornell Tech, Cornell University, New York City, NY, United States
| | - John M Kane
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
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Sayer NA, Wiltsey-Stirman S, Rosen CS, Bernardy NC, Spoont MR, Kehle-Forbes SM, Eftekhari A, Chard KM, Nelson DB. Investigation of Therapist Effects on Patient Engagement in Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in the Veterans Health Administration. J Trauma Stress 2022; 35:66-77. [PMID: 34048602 DOI: 10.1002/jts.22679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 12/11/2022]
Abstract
The present study examined whether certain Veterans Health Administration (VHA) therapists have more success than others in keeping patients engaged in evidence-based psychotherapies for posttraumatic stress disorder (PTSD). Our objective was to use multilevel modeling to quantify the variability between therapists in two indicators of patient engagement: early dropout (i.e., < 3 sessions) and adequate dose (i.e., ≥ 8 sessions). The phenomenon of systematic variability between therapists in patients' treatment experience and outcomes is referred to as "therapist effects." The sample included the 2,709 therapists who provided individual cognitive processing therapy (CPT) or prolonged exposure (PE) to 18,461 veterans with PTSD across 140 facilities in 2017. Data were extracted from administrative databases. For CPT, therapist effects accounted for 10.9% of the variance in early dropout and 8.9% of the variance in adequate dose. For PE, therapist effects accounted for 6.0% and 8.8% of the variance in early dropout and adequate dose, respectively. Facility only accounted for an additional 1.1%-3.1% of the variance in early dropout and adequate dose. For CPT, patients' odds of receiving an adequate dose almost doubled, OR = 1.41/0.72 = 1.96, if they were seen by a therapist in the highest compared with the lowest retention decile. For PE, the odds of a patient receiving an adequate dose were 84% higher, OR = 1.38/0.75 = 1.84, when treated by a therapist in the highest compared with the lowest retention decile. Therapist skills and work environment may contribute to variability across therapists in early dropout and adequate dose.
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Affiliation(s)
- Nina A Sayer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shannon Wiltsey-Stirman
- Dissemination & Training Division, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Craig S Rosen
- Dissemination & Training Division, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Nancy C Bernardy
- Executive Division, National Center for PTSD, White River Junction, Vermont, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Michele R Spoont
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shannon M Kehle-Forbes
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Afsoon Eftekhari
- Dissemination & Training Division, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Kathleen M Chard
- Cincinnati Department of Veterans Affairs (VA) Medical Center, Cincinnati, Ohio, USA.,University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David B Nelson
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Xu W, Gu G, Dong L, Wang L. Analysis of Factors Influencing Telemedicine-Based Psychiatric Extended Care and Care of Psychiatric Patients. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9434820. [PMID: 35083029 PMCID: PMC8786483 DOI: 10.1155/2022/9434820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022]
Abstract
The aim of this paper is to understand the current situation of the care burden of patients with mental illness in remission and the factors affecting it in order to provide a scientific basis for targeted interventions. This paper reviews the concept of telemedicine, the application of telemedicine in home hospice care, and the remaining problems and improvement strategies of telemedicine in home hospice care, with the aim of providing a reference for the application of telemedicine in home hospice care in China. The Zarit Burden Scale, Family Care Scale, and Social Functioning Scale were used to conduct one-to-one interviews with 201 schizophrenic patients in remission and their primary caregivers in Hubei Province. Among them, 66, 72, and 25 cases (32.8%, 35.9%, and 12.4%) had mild, moderate, and severe burdens, respectively. Caregivers' family care and patients' social functioning were generally poor. The results of multiple linear regression analysis showed that caregiver age, caregiver education, caregiver family care, patient medical costs, and patient social functioning were factors influencing the burden of care for patients with schizophrenia in remission (P < 0.05). The government, mental health centers, and families should understand the level of caregiving burden of patients with schizophrenia in remission and the factors influencing it and provide targeted measures to reduce the caregiving burden.
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Affiliation(s)
- Wenjian Xu
- Tian Jin An Ding Hospital, Tianjin 300000, China
| | - Guang Gu
- Liaocheng Fourth People's Hospital, Liaocheng 252000, China
| | - Libo Dong
- Heilongjiang Armed Police Corps Hospital, Harbin 150010, China
| | - Lina Wang
- Tian Jin An Ding Hospital, Tianjin 300000, China
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Wong ES, Rajan S, Liu CF, Morland LA, Pyne JM, Simsek-Duran F, Reisinger HS, Moeckli J, Fortney JC. Economic costs of implementing evidence-based telemedicine outreach for posttraumatic stress disorder in VA. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221116771. [PMID: 37091111 PMCID: PMC9924252 DOI: 10.1177/26334895221116771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Telemedicine outreach for posttraumatic stress disorder (TOP) is a virtual evidence-based practice (EBP) involving telephone care management and telepsychology that engages rural patients in trauma-focused psychotherapy. This evaluation examined implementation and intervention costs attributable to deploying TOP from a health system perspective. Methods Costs were ascertained as part of a stepped wedge cluster randomized trial at five sites within the Veterans Affairs (VA) Healthcare System. All sites initially received a standard implementation strategy, which included internal facilitation, dissemination of an internal facilitators operational guide, funded care manager, care managing training, and technical support. A subset of clinics that failed to meet performance metrics were subsequently randomized to enhanced implementation, which added external facilitation that focused on incorporating TOP clinical processes into existing clinic workflow. We measured site-level implementation activities using project records and structured activity logs tracking personnel-level time devoted to all implementation activities. We monetized time devoted to implementation activities by applying an opportunity cost approach. Intervention costs were measured as accounting-based costs for telepsychiatry/telepsychology and care manager visits, ascertained using VA administrative data. We conducted descriptive analyses of strategy-specific implementation costs across five sites. Descriptive analyses were conducted instead of population-level cost-effectiveness analysis because previous research found enhanced implementation was not more successful than the standard implementation in improving uptake of TOP. Results Over the 40-month study period, four of five sites received enhanced implementation. Mean site-level implementation cost per month was $919 (SD = $238) during standard implementation and increased to $1,651 (SD = $460) during enhanced implementation. Mean site-level intervention cost per patient-month was $46 (SD = $28) during standard implementation and $31 (SD = $21) during enhanced implementation. Conclusions Project findings inform the expected cost of implementing TOP, which represents one factor health systems should consider in the decision to broadly adopt this EBP. Plain Language Summary: What is already known about the topic: Trauma-focused psychotherapy delivered through telemedicine has been demonstrated as an effective approach for the treatment of post-traumatic stress disorder (PTSD). However, uptake of this evidence-based approach by integrated health systems such as the Veterans Affairs (VA) Health Care System is low. What does this paper add: This paper presents new findings on the costs of two implementation approaches designed to increase adoption telemedicine outreach for PTSD from a health system perspective. What are the implications for practice, research, and policy: Cost estimates from this paper can be used by health systems to inform the relative value of candidate implementation strategies to increase adoption of evidence-based treatments for PTSD or other mental health conditions.
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Affiliation(s)
- Edwin S. Wong
- Center for Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Health Care System, Seattle, WA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | - Suparna Rajan
- Center for Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Health Care System, Seattle, WA
| | - Chuan-Fen Liu
- Center for Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Health Care System, Seattle, WA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | - Leslie A. Morland
- VA San Diego Healthcare System, San Diego, CA
- Department of Psychiatry, University of California-San Diego, San Diego, CA
| | - Jeffrey M. Pyne
- Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Fatma Simsek-Duran
- Iowa City VA Health Care System, Iowa City, IA
- Department of Psychiatry, University of Iowa, Iowa City, IA
| | - Heather S. Reisinger
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA
- Department of Internal Medicine, University of Iowa, Iowa
City, IA
| | - Jane Moeckli
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA
| | - John C. Fortney
- Center for Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Health Care System, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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Talal AH, Markatou M, Sofikitou EM, Brown LS, Perumalswami P, Dinani A, Tobin JN. Patient-centered HCV care via telemedicine for individuals on medication for opioid use disorder: Telemedicine for Evaluation, Adherence and Medication for Hepatitis C (TEAM-C). Contemp Clin Trials 2021; 112:106632. [PMID: 34813962 DOI: 10.1016/j.cct.2021.106632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Telemedicine has the potential to increase healthcare access especially for vulnerable populations. Telemedicine for Evaluation, Adherence, and Medication for Hepatitis C (TEAM-C) is comparing telemedicine access to specialty medical care to usual care for management of hepatitis C virus (HCV) infection among persons with opioid use disorder (PWOUD). PWOUD have the highest hepatitis C virus (HCV) prevalence and incidence, yet they infrequently receive HCV care. The study objectives are to compare access to specialty care via telemedicine to offsite specialty referral (usual care) on 1) treatment initiation, completion, and sustained virological response, 2) patient satisfaction with health care delivery, and 3) HCV reinfection after successful HCV cure. METHODS TEAM-C is a multi-site, non-blinded, randomized pragmatic clinical trial conducted at 12 opioid treatment programs (OTP) throughout New York State that utilizes the stepped-wedge design. The unit of randomization is the OTP with a total sample size of 624 participants. HCV-infected PWOUD were treated via telemedicine or referral. Telemedicine encounters are conducted onsite in the OTP with co-administration of direct acting antivirals for HCV with medications for opioid use disorder. The primary outcome is undetectable HCV RNA obtained 12 weeks post-treatment cessation. We also follow participants for two years to assess for reinfection. CONCLUSIONS The study utilizes a rigorous study design to evaluate the effectiveness and implementation of virtual treatment for HCV integrated into behavioral treatment. We demonstrate the feasibility, engagement principles and lessons learned from the initial prospective randomized trial of telemedicine targeted to a vulnerable population.
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Affiliation(s)
- Andrew H Talal
- Division of Gastroenterology, Hepatology, and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicot Street, Suite 6090, Buffalo, NY 14203, USA.
| | - Marianthi Markatou
- Department of Biostatistics, University at Buffalo, 726 Kimball Tower, Buffalo, NY 14214, USA.
| | - Elisavet M Sofikitou
- Department of Biostatistics, University at Buffalo, 726 Kimball Tower, Buffalo, NY 14214, USA.
| | - Lawrence S Brown
- START Treatment & Recovery Centers, 22 Chapel Street, Brooklyn, NY 11201, USA.
| | - Ponni Perumalswami
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, 17 East 102nd Street 8th Floor, New York, NY 10029, USA.
| | - Amreen Dinani
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, 17 East 102nd Street 8th Floor, New York, NY 10029, USA.
| | - Jonathan N Tobin
- Clinical Directors Network, Inc. (CDN), New York, NY, USA; The Rockefeller University, 5 West 37th Street, 10(th) floor, New York, NY 10018, USA.
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Fortney JC, Bauer AM, Cerimele JM, Pyne JM, Pfeiffer P, Heagerty PJ, Hawrilenko M, Zielinski MJ, Kaysen D, Bowen DJ, Moore DL, Ferro L, Metzger K, Shushan S, Hafer E, Nolan JP, Dalack GW, Unützer J. Comparison of Teleintegrated Care and Telereferral Care for Treating Complex Psychiatric Disorders in Primary Care: A Pragmatic Randomized Comparative Effectiveness Trial. JAMA Psychiatry 2021; 78:1189-1199. [PMID: 34431972 PMCID: PMC8387948 DOI: 10.1001/jamapsychiatry.2021.2318] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/29/2021] [Indexed: 11/14/2022]
Abstract
Importance Only one-third of patients with complex psychiatric disorders engage in specialty mental health care, and only one-tenth receive adequate treatment in primary care. Scalable approaches are critically needed to improve access to effective mental health treatments in underserved primary care settings. Objective To compare 2 clinic-to-clinic interactive video approaches to delivering evidence-based mental health treatments to patients in primary care clinics. Design, Setting, and Participants This pragmatic comparative effectiveness trial used a sequential, multiple-assignment, randomized trial (SMART) design with patient-level randomization. Adult patients treated at 24 primary care clinics without on-site psychiatrists or psychologists from 12 federally qualified health centers in 3 states who screened positive for posttraumatic stress disorder and/or bipolar disorder and who were not already receiving pharmacotherapy from a mental health specialist were recruited from November 16, 2016, to June 30, 2019, and observed for 12 months. Interventions Two approaches were compared: (1) telepsychiatry/telepsychology-enhanced referral (TER), where telepsychiatrists and telepsychologists assumed responsibility for treatment, and (2) telepsychiatry collaborative care (TCC), where telepsychiatrists provided consultation to the primary care team. TER included an adaptive intervention (phone-enhanced referral [PER]) for patients not engaging in treatment, which involved telephone outreach and motivational interviewing. Main Outcomes and Measures Survey questions assessed patient-reported outcomes. The Veterans RAND 12-item Health Survey Mental Component Summary (MCS) score was the primary outcome (range, 0-100). Secondary outcomes included posttraumatic stress disorder symptoms, manic symptoms, depressive symptoms, anxiety symptoms, recovery, and adverse effects. Results Of 1004 included participants, 701 of 1000 (70.1%) were female, 660 of 994 (66.4%) were White, and the mean (SD) age was 39.4 (12.9) years. Baseline MCS scores were 2 SDs below the US mean; the mean (SD) MCS scores were 39.7 (14.1) and 41.2 (14.2) in the TCC and TER groups, respectively. There was no significant difference in 12-month MCS score between those receiving TCC and TER (β = 1.0; 95% CI, -0.8 to 2.8; P = .28). Patients in both groups experienced large and clinically meaningful improvements from baseline to 12 months (TCC: Cohen d = 0.81; 95% CI, 0.67 to 0.95; TER: Cohen d = 0.90; 95% CI, 0.76 to 1.04). For patients not engaging in TER at 6 months, there was no significant difference in 12-month MCS score between those receiving PER and TER (β = 2.0; 95% CI, -1.7 to 5.7; P = .29). Conclusions and Relevance In this comparative effectiveness trial of patients with complex psychiatric disorders randomized to receive TCC or TER, significantly and substantially improved outcomes were observed in both groups. From a health care system perspective, clinical leadership should implement whichever approach is most sustainable. Trial Registration ClinicalTrials.gov Identifier: NCT02738944.
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Affiliation(s)
- John C. Fortney
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
- Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington
| | - Amy M. Bauer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Joseph M. Cerimele
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Jeffrey M. Pyne
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock
- Department of Veterans Affairs, Health Services Research and Development, Center for Mental Healthcare and Outcomes Research, Little Rock, Arkansas
| | - Paul Pfeiffer
- University of Michigan Medical School, Ann Arbor
- Department of Veterans Affairs, Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Patrick J. Heagerty
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Matt Hawrilenko
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Melissa J. Zielinski
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Deborah J. Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle
| | - Danna L. Moore
- School of Economic Sciences, Washington State University, Pullman
| | - Lori Ferro
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | | | | | - Erin Hafer
- Community Health Plan of Washington, Seattle
| | | | | | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
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Commiskey P, Armstrong AW, Coker TR, Dorsey ER, Fortney JC, Gaines KJ, Gibbons BM, Nguyen HQ, Singla DR, Szigethy E, Krupinski EA. A Blueprint for the Conduct of Large, Multisite Trials in Telemedicine. J Med Internet Res 2021; 23:e29511. [PMID: 34542417 PMCID: PMC8491114 DOI: 10.2196/29511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
Recent literature supports the efficacy and efficiency of telemedicine in improving various health outcomes despite the wide variability in results. Understanding site-specific issues in the implementation of telemedicine trials for broader replication and generalizability of results is needed. Lessons can be learned from existing trials, and a blueprint can guide researchers to conduct these challenging studies using telemedicine more efficiently and effectively. This viewpoint presents relevant challenges and solutions for conducting multisite telemedicine trials using 7 ongoing and completed studies funded by the Patient-Centered Outcomes Research Institute portfolio of large multisite trials to highlight the challenges in implementing telemedicine trials. Critical issues of ensuring leadership and buy-in, appropriate funding, and diverse and representative trials are identified and described, as well as challenges related to clinical, informatics, regulatory, legal, quality, and billing. The lessons learned from these studies were used to create a blueprint of key aspects to consider for the design and implementation of multisite telemedicine trials.
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Affiliation(s)
- Patricia Commiskey
- Division of Stroke, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - April W Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Earl Ray Dorsey
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, United States
| | - John C Fortney
- Division of Population Health, Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, Department of Veteran's Affairs, Seattle, WA, United States
| | - Kenneth J Gaines
- Division of Stroke, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Brittany M Gibbons
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Huong Q Nguyen
- Division of Health Services Research & Implementation Science, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Daisy R Singla
- Center of Addiction and Mental Health, Toronto, ON, Canada
- Lunenfeld Tanenbaum Research Institute, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eva Szigethy
- Center for High Value Health Care, UPMC Insurances Division, Department of Psychiatry, Medicine, and Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Elizabeth A Krupinski
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
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45
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Howland M, Tennant M, Bowen DJ, Bauer AM, Fortney JC, Pyne JM, Shore J, Cerimele JM. Psychiatrist and Psychologist Experiences with Telehealth and Remote Collaborative Care in Primary Care: A Qualitative Study. J Rural Health 2021; 37:780-787. [PMID: 33022079 PMCID: PMC8518862 DOI: 10.1111/jrh.12523] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Availability of mental health services is limited in the rural United States. Two promising models to reach patients with limited access to care are telehealth referral and collaborative care. The objective of this study was to assess telepsychiatrist- and telepsychologist-level facilitators and barriers to satisfaction with and implementation of these 2 telehealth models in rural settings. METHODS Focus groups were held in 2019 using a semistructured interview guide. Participants were off-site telepsychiatrists (N = 10) and telepsychologists (N = 4) for primary care clinics across 3 states (Washington, Michigan, and Arkansas) involved in a recent pragmatic comparative effectiveness trial. Qualitative analysis occurred inductively by 2 independent coders. FINDINGS Participants were satisfied with the models partly owing to good patient rapport and expanding access to care. Teamwork was highlighted as a facilitator in collaborative care and was often related to work with care managers. However, participants described communication with primary care providers as a challenge, especially in the telehealth referral arm. Barriers centered on variability of logistical processes (eg, symptom monitoring, scheduling, electronic medical record processes, and credentialing) among sites. Staff turnover, variable clinic investment, and inadequacy of training were possible explanations for these barriers. CONCLUSIONS Participants described high motivation to provide team-based, remote care for patients, though they experienced operational challenges. Centralized credentialing, scheduling, and record keeping are possible solutions. These findings are important because consulting psychiatrists and psychologists may play a leadership role in the dissemination of these models.
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Affiliation(s)
- Molly Howland
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashington
| | - McKenna Tennant
- Department of Public Health GeneticsUniversity of Washington School of Public HealthSeattleWashington
| | - Deborah J. Bowen
- Department of Bioethics and HumanitiesUniversity of WashingtonSeattleWashington
| | - Amy M. Bauer
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashington
| | - John C. Fortney
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashington
- Department of Veterans Affairs, HSR&D Center of Innovation for Veteran‐Centered and Value‐Driven CareVA Puget Sound Health Care SystemSeattleWashington
- Department of Health ServicesUniversity of Washington School of Public HealthSeattleWashington
| | - Jeffrey M. Pyne
- Department of Psychiatry and Behavioral Sciences, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansas
| | - Jay Shore
- Helen and Arthur E. Johnson Depression Center, Anschutz Medical Campus, Departments of Psychiatry and Family MedicineUniversity of Colorado School of MedicineAuroraColorado
- Centers for American Indian and Alaska Native Health, Colorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraColorado
| | - Joseph M. Cerimele
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashington
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Bae YS, Kim KH, Choi SW, Ko T, Lim JS, Piao M. Satisfaction and Usability of an Information and Communications Technology-Based System by Clinically Healthy Patients With COVID-19 and Medical Professionals: Cross-sectional Survey and Focus Group Interview Study. JMIR Form Res 2021; 5:e26227. [PMID: 34254946 PMCID: PMC8396536 DOI: 10.2196/26227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/22/2020] [Accepted: 07/06/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Digital health care is an important strategy in the war against COVID-19. South Korea introduced living and treatment support centers (LTSCs) to control regional outbreaks and care for patients with asymptomatic or mild COVID-19. Seoul National University Hospital (SNUH) introduced information and communications technology (ICT)-based solutions to manage clinically healthy patients with COVID-19. OBJECTIVE This study aims to investigate satisfaction and usability by patients and health professionals in the optimal use of a mobile app and wearable device that SNUH introduced to the LTSC for clinically healthy patients with COVID-19. METHODS Online surveys and focus group interviews were conducted to collect quantitative and qualitative data. RESULTS Regarding usability testing of the wearable device, perceived usefulness had the highest mean score of 4.45 (SD 0.57) points out of 5. Regarding usability of the mobile app, perceived usefulness had the highest mean score of 4.62 (SD 0.48) points out of 5. Regarding satisfaction items for the mobile app among medical professionals, the "self-reporting" item had the highest mean score of 4.42 (SD 0.58) points out of 5. In focus group interviews of health care professionals, hospital information system interfacing was the most important functional requirement for ICT-based COVID-19 telemedicine. CONCLUSIONS Improvement of patient safety and reduction of the burden on medical staff were the expected positive outcomes. Stability and reliability of the device, patient education, accountability, and reimbursement issues should be considered as part of the development of remote patient monitoring. In responding to a novel contagious disease, telemedicine and a wearable device were shown to be useful during a global crisis.
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Affiliation(s)
- Ye Seul Bae
- Office of Hospital Information, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Hwan Kim
- Department of Thoracic & Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Thoracic & Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sae Won Choi
- Office of Hospital Information, Seoul National University Hospital, Seoul, Republic of Korea
| | - Taehoon Ko
- Department of Medical Informatics, Catholic University of Korea, Seoul, Republic of Korea
| | - Jun Seo Lim
- Office of Hospital Information, Seoul National University Hospital, Seoul, Republic of Korea
| | - Meihua Piao
- Office of Hospital Information, Seoul National University Hospital, Seoul, Republic of Korea
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Fondren AH, Banducci AN, Cox R, Contractor AA. Processing of Positive Memories Technique among Clients Reporting Traumatic Experiences: A Case Series. Clin Case Stud 2021. [DOI: 10.1177/15346501211035841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many current treatments for posttraumatic stress disorder (PTSD) emphasize processing and engaging with trauma memories as the key mechanism of therapeutic change. However, promising emerging research indicates links between PTSD symptoms and positive memories. Processing positive memories, to therapeutically impact health outcomes for trauma-exposed individuals, may have several benefits, including (a) increasing access to positive coping mechanisms via activating positive affect and thoughts; (b) addressing avoidance of positive affect and thoughts; and (c) honing skills that will aid in the eventual processing of trauma memories. The present article demonstrates the utility and effects of a novel Processing of Positive Memories Technique (PPMT) with three clients who reported a history of traumatic experiences. We outline the procedures of a 5-session PPMT, that incorporates symptom assessment, detailed imaginal experiencing of positive memories, and processing of associated positive values, affect, strengths, and thoughts. We utilize longitudinal assessment data to demonstrate the clinical benefits of PPMT, such as less PTSD severity, improved mood (e.g., less negative affect), and greater self-esteem. Finally, we discuss treatment considerations based on unique client factors and treatment modalities (i.e., in-person vs. video telehealth).
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Affiliation(s)
- Alana H. Fondren
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Anne N. Banducci
- The National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Randall Cox
- Department of Psychology, University of North Texas, Denton, TX, USA
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Whitfield J, LePoire E, Stanczyk B, Ratzliff A, Cerimele JM. Remote Collaborative Care with Off-Site Behavioral Health Care Managers: A Systematic Review of Clinical Trials. J Acad Consult Liaison Psychiatry 2021; 63:71-85. [PMID: 34389509 DOI: 10.1016/j.jaclp.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/29/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND In the United States, the majority of patients who require behavioral health care do not receive it due to an overall shortage of behavioral health specialists. The Collaborative Care Model (CoCM) is a team-based, highly-coordinated approach to treating common mental health conditions in primary care that has a robust evidence base. Several recent randomized controlled trials (RCTs) have demonstrated the effectiveness of remote CoCM teams. As telehealth technology and uptake expands, understanding the evidence for remote CoCM becomes increasingly crucial to inform CoCM practice and implementation. OBJECTIVE To systematically review RCTs regarding the effectiveness of remote CoCM teams in treating common psychiatric conditions in primary care and medical settings. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used to structure our review. Our search strategy and development of search terms was informed by knowledge and review of the CoCM literature. Articles were reviewed by three authors and once selected, sent to two authors for further data extraction to describe various study characteristics and process measures relating to remote CoCM. RESULTS The literature search identified 13,211 articles, nine of which met inclusion criteria. The nine studies collectively demonstrate effectiveness of remote CoCM in treating a range of behavioral health conditions [(depression (n=7), anxiety (n=2), and PTSD (n=1)], across various populations and settings. Sample sizes ranged from 191 patients to 704 patients, publication dates from 2004 to 2018, and studies were conducted from 2000 to 2014. Various process measures were also reported. CONCLUSIONS As the nine studies included in our systematic review demonstrate, remote CoCM can be effective in treating a range of behavioral health conditions in various primary care and specialty medical settings. These findings suggest organizations may have more flexibility in building their CoCM team and drawing upon wider workforces than previously recognized. As recent shifts in telehealth policy and practice continue to motivate telehealth approaches, further research that can inform best practices for remote CoCM will be useful and valuable to those making organizational decisions when implementing integrated care models.
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Affiliation(s)
- Jessica Whitfield
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA.
| | - Erin LePoire
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA
| | - Brenna Stanczyk
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA
| | - Anna Ratzliff
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA
| | - Joseph M Cerimele
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA
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Edwards-Stewart A, Smolenski DJ, Bush NE, Cyr BA, Beech EH, Skopp NA, Belsher BE. Posttraumatic Stress Disorder Treatment Dropout Among Military and Veteran Populations: A Systematic Review and Meta-Analysis. J Trauma Stress 2021; 34:808-818. [PMID: 33524199 DOI: 10.1002/jts.22653] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/17/2020] [Accepted: 01/06/2021] [Indexed: 11/06/2022]
Abstract
High treatment dropout rates reported in recent literature have brought into question the effectiveness of trauma-focused posttraumatic stress disorder (PTSD) treatments among military populations. The aim of the current systematic review was to evaluate PTSD treatment dropout rates among military populations by treatment type and other study-level variables. We searched four databases as well as gray literature for randomized controlled trials that evaluated evidence-based PTSD treatments in samples of active duty personnel and/or veterans. In total, 26 studies were included in this review, with a total of 2,984 participants. We analyzed dropout rates across treatment types using multivariate meta-analysis. Across all forms of treatment, the aggregated dropout rate was 24.2%. Dropout percentages based on treatment type were 27.1% for trauma-focused treatments, 16.1% for non-trauma-focused treatments, and 6.8% for waitlist groups. We found substantial heterogeneity between studies that was not explained by military status or other study-level covariates. Summary risk ratios (RRs) comparing relative dropout between treatment groups indicated that trauma-focused treatment groups had a higher risk of dropout compared to non-trauma-focused treatments, RR = 1.60. The statistical heterogeneity of within-treatment dropout risk ratios was negligible. Dropout rates among military patients receiving trauma-focused therapies were only slightly higher than those reported in the literature among civilian populations and were not explained by study-level covariates.
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Affiliation(s)
- Amanda Edwards-Stewart
- Department of Health Affairs, Psychological Health Center of Excellence, Research Branch, Tacoma, Washington, USA
| | - Derek J Smolenski
- Department of Health Affairs, Psychological Health Center of Excellence, Performance & Analytics Branch, Tacoma, Washington, USA
| | - Nigel E Bush
- Department of Health Affairs, Psychological Health Center of Excellence, Research Branch, Tacoma, Washington, USA
| | - Betty-Ann Cyr
- Alliant International University, the California School of Professional Psychology, Clinical Psychology, San Francisco, California, USA
| | - Erin H Beech
- Department of Health Affairs, Psychological Health Center of Excellence, Research Branch, Tacoma, Washington, USA
| | - Nancy A Skopp
- Department of Health Affairs, Psychological Health Center of Excellence, Research Branch, Tacoma, Washington, USA
| | - Bradley E Belsher
- Department of Health Affairs, Psychological Health Center of Excellence, Research Branch, Tacoma, Washington, USA
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Barnett P, Goulding L, Casetta C, Jordan H, Sheridan-Rains L, Steare T, Williams J, Wood L, Gaughran F, Johnson S. Implementation of Telemental Health Services Before COVID-19: Rapid Umbrella Review of Systematic Reviews. J Med Internet Res 2021; 23:e26492. [PMID: 34061758 PMCID: PMC8335619 DOI: 10.2196/26492] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/30/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Telemental health care has been rapidly adopted for maintaining services during the COVID-19 pandemic, and a substantial interest is now being devoted in its future role. Service planning and policy making for recovery from the pandemic and beyond should draw on both COVID-19 experiences and the substantial research evidence accumulated before this pandemic. OBJECTIVE We aim to conduct an umbrella review of systematic reviews available on the literature and evidence-based guidance on telemental health, including both qualitative and quantitative literature. METHODS Three databases were searched between January 2010 and August 2020 for systematic reviews meeting the predefined criteria. The retrieved reviews were independently screened, and those meeting the inclusion criteria were synthesized and assessed for risk of bias. Narrative synthesis was used to report these findings. RESULTS In total, 19 systematic reviews met the inclusion criteria. A total of 15 reviews examined clinical effectiveness, 8 reported on the aspects of telemental health implementation, 10 reported on acceptability to service users and clinicians, 2 reported on cost-effectiveness, and 1 reported on guidance. Most reviews were assessed to be of low quality. The findings suggested that video-based communication could be as effective and acceptable as face-to-face formats, at least in the short term. Evidence on the extent of digital exclusion and how it can be overcome and that on some significant contexts, such as children and young people's services and inpatient settings, was found to be lacking. CONCLUSIONS This umbrella review suggests that telemental health has the potential to be an effective and acceptable form of service delivery. However, we found limited evidence on the impact of its large-scale implementation across catchment areas. Combining previous evidence and COVID-19 experiences may allow realistic planning for the future implementation of telemental health.
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Affiliation(s)
- Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Division of Psychology and Language Sciences, University College London, London, United Kingdom
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Lucy Goulding
- King's Improvement Science, Centre for Implementation Science, King's College London, London, United Kingdom
| | - Cecilia Casetta
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom
| | - Harriet Jordan
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom
- Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Trust, London, United Kingdom
| | - Luke Sheridan-Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Thomas Steare
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Julie Williams
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
| | - Lisa Wood
- Division of Psychiatry, University College London, London, United Kingdom
| | - Fiona Gaughran
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom
- Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Trust, London, United Kingdom
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
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