Can Physician Incentives Improve Continuity of Care For Patients Receiving Depression Treatment in the Primary Care Setting?

2016 ◽  
Vol 33 (S1) ◽  
pp. S481-S481
Author(s):  
P. Joseph ◽  
A. Kazanjian
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Continuity Of Care ◽  
Mental Health Treatment ◽  
Financial Incentives ◽  
Vital Statistics ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Physician Incentives ◽  
The Impact

IntroductionIn 2008, the province of British Columbia, Canada introduced financial incentives to encourage general practitioners (GPs) to assume the role of major source of care for patients seeking mental health treatment in primary care. If successful, this intervention could strengthen GP–patient attachment and consequently improve continuity of care. The impact of this intervention, however, has never been investigated.AimTo estimate the population level impact of physician incentives on continuity of care (COC).MethodThis retrospective study examined linked health administrative data from physician claims, hospital separations, vital statistics, and insurance plan registries. Monthly cohorts of individuals with depression were identified and their GP visits tracked for 12 months, following receipt of initial diagnosis. COC indices were created, one for any visits (AV) and another for mental health visits (MHV) only. COC (range: 0–100) was calculated using published formula that accounts for the number of visits and number of GPs visited. Interrupted time series analysis was used to estimate the changes in COC before (01/2005–12/2007) and after (01/2008–12/2012) the introduction of physician incentives.ResultsThe monthly number of people diagnosed with depression ranged from 7497 to 10,575; yearly rates remained stable throughout the study period. At the start of the study period, mean COC for AV and MHV were 75.6 and 82.2 respectively, with slopes of –0.11 and –0.06. Post-intervention, the downward trend was disrupted but did not reverse.ConclusionsPhysician incentives failed to enhance COC. However, results suggest that COC could have been worse without the incentives.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Opportunistic pulse checks in primary care to improve recognition of atrial fibrillation: a retrospective analysis of electronic patient records

2018 ◽  
Vol 68 (671) ◽  
pp. e388-e393 ◽  
Author(s):  
James Cole ◽  
Payam Torabi ◽  
Isabel Dostal ◽  
Kate Homer ◽  
John Robson
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Retrospective Analysis ◽  
Financial Incentives ◽  
Primary Care Patient ◽  
Patient Records ◽  
Intervention Period ◽  
Public Health Importance ◽  
Post Intervention ◽  
The Impact

BackgroundAtrial fibrillation (AF) is an important and modifiable risk factor for stroke. Earlier identification may reduce stroke-related morbidity and mortality. Trial evidence shows that opportunistic pulse regularity checks in individuals aged ≥65 years increases detection of AF. However, this is not currently recommended by the National Screening Programme or implemented by most clinical commissioning groups (CCGs).AimTo evaluate the impact of a systematic programme to promote pulse regularity checks, the programme’s uptake in general practice, and the prevalence of AF.Design and settingRetrospective analysis of electronic primary care patient records in three east London CCGs (City and Hackney, Newham, and Tower Hamlets) over 10 years.MethodRates of pulse regularity checks and prevalence of AF in individuals aged ≥65 years were compared from the pre-intervention period, 2007–2011, to the post-intervention period, 2012–2017.ResultsAcross the three CCGs, rates of pulse regularity checks increased from a mean of 7.3% pre-intervention to 66.4% post-intervention, achieving 93.1% (n = 58 722) in the final year. Age-standardised prevalence of AF in individuals aged ≥65 years increased significantly from a pre-intervention mean of 61.4/1000 to a post-intervention mean of 64.5/1000. There was a significant increase in a post-intervention trend to a final-year mean of 67.3/1000: an improvement of 9.6% (5.9/1000) with 790 additional new cases identified.ConclusionOrganisational alignment, standardised data entry, peer-performance dashboards, and financial incentives rapidly and generally increased opportunistic screening with pulse regularity checks. This was associated with a significant increase in detection and prevalence of AF and is of public health importance.

scholarly journals Primary care teams’ experiences of delivering mental health care during the COVID-19 pandemic: a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rachelle Ashcroft ◽  
Catherine Donnelly ◽  
Maya Dancey ◽  
Sandeep Gill ◽  
Simon Lam ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Qualitative Study ◽  
Mental Health Care ◽  
Focus Groups ◽  
Care Delivery ◽  
Virtual Care ◽  
Primary Care Teams ◽  
The Impact

Abstract Background Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams’ delivery of mental health care. Methods A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. Results We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. Conclusions From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care’s capacity for mental health care for the duration of the pandemic and beyond.

The Impact of Psychiatric Symptoms on Tuberous Sclerosis Complex and Utilization of Mental Health Treatment

2019 ◽  
Vol 91 ◽  
pp. 41-49 ◽  
Author(s):  
Kate E. Mowrey ◽  
Myla Ashfaq ◽  
Deborah A. Pearson ◽  
Syed S. Hashmi ◽  
Steven L. Roberds ◽  
...  
Keyword(s):  
Mental Health ◽  
Tuberous Sclerosis ◽  
Tuberous Sclerosis Complex ◽  
Mental Health Treatment ◽  
Psychiatric Symptoms ◽  
Health Treatment ◽  
The Impact

scholarly journals Cultivating the compassionate self against depression: An exploration of processes of change

2017 ◽  
Vol 41 (S1) ◽  
pp. S356-S356 ◽  
Author(s):  
M. Matos ◽  
J. Duarte ◽  
C. Duarte ◽  
J. Pinto-Gouveia ◽  
P. Gilbert
Keyword(s):  
Mental Health ◽  
Depressive Symptoms ◽  
Longitudinal Design ◽  
Self Report ◽  
Processes Of Change ◽  
Post Intervention ◽  
Mediation Analyses ◽  
Self Compassion ◽  
Compassion Focused Therapy ◽  
The Impact

IntroductionCompassion and self-compassion can be protective factors against mental health difficulties, in particular depression. The cultivation of the compassionate self, associated with a range of practices such as slow and deeper breathing, compassionate voice tones and facial expressions, and compassionate focusing, is central to compassion focused therapy (Gilbert, 2010). However, no study has examined the processes of change that mediate the impact of compassionate self-cultivation practices on depressive symptoms.AimsThe aim of this study is to investigate the impact of a brief compassionate self training (CST) intervention on depressive symptoms, and explore the psychological processes that mediate the change at post intervention.MethodsUsing a longitudinal design, participants (general population and college students) were randomly assigned to one of two conditions: Compassionate self training (n = 56) and wait-list control (n = 37). Participants in the CST condition were instructed to practice CST exercises for 15 minutes everyday or in moments of stress during two weeks. Self-report measures of depression, self-criticism, shame and compassion, were completed at pre and post in both conditions.ResultsResults showed that, at post-intervention, participants in the CST condition decreased depression, self-criticism and shame, and increased self-compassion and openness to receive compassion from others. Mediation analyses revealed that changes in depression from pre to post intervention were mediated by decreases in self-criticism and shame, and increases in self-compassion and openness to the compassion from others.ConclusionsThese findings support the efficacy of compassionate self training components on lessening depressive symptoms and promoting mental health.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Addressing the Disparity in Refugee Mental Health Services: a Pilot Study of a Traumatic Stress Intervention Utilizing a Language‑Free mHealth Application

2021 ◽  
Author(s):  
Emily Mazzulla ◽  
Karen M. Fondacaro ◽  
Holly C Weldon ◽  
Marguerite Dibble ◽  
Matthew Price
Keyword(s):  
Mental Health ◽  
Pilot Study ◽  
Traumatic Stress ◽  
Mental Health Treatment ◽  
Group Intervention ◽  
Post Intervention ◽  
Somali Bantu ◽  
Paired Samples ◽  
Mental Health Treatments ◽  
Anxiety Depression

Objective: After resettlement, an overwhelming number of refugees struggle with Chronic Traumatic Stress (CTS), the persistence of traumatic events (e.g., re-experiencing past trauma; news of on-going war) coupled with daily post-migration stressors (e.g., poverty, lack of transportation). CTS significantly increases the burden of mental health challenges experienced by refugees. Evidence-based mental health treatments often rely on worksheets, mobile applications, websites, or telephone calls to facilitate the management of distress outside of treatment sessions. Language barriers prevent these strategies from being incorporated into mental health treatment for refugees, which results in a significant disparity in care. Treatments delivered via mobile devices can address this barrier through the use of intuitive images that eliminate the need for text or language-based instruction.Methods: A six-week pilot study assessing the effectiveness of group intervention utilizing a language free, culturally relevant mobile health (mHealth) application was conducted in a sample of Somali-Bantu and Nepali-Bhutanese adult refugee men and women (N=18). Paired-samples t-tests were conducted to compare pre- and post-intervention levels of psychosocial distress, anxiety, depression, and traumatic stress, on the Refugee Health Screener (RHS-15) and an investigator generated coping measure.Results: Results indicated significant reduction (p<.001) in symptoms related to traumatic stress, anxiety, depression and somatic complaints in addition to a significant increase (p<.001) in the use of coping skills.Conclusions: The use of a mobile mental health app, in combination with in-person therapy, was effective in reducing mental health symptomology and in increasing the use of coping skills in Somali-Bantu and Nepali-Bhutanese refugees.

scholarly journals The impact of a teacher-based positive education intervention on student wellbeing literacy

2021 ◽  
Vol 2 (1) ◽  
pp. 22-43
Author(s):  
Lea Waters ◽  
Matthew Charles Higgins
Keyword(s):  
Mental Health ◽  
Education Intervention ◽  
Positive Education ◽  
Post Intervention ◽  
Emotional Management ◽  
Strength Based ◽  
Before And After ◽  
Education Interventions ◽  
Written Descriptions ◽  
The Impact

Over the past decade, research has consistently found that positive education interventions have a beneficial effect on mental health outcomes for students, such as improvements in life satisfaction and reduction of anxiety. While it is encouraging to see these changes in student mental health, the research has not yet adequately explored whether positive education interventions change a student’s understanding of wellbeing itself. Wellbeing literacy is a new construct within the field of positive education and is defined as the ability to understand the concept and language of wellbeing. This study examines whether student language and understanding of wellbeing changes following an intervention that trains teachers in the core principles of positive education. Students across grades five, six and seven (ages 11–13; n = 231) from three Australian schools provided brief written descriptions of their understanding of wellbeing before and after their teachers undertook an eight-month positive education intervention. Thematic analysis was used as the methodological tool to analyze student language and understanding of wellbeing. Inferential frequency-based statistical analyses were used to compare the pre-intervention and post-intervention responses. The results revealed that student understanding of wellbeing evolved in four key ways to become more: (1) detailed; (2) strength based; (3) expanded/multidimensional; and (4) relational. Post-intervention understanding of wellbeing was significantly more likely to include aspects of emotional management, strengths, coping, mindfulness and self-kindness. Implications, limitations and future directions are discussed.

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