Care Managers' Experiences in a Collaborative Care Program for High Risk Mothers with Depression

Problem Children with cleft-related articulation disorders receive ineffectual or inappropriate speech therapy locally due to lack of training and a disconnect between the team and local speech-language pathologists. Solution A collaborative care program that is billable for the team allows the local speech-language pathologist to earn continuing education units and facilitates effective local speech therapy. This program is the first of its kind, according to the American Speech-Language-Hearing Association Continuing Education Board for Speech Pathology.

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Spatial analysis of hepatobiliary abnormalities in a population at high-risk of cholangiocarcinoma in Thailand

Scientific Reports ◽

10.1038/s41598-020-73771-0 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Kavin Thinkhamrop ◽

Apiporn T. Suwannatrai ◽

Nittaya Chamadol ◽

Narong Khuntikeo ◽

Bandit Thinkhamrop ◽

...

Keyword(s):

Spatial Analysis ◽

High Risk ◽

Screening Program ◽

Care Program ◽

Population Based ◽

Northeast Thailand ◽

Survival Prognosis ◽

Healthcare Facilities ◽

History Of ◽

Risk Areas

Abstract Cholangiocarcinoma (CCA) is a serious health challenge with low survival prognosis. The liver fluke, Opisthorchis viverrini, plays a role in the aetiology of CCA, through hepatobiliary abnormalities: liver mass (LM), bile duct dilation, and periductal fibrosis (PDF). A population-based CCA screening program, the Cholangiocarcinoma Screening and Care Program, operates in Northeast Thailand. Hepatobiliary abnormalities were identified through ultrasonography. A multivariate zero-inflated, Poisson regression model measured associations between hepatobiliary abnormalities and covariates including age, sex, distance to water resource, and history of O. viverrini infection. Geographic distribution was described using Bayesian spatial analysis methods. Hepatobiliary abnormality prevalence was 38.7%; highest in males aged > 60 years (39.8%). PDF was most prevalent (20.1% of males). The Standardized Morbidity Ratio (SMR) for hepatobiliary abnormalities was highest in the lower and upper parts of the Northeast region. Hepatobiliary abnormalities specifically associated with CCA were also more common in males and those aged over 60 years and distributed along the Chi, Mun, and Songkram Rivers. Our findings demonstrated a high risk of hepatobiliary disorders in Northeast Thailand, likely associated with infection caused by O. viverrini. Screening for CCA and improvement of healthcare facilities to provide better treatment for CCA patients should be prioritized in these high-risk areas.

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Lamotrigine and lithium in primary care psychiatric consultation: adoption and adverse effects

Family Practice ◽

10.1093/fampra/cmaa131 ◽

2020 ◽

Author(s):

James R Phelps ◽

Olivia R Pipitone ◽

Kenneth Squires ◽

Jonathan D Bale

Keyword(s):

Primary Care ◽

Weight Gain ◽

Adverse Effects ◽

Collaborative Care ◽

Bipolar Depression ◽

Care Program ◽

Primary Care Providers ◽

Thyroid Stimulating Hormone ◽

Care Providers ◽

Psychiatric Consultation

Abstract Background The Collaborative Care Model of psychiatric consultation in primary care has improved outcomes for unipolar depression, but bipolar depressions are challenging for providers and consultants. Although lamotrigine and lithium are both first line medications for bipolar depression, their use in primary care has been declining over the last decade. Objective Our project aimed to quantify the frequency of and adoption of recommendations for lamotrigine and lithium, and their adverse effects, in a Collaborative Care program. Methods Chart review. Results For 620 depressed adult patients (Public Health Questionnaire, 9-item ≥10), lamotrigine and lithium were recommended by psychiatric consultant for 35% and 26% of patients, respectively; and when recommended, were prescribed by primary care providers 50% and 32% of the time, respectively. Eighty-four percent of lithium dosages were 600 mg or less; average serum level 0.32 mEq/l. In follow-up up to 6 months, lithium was associated with no more weight gain than lamotrigine; but 12% of patients receiving lithium had thyroid stimulating hormone increases exceeding the upper limit of normal, occurring in an average of 32 days after the initial prescription. Conclusions (i) In a Collaborative Care program of psychiatric consultation, recommendations for lamotrigine and lithium were very frequent. (ii) Adoption of these recommendations is variable, warranting further investigation. (iii) Like higher doses, low doses of lithium induced hypothyroidism (rapidly)—but not weight gain.

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Assessing Safety Attitudes among Healthcare Providers after a Hospital-Wide High-Risk Patient Care Program

Yonsei Medical Journal ◽

10.3349/ymj.2014.55.2.523 ◽

2014 ◽

Vol 55 (2) ◽

pp. 523 ◽

Cited By ~ 3

Author(s):

Sang Mo Je ◽

Hyun Jong Kim ◽

Je Sung You ◽

Sung Phil Chung ◽

Junho Cho ◽

...

Keyword(s):

High Risk ◽

Patient Care ◽

Healthcare Providers ◽

High Risk Patient ◽

Care Program ◽

Risk Patient ◽

Safety Attitudes

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Process evaluation of a cluster randomised intervention in Swedish primary care: using care managers in collaborative care to improve care quality for patients with depression

BMC Family Practice ◽

10.1186/s12875-019-0998-4 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

I. Svenningsson ◽

E-L Petersson ◽

C. Udo ◽

J. Westman ◽

C. Björkelund ◽

...

Keyword(s):

Primary Care ◽

Process Evaluation ◽

Collaborative Care ◽

Care Quality ◽

Care Managers ◽

Cluster Randomised

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Implementation of care managers for patients with depression: a cross-sectional study in Swedish primary care

BMJ Open ◽

10.1136/bmjopen-2019-035629 ◽

2020 ◽

Vol 10 (5) ◽

pp. e035629

Author(s):

Pia Augustsson ◽

Anna Holst ◽

Irene Svenningsson ◽

Eva-Lisa Petersson ◽

Cecilia Björkelund ◽

...

Keyword(s):

Primary Care ◽

Collaborative Care ◽

Qualitative Content Analysis ◽

Controlled Trial ◽

Cross Sectional Study ◽

Healthcare Management ◽

Sectional Study ◽

Cross Sectional ◽

Care Manager ◽

Care Managers

ObjectivesTo perform an analysis of collaborative care with a care manager implementation in a primary healthcare setting. The study has a twofold aim: (1) to examine clinicians’ and directors’ perceptions of implementing collaborative care with a care manager for patients with depression at the primary care centre (PCC), and (2) to identify barriers and facilitators that influenced this implementation.DesignA cross-sectional study was performed in 2016–2017 in parallel with a cluster-randomised controlled trial.Setting36 PCCs in south-west Sweden.ParticipantsPCCs’ directors and clinicians.OutcomeData regarding the study’s aims were collected by two web-based questionnaires (directors, clinicians). Descriptive statistics and qualitative content analysis were used for analysis.ResultsAmong the 36 PCCs, 461 (59%) clinicians and 36 (100%) directors participated. Fifty-two per cent of clinicians could cooperate with the care manager without problems. Forty per cent regarded to their knowledge of the care manager assignment as insufficient. Around two-thirds perceived that collaborating with the care manager was part of their duty as PCC staff. Almost 90% of the PCCs’ directors considered that the assignment of the care manager was clearly designed, around 70% considered the priority of the implementation to be high and around 90% were positive to the implementation. Facilitators consisted of support from colleagues and directors, cooperative skills and positive attitudes. Barriers were high workload, shortage of staff and extensive requirements and demands from healthcare management.ConclusionsOur study confirms that the care manager puts collaborative care into practice. Facilitators and barriers of the implementation, such as time, information, soft values and attitudes, financial structure need to be considered when implementing care managers at PCCs.

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