PTSD Treatment of African American Adults in Primary Care: The Gap Between Current Practice and Evidence-Based Treatment Guidelines

2011 ◽  
Vol 103 (7) ◽  
pp. 585-593 ◽  
Author(s):  
Ruth Elaine Graves ◽  
John R. Freedy ◽  
Notalelomwan U. Aigbogun ◽  
William B. Lawson ◽  
Thomas A. Mellman ◽  
...  
Keyword(s):  
Primary Care ◽  
African American ◽  
Current Practice ◽  
Treatment Guidelines ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
Ptsd Treatment ◽  
African American Adults

scholarly journals Engaging primary care providers in managing pediatric eating disorders: a mixed methods study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Jocelyn Lebow ◽  
Cassandra Narr ◽  
Angela Mattke ◽  
Janna R. Gewirtz O’Brien ◽  
Marcie Billings ◽  
...  
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Mixed Methods ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Mixed Methods Study ◽  
Evidence Based ◽  
Care Providers ◽  
Evidence Based Treatment

Abstract Background The primary care setting offers an attractive opportunity for, not only the identification of pediatric eating disorders, but also the delivery of evidence-based treatment. However, constraints of this setting pose barriers for implementing treatment. For interventions to be successful, they need to take into consideration the perspectives of stakeholders. As such, the purpose of this study was to examine in-depth primary care providers’ perspective of challenges to identifying and managing eating disorders in the primary care setting. Methods This mixed methods study surveyed 60 Pediatric and Family Medicine providers across 6 primary care practices. Sixteen of these providers were further interviewed using a qualitative, semi-structured interview. Results Providers (n = 60, response rate of 45%) acknowledged the potential of primary care as a point of contact for early identification and treatment of pediatric eating disorders. They also expressed that this was an area of need in their practices. They identified numerous barriers to successful implementation of evidence-based treatment in this setting including scarcity of time, knowledge, and resources. Conclusions Investigations seeking to build capacities in primary care settings to address eating disorders must address these barriers.

Treatment of interictal psychiatric disorder in epilepsy. I. Affective and anxiety disorders

2002 ◽  
Vol 14 (1) ◽  
pp. 39-43 ◽  
Author(s):  
Cm van der Feltz-Cornelis
Keyword(s):  
Anxiety Disorders ◽  
Psychiatric Disorder ◽  
Affective Disorders ◽  
Treatment Guidelines ◽  
Systematic Research ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
General Psychiatry ◽  
Dsm Iv ◽  
Patients With Epilepsy

Background:Interictal affective disorders are common in patients with epilepsy and there is a need for evidence-based treatment guidelines.Objective:This paper gives an overview of research concerning treatment of interictal affective disorders and interictal anxiety disorders in epilepsy.Methods:Literature review supplemented by clinical experience.Results:Interictal psychiatric disorder can be characterized as intermittent pleomorphic psychopathology. The most common manifestations are interictal dysphoric disorder (IDD) and depression. There is a lack of randomized control trials (RCTs) concerning effectiveness and side-effects of antidepressants in epilepsy patients.Conclusion:Treatment implications of the concept of IDD and other interictal disorders are an optimized dosage of anti-epileptics in combination with antidepressants. This coincides with recent guidelines concerning combinations of psychotropic medication, such as for depression and bipolar disorder, in general psychiatry. Systematic research involving the DSM-IV categories of generalized anxiety disorder, panic disorder and agoraphobia and depression is not yet available. Prevalence and treatment of interictal anxiety disorders and depressive disorder in epilepsy should be the subject of further research, in order to enable development of evidence-based treatment guidelines for these disorders in epilepsy patients.

Psychosocial Factors and Diabetes Mellitus: Evidence-Based Treatment Guidelines

2005 ◽  
Vol 1 (3) ◽  
pp. 255-270 ◽  
Author(s):  
Frank Petrak ◽  
Stephan Herpertz ◽  
Christian Albus ◽  
Axel Hirsch ◽  
Bernhard Kulzer ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Psychosocial Factors ◽  
Treatment Guidelines ◽  
Evidence Based ◽  
Evidence Based Treatment

scholarly journals Primary Care Clinician perspectives on ADHD care and suggestions for improvement initiatives

2020 ◽  
Author(s):  
Sean O'Dell ◽  
Matthew J. Gormley ◽  
Victoria Schlieder ◽  
Tracey Klinger ◽  
Kathy DeHart ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Treatment Guidelines ◽  
Behavioral Health Care ◽  
Screening Tools ◽  
Care Process ◽  
Future Research ◽  
Evidence Based ◽  
Evidence Based Guidelines ◽  
Current Practices

Abstract Background and Objectives: Despite efficacious treatments and evidence-based guidelines, youth coping with attention deficit hyperactivity disorder (ADHD) receive suboptimal care. Primary care clinicians (PCCs) are frontline providers of ADHD care; however, little is known about PCC perspectives regarding this care gap and how to effectively address it within health systems. We investigated PCC perspectives on determinants of pediatric ADHD care and considerations for improving adherence to evidence-based guidelines. Methods: Semi-structured qualitative interviews were conducted with 26 PCCs representing clinics within a health system on improving adherence to treatment guidelines for pediatric ADHD. Interview guides were based on the Pragmatic Robust Implementation and Sustainability Model (PRISM) to elicit PCC views regarding determinants of current practices and suggestions to guide improvement efforts. We used thematic analysis to identify patterns of responding that were common across participants.Results: We identified 12 themes categorized into two broad domains: Status Quo of Pediatric ADHD Care and Supporting and Constraining Factors for Improvement Initiatives. PCCs identified several internal and external contextual factors as determinants of current practices. Of note, PCCs reported they face challenges at multiple steps in the care process, including mental health stigma, coordinating care across settings, clinical productivity pressures, access to behavioral health care, and insurance mandates regarding medications. PCCs recommended efficient continuing education trainings accompanied by improvements to the electronic health record to include validated screening tools and documentation templates.Conclusions: Future research triangulating these findings may help to more efficiently improve the quality of pediatric ADHD care in health systems.

scholarly journals “You Didn’t Cause Racism, and You Have to Solve it Anyways”: Antiracist Therapist Adaptations to Dialectical Behavior Therapy (DBT)

2021 ◽  
Author(s):  
Ashley Pierson ◽  
Vinushini Arunagiri ◽  
Debra Bond
Keyword(s):  
African American ◽  
Behavior Therapy ◽  
Dialectical Behavior Therapy ◽  
Culturally Responsive ◽  
Theoretical Models ◽  
Cultural Responsiveness ◽  
Evidence Based ◽  
Future Directions ◽  
Black African ◽  
Evidence Based Treatment

AbstractThere are currently no published studies that investigate or discuss the cultural responsiveness of Dialectical Behavior Therapy (DBT) to the needs of Black/African-American patients. In addition, no published scholarly works offer guidance to therapists on how to practice antiracism within the context of delivering evidence-based treatment. Methods for developing culturally responsive treatment are discussed within a dialectical framework. We propose that an antiracist adaptation to DBT is needed to correct for context minimization errors in the DBT model that create an invisibility of racism. Recommendations are made for an additional DBT Therapist Agreement that encourages labeling and targeting therapist treatment-interfering racist behavior. An additional Therapist Consultation Agreement is also proposed to guide therapist antiracist advocacy and functional validation for Black/African-American patients. The DBT technology is used in conjunction with other multicultural theoretical models to recommend strategies for developing White DBT therapists’ antiracist competencies. Future directions for qualitative research and applications to DBT supervision are discussed.

A practice transformation model to improve lung cancer care.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 92-92
Author(s):  
Daisy E. Escobar ◽  
Mohd Khushman ◽  
Jennifer Young Pierce ◽  
Cathy Tinnea ◽  
Austin Cadden ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Treatment Guidelines ◽  
Quality Care ◽  
Treatment Decision ◽  
Baseline Period ◽  
Transformation Model ◽  
Molecular Testing ◽  
Evidence Based ◽  
Exact Test ◽  
Evidence Based Treatment

92 Background: Lung cancer has the highest cause of cancer death, treatment of which is both complicated and expensive. Emerging actionable biomarkers and treatments provide both opportunity and treatment challenges. Adherence to evidence-based treatment and advanced care discussions add value to care. Oncology practices need to document the above to participate in value-based care reimbursement models. A Practice Transformation (PT) model was implemented to address quality and cost issues. Methods: After IRB approval, baseline data on lung cancer patients diagnosed during a 6-month period (Jul-Dec 2017) were collected through chart abstraction and treatment planning surveys. Rates of molecular testing ordered, results available at time of treatment decision-making, guideline concordant treatment decisions, and documentation of advanced care discussions were presented to the PT team. After education on recent clinical trial results and NCCN treatment guidelines, the PT team determined strategies for change. The PT team met after two 3-month periods of PT for education updates and progress reports. Data was compared on newly diagnosed patients during a 6-month period (Jul-Dec 2018), one year after the baseline period. Results: A total of forty-two patients were diagnosed in two 6-month periods, baseline and study period. Average age was 65 years, 57% male, 71% Caucasian, 95% ever smokers, 71% adenocarcinoma histology. Rate of ordering any molecular testing was (16/19) 84% in the baseline period vs (20/23) 86% in the study period. However, extended molecular testing increased from 16% (3/19) to 60% (12/20), p = .05 Fishers exact test. At treatment initiation, evidence-based treatment selections went from 47% to 52%. Documentation of advanced care discussions, 42% (8/19) to 56% (13/23), did not change significantly. Conclusions: A PT model that included education, and two cycles of implementation and feedback, resulted in increased molecular testing to inform evidence-based treatment selections. Increased awareness of the lack of documentation of advanced care discussions provides opportunity for continued improvement to effect quality care.

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