scholarly journals Minimally Adequate Mental Health Treatment and Mortality in Primary Care Older Adults With Depression and Anxiety

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 864-865
Author(s):  
Helen-Maria Vasiliadis ◽  
Catherine Lamoureux-Lamarche ◽  
Sébastien Grenier ◽  
Pasquale Roberge
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Health System ◽  
Emergency Department Visits ◽  
Adequate Treatment ◽  
Risk Of Mortality ◽  
Follow Up Care ◽  
System Factors

Abstract Receipt of quality mental health (MH) care can influence mortality. Given the scarce literature on the topic, the aim was to assess the 3-year risk of mortality in older adults (OA) associated with receiving adequate MH treatment for depression/anxiety in an epidemiologic context. The study sample included 358 OA with depression/anxiety recruited in primary care practices and followed prospectively for 3 years. Mortality was assessed from vital statistics data. Adequate care was based on receipt of pharmacotherapy, follow-up care and psychotherapy. Propensity score analysis was carried out where the inverse probability (IPW) of receiving adequate treatment was calculated. Time to event analyses with IPW was used to assess the effect of receipt of adequate MH treatment on the risk of mortality controlling for individual and health system factors. The results showed that receipt of adequate MH treatment reduced the risk of mortality (HR0.44; 95% CI: 0.22 – 0.99). Individual factors that increased mortality were male sex, being single, reduced functional status and cognitive functioning, # physical disorders, current smoking; while exercise reduced risk. Health system factors such as past # of hospitalizations increased the risk; while # of emergency department visits and continuity of care reduced mortality. Finally, treating depression/anxiety with minimal follow-up care and pharmacotherapy or psychotherapy has a significant impact on reducing mortality in OA. Primary care physicians should recognize the important potential impact of years of lives saved when providing quality MH care to OA.

Oncologist and primary care physician attitudes and practices toward cancer survivor follow-up care in an integrated health system.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 105-105 ◽  
Author(s):  
Bijal A. Balasubramanian ◽  
Katelyn K Jetelina ◽  
Simon Craddock Lee
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Health System ◽  
Care Physician ◽  
Cancer Surveillance ◽  
Attitudes And Practices ◽  
Follow Up Care ◽  
Integrated Health ◽  
Communication And Coordination

105 Background: Previous research using nationally representative data showed significant differences between primary care physician (PCP) and oncologists’ attitudes and practices with respect to care of cancer survivors and called for more effective communication and coordination to improve care. This study compared PCP and oncologists’ attitudes and practices for follow-up cancer care within an integrated health system sharing a common electronic health record and clinical infrastructure to examine whether the integrated setting facilitated communication and coordination between PCPs and oncologists. Methods: 41 PCPs and 24 oncologists (response rate = 52%) affiliated with an integrated safety-net health system completed a validated survey. The survey assessed PCP and oncologists’ preferred models for delivering care, attitudes towards follow-up care, and cancer surveillance practices in this setting. Results: 41% of PCPs preferred an oncologist-led care delivery model as compared to 21% of oncologists. More PCPs than oncologists (73% vs 58%) agreed that PCPs have the skills necessary to initiate cancer surveillance. Yet, PCPs more often disagreed (56% vs 42% of oncologists) that they should have primary responsibility for providing cancer follow-up care. PCPs and oncologists differed significantly over cancer surveillance practices. Oncologists more consistently reported that PCPs ordered tests for cancer surveillance, evaluated patients for cancer recurrence and for adverse physical and psychological effects of cancer or its treatment, as well as managed pain and adverse outcomes of cancer treatment. PCPs, however, did not report equivalent ordering for these services. Conclusions: Even within an integrated health system, we found significant uncertainty as to who is responsible for care of cancer survivors. Oncologists more commonly assigned responsibility for cancer survivorship care to PCPs than PCPs recognized. This imbalance indicates many cancer survivors may not be receiving recommended care. Consensus guidelines are needed to delineate shared responsibilities for cancer survivors between primary care and oncology specialty care physicians.

scholarly journals Preventable readmissions and physician notification

2013 ◽  
Vol 3 (1) ◽  
pp. 1
Author(s):  
Daniel Kazzaz
Keyword(s):  
Primary Care ◽  
Health System ◽  
Hospital Readmissions ◽  
National Standards ◽  
Follow Up Care

Preventable hospital readmissions burden our health system with excessive costs. The key to reducing readmissions is appropriate follow-up care for patients upon discharge. Many patients today do not receive necessary follow-up care for the simple reason that their primary care and specialist physicians are not made aware of the hospitalization. A simple and scalable solution is needed to provide automatic notifications to physicians when their patients are admitted to and discharged from hospitals. Such systems, based on national standards for universal adoption, are emerging in several forms, making headway in reducing preventable hospital readmissions. 

scholarly journals Evaluating mental health service use during and after emergency department visits in a multisite cohort of Canadian children and youth

CJEM ◽  
2017 ◽  
Vol 21 (1) ◽  
pp. 75-86 ◽  
Author(s):  
Mario Cappelli ◽  
Paula Cloutier ◽  
Amanda S. Newton ◽  
Eleanor Fitzpatrick ◽  
Samina Ali ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Emergency Department Visits ◽  
Health Needs ◽  
Children And Youth ◽  
Mental Health Service Use ◽  
Mental Health Needs ◽  
Health Crisis ◽  
Follow Up Care

AbstractObjectivesThe goal of this study was to examine the mental health needs of children and youth who present to the emergency department (ED) for mental health care and to describe the type of, and satisfaction with, follow-up mental health services accessed.MethodsA 6-month to 1.5-year prospective cohort study was conducted in three Canadian pediatric EDs and one general ED, with a 1-month follow-up post-ED discharge. Measures included 1) clinician rating of mental health needs, 2) patient and caregiver self-reports of follow-up services, and 3) interviews regarding follow-up satisfaction. Data analysis included descriptive statistics and the Fisher’s exact test to compare sites.ResultsThe cohort consisted of 373 children and youth (61.1% female; mean age 15.1 years, 1.5 standard deviation). The main reason for ED presentations was a mental health crisis. The three most frequent areas of need requiring action were mood (43.8%), suicide risk (37.4%), and parent-child relational problems (34.6%). During the ED visit, 21.6% of patients received medical clearance, 40.9% received a psychiatric consult, and 19.4% were admitted to inpatient psychiatric care. At the 1-month post-ED visit, 84.3% of patients/caregivers received mental health follow-up. Ratings of service recommendations were generally positive, as 60.9% of patients obtained the recommended follow-up care and 13.9% were wait-listed.ConclusionsChildren and youth and their families presenting to the ED with mental health needs had substantial clinical morbidity, were connected with services, were satisfied with their ED visit, and accessed follow-up care within 1-month with some variability.

An evaluation of the breast cancer Well Follow-up Care Initiative using administrative databases: A new model of analysis.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 1-1
Author(s):  
Nicole Mittmann ◽  
Craig Earle ◽  
Hasmik Beglaryan ◽  
Ning Liu ◽  
Julie Gilbert ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Health System ◽  
Primary Care Providers ◽  
Administrative Databases ◽  
Care Providers ◽  
Significant Difference ◽  
Follow Up Care ◽  
System Resources

1 Background: Cancer Care Ontario (CCO) implemented the Well Follow-up Care Initiative (WFCI) to transition low-risk breast cancer (BC) survivors from oncologist to primary care providers. The objective of this work was to compare both the health system resources utilized and their associated costs, among women in the WFCI (cases) and women who were not transitioned (controls). Methods: Cases were linked to provincial administrative databases and matched to a control group based on year of diagnosis, cancer stage, age, comorbidity, income, geographic area of residence, and prior health system use. Health system resource utilization (physician, hospitalization, diagnostics, medication, and homecare) was ascertained per group. The annual mean and median costs (CAD 2014) per patient were determined. Annualized incremental costs between cases and controls were estimated using generalized estimating equations, accounting for matched pairs. Results: Results are based on 2,324 cases and 2,324 controls (mean age 64.4 and 64.9 years, respectively). During an average of 2.5 years of follow-up since the transition date, there were significant differences between the two groups for mean annual visits per patient with a medical oncologist (0.4 vs. 1.3, p<0.001) and radiation oncologist (0.2 vs. 0.4, p<0.001). There was no significant difference in mean annual family physician visits per patient (7.4 vs. 7.9, p=0.082). The intervention group had fewer inpatient hospitalizations (75.6% vs. 79.9%) and cancer clinic visits (84.9% vs. 94.0%). While there was a higher number of mammograms for cases compared to controls, other diagnostic tests (bone scan, CT, MRI, ultrasound, and x-rays) were done less frequently. The model was associated with a 39.3% reduction in mean annual costs ($6,575 among cases and $10,832 among controls) and a 22.1% reduction in median annual costs ($2,261 among cases and $2,903 among controls). Conclusions: Transitioning BC survivors to primary care was associated with fewer health system resources and had a lower annual mean cost per patient than women who were not transitioned.

scholarly journals Treatment and Follow-up Care Associated With Patient-Scheduled Primary Care Telemedicine and In-Person Visits in a Large Integrated Health System

2021 ◽  
Vol 4 (11) ◽  
pp. e2132793
Author(s):  
Mary Reed ◽  
Jie Huang ◽  
Ilana Graetz ◽  
Emilie Muelly ◽  
Andrea Millman ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Follow Up Care ◽  
Integrated Health

Addressing COVID-19 Worry and Social Isolation in Home-Based Primary Care

2020 ◽  
Author(s):  
Rachel Elizabeth Weiskittle ◽  
Michelle Mlinac ◽  
LICSW Nicole Downing
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Social Workers ◽  
Social Isolation ◽  
Mental Health Providers ◽  
Health Providers ◽  
Home Based Primary Care ◽  
Home Based ◽  
Socially Isolated

Social distancing measures following the outbreak of COVID-19 have led to a rapid shift to virtual and telephone care. Social workers and mental health providers in VA home-based primary care (HBPC) teams face challenges providing psychosocial support to their homebound, medically complex, socially isolated patient population who are high risk for poor health outcomes related to COVID-19. We developed and disseminated an 8-week telephone or virtual group intervention for front-line HBPC social workers and mental health providers to use with socially isolated, medically complex older adults. The intervention draws on skills from evidence-based psychotherapies for older adults including Acceptance and Commitment Therapy, Cognitive-Behavioral Therapy, and Problem-Solving Therapy. The manual was disseminated to VA HBPC clinicians and geriatrics providers across the United States in March 2020 for expeditious implementation. Eighteen HBPC teams and three VA Primary Care teams reported immediate delivery of a local virtual or telephone group using the manual. In this paper we describe the manual’s development and clinical recommendations for its application across geriatric care settings. Future evaluation will identify ways to meet longer-term social isolation and evolving mental health needs for this patient population as the pandemic continues.

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