scholarly journals Collaborative care model for depression in rural Nepal: a mixed-methods implementation research study

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e048481
Author(s):  
Pragya Rimal ◽  
Nandini Choudhury ◽  
Pawan Agrawal ◽  
Madhur Basnet ◽  
Bhavendra Bohara ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mixed Methods ◽  
Implementation Research ◽  
Collaborative Care ◽  
Mental Healthcare ◽  
Clinical Impact ◽  
Care Model ◽  
Collaborative Care Model ◽  
Rural Nepal

IntroductionDespite carrying a disproportionately high burden of depression, patients in low-income countries lack access to effective care. The collaborative care model (CoCM) has robust evidence for clinical effectiveness in improving mental health outcomes. However, evidence from real-world implementation of CoCM is necessary to inform its expansion in low-resource settings.MethodsWe conducted a 2-year mixed-methods study to assess the implementation and clinical impact of CoCM using the WHO Mental Health Gap Action Programme protocols in a primary care clinic in rural Nepal. We used the Capability Opportunity Motivation-Behaviour (COM-B) implementation research framework to adapt and study the intervention. To assess implementation factors, we qualitatively studied the impact on providers’ behaviour to screen, diagnose and treat mental illness. To assess clinical impact, we followed a cohort of 201 patients with moderate to severe depression and determined the proportion of patients who had a substantial clinical response (defined as ≥50% decrease from baseline scores of Patient Health Questionnaire (PHQ) to measure depression) by the end of the study period.ResultsProviders experienced improved capability (enhanced self-efficacy and knowledge), greater opportunity (via access to counsellors, psychiatrist, medications and diagnostic tests) and increased motivation (developing positive attitudes towards people with mental illness and seeing patients improve) to provide mental healthcare. We observed substantial clinical response in 99 (49%; 95% CI: 42% to 56%) of the 201 cohort patients, with a median seven point (Q1:−9, Q3:−2) decrease in PHQ-9 scores (p<0.0001).ConclusionUsing the COM-B framework, we successfully adapted and implemented CoCM in rural Nepal, and found that it enhanced providers’ positive perceptions of and engagement in delivering mental healthcare. We observed clinical improvement of depression comparable to controlled trials in high-resource settings. We recommend using implementation research to adapt and evaluate CoCM in other resource-constrained settings to help expand access to high-quality mental healthcare.

scholarly journals Evidence-Based Approaches to Suicide in Older Adults—Collaborative Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 625-625
Author(s):  
Michael Schoenbaum
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Suicidal Ideation ◽  
Collaborative Care ◽  
Mental Health Treatment ◽  
Evidence Based ◽  
Care Model ◽  
Health Treatment ◽  
Collaborative Care Model

Abstract This individual symposium abstract will focus another evidence-based approach to mental health treatment and in older adults, the collaborative care model. Collaborative care is a consultation-based approach in primary care that has been described with multiple clinical trials, with significant benefit for access and treatment. The Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) using the collaborative care model found that those older adults receiving the intervention had a higher utilization of mental health treatment (psychotherapy and/or antidepressant treatment) and had a 2.2 times greater decline in suicidal ideation over 24 months. The authors will describe the utility of using the collaborative care model on the identification of suicidal ideation and subsequent mental health treatment for older adults. The authors will also share about challenges and successes related to collaborative care implementation in healthcare settings for older adults, and relevant policy and financing components for the model.

Applying the Collaborative Care Model to treat depression and anxiety in breast cancer (BC) patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14004-e14004
Author(s):  
Kevin Nathaniel Johns ◽  
Steven Kalister ◽  
Noah Mwandha ◽  
Elizabeth J. Adams ◽  
Heidi Basinger ◽  
...  
Keyword(s):  
Mental Health ◽  
Collaborative Care ◽  
Single Agent ◽  
Stage Iv ◽  
Satisfaction Score ◽  
Depression And Anxiety ◽  
Care Model ◽  
Patient Satisfaction Score ◽  
Collaborative Care Model ◽  
Initial Score

e14004 Background: Depression and anxiety are frequent causes of excess morbidity for cancer patients, but access to mental health care, including outpatient psychiatry, is limited across academic and community settings. The Collaborative Care Model (CoCM) is a team-based model of care that is proven to leverage limited mental health resources across a wider population in primary care (Raney L, Am J Psychiatry, 2015). Evidence suggests that CoCM can be effectively applied to cancer populations too (Walker J, Gen Hosp Psychiatry, 2009). Methods: The investigators adapted CoCM to treat depression and anxiety in an academic BC clinic. A quality protocol was approved by the institutional board. All English-speaking BC patients were screened for depression using the PHQ-2 and PHQ-9. Patients with PHQ-9 ≥15 or clinical suspicion of severe anxiety or depression were referred to CoCM. The CoCM intervention included social work care management and regular case reviews by a psychiatrist. Medical oncologists prescribed all psychiatric medications. Patients were referred to mental health services in the community as needed. Results: From November 2018 through January 2020, a total of 74 patients were enrolled in CoCM. Median age was 50 years (range: 28-74 years) with BC stages I-III (n = 49, 66.2%) and stage IV (n = 25, 33.8%). Treatments within the cohort include: endocrine therapy (n = 39, 52.7%), chemotherapy (n = 18, 24.3%), observation (n = 9, 12.1%), single agent HER2 inhibitor targeted therapy (n = 4, 5.4%), immunotherapy (n = 2, 2.7%), single agent CDK4/6 inhibitor (n = 1, 1.4%), and radiation (n = 1, 1.4%). Of the 74 patients, 28 had PHQ-9 scores ≥15 at enrollment. On average, ending PHQ-9 scores decreased 39% from the initial score (average beginning score of 19.3 and ending score of 11.3 [n = 19]). 50 patients had GAD-7 ≥10 at enrollment. On average, ending GAD-7 scores decreased 36% from the initial score (average beginning score of 15.4 and ending score of 9.9 [n = 32]). On a 5-point scale, the average patient satisfaction score was 4.3 [range: 4.1-4.5] and the average medical oncology satisfaction score was 4.6 [range: 4.5-4.7]. Financial viability is promising based on projections that 93.4% of psychiatry costs (10% salary + benefits) are covered by reimbursements for care and 2 existing social workers serving as care managers. Conclusions: The collaborative care model is an effective and financially sustainable approach to promptly address depression and anxiety symptoms in BC. Further studies are needed to assess its applicability to patients with other forms of cancers.

scholarly journals SMI Life Goals: Description of a randomized trial of a Collaborative Care Model to improve outcomes for persons with serious mental illness

2014 ◽  
Vol 39 (1) ◽  
pp. 74-85 ◽  
Author(s):  
Amy M. Kilbourne ◽  
Margretta Bramlet ◽  
Michelle M. Barbaresso ◽  
Kristina M. Nord ◽  
David E. Goodrich ◽  
...  
Keyword(s):  
Mental Illness ◽  
Randomized Trial ◽  
Serious Mental Illness ◽  
Collaborative Care ◽  
Life Goals ◽  
Care Model ◽  
Collaborative Care Model

scholarly journals Utilization of a mental health collaborative care model among patients who require interpreter services

2016 ◽  
Vol 10 (1) ◽  
Author(s):  
Jane W. Njeru ◽  
Ramona S. DeJesus ◽  
Jennifer St. Sauver ◽  
Lila J. Rutten ◽  
Debra J. Jacobson ◽  
...  
Keyword(s):  
Mental Health ◽  
Collaborative Care ◽  
Care Model ◽  
Collaborative Care Model ◽  
Interpreter Services

scholarly journals An integrative collaborative care model for people with mental illness and physical comorbidities

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
C. Ee ◽  
J. Lake ◽  
J. Firth ◽  
F. Hargraves ◽  
M. de Manincor ◽  
...  
Keyword(s):  
Mental Health ◽  
Collaborative Care ◽  
Mental Health Problems ◽  
Health Problems ◽  
Integrative Model ◽  
Evidence Based ◽  
Model Of Care ◽  
Care Model ◽  
Collaborative Care Model ◽  
Physical Conditions

Abstract Background Many individuals with mental health problems have comorbid physical conditions, or may present with substance/alcohol misuse or abuse issues. This results in complex treatment challenges that may not be adequately addressed by a model of care that is solely delivered by an individual clinician using a sole intervention. Mainstream pharmacotherapeutic treatment of mental health problems often have limited effectiveness in completely resolving symptoms, and may cause adverse side effects. Adjunctive treatment approaches, including nutraceuticals, lifestyle and behaviour change interventions, are widely used to assist with treatment of mental health problems. However, whilst these can be generally safer with fewer side effects, they have varying levels of evidentiary support. These circumstances warrant reframing the current treatment approach towards a more evidence-based integrative model which may better address the real-world challenges of psychiatric disorders and comorbid physical conditions. In essence, this means developing an integrative model of care which embodies an evidence-informed, personalized stepwise approach using both conventional pharmacological treatments alongside novel adjunctive treatments (where applicable) via the application of a collaborative care approach. Discussion In order to inform this position, a brief review of findings on common patterns of comorbidity in mental illness is presented, followed by identification of limitations of conventional treatments, and potential applications of integrative medicine interventions. Advantages and challenges of integrative mental health care, collaborative models of care, review of research highlights of select integrative approaches, and comment on potential cost advantages are then discussed. Summary We propose that a collaborative care model incorporating evidence-based integrative medicine interventions may more adequately address mental health problems with comorbid medical conditions. Robust research is now required of such a model, potentially within an integrative clinical practice.

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