scholarly journals Antidepressant Medication Use Among Patients with Depression: Comparison between Usual Care and Collaborative Care Using Care Managers

2013 ◽  
Vol 9 (1) ◽  
pp. 84-87 ◽  
Author(s):  
Ramona S DeJesus ◽  
Kurt B Angstman ◽  
Stephen S Cha ◽  
Mark D Williams
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
Collaborative Care ◽  
Antidepressant Medication ◽  
Primary Care Clinics ◽  
Primary Care Settings ◽  
Care Managers ◽  
Significant Difference ◽  
Depression Management ◽  
Treatment Improvement

Depression poses a significant economic and health burden, yet it remains underdiagnosed and inadequately treated. The STAR*D trial funded by the National Institute of Mental Health showed that more than one antidepressant medication is often necessary to achieve disease remission among patients seen in both psychiatric and primary care settings. The collaborative care model (CCM), using care managers, has been shown to be effective in numerous studies in achieving sustained outcomes in depression management compared to usual care. This model was adopted in a statewide depression treatment improvement initiative among primary care clinics in Minnesota, which was launched in March 2008. In this study, records of patients who were enrolled in CCM from March 2008 until March 2009 were reviewed and compared to those under usual care. Patients who were followed under the CCM had a significantly greater number of antidepressant medication utilizations when compared to those under usual care. After 6 months, mean PHQ-9 score of patients under CCM was statistically lower than those in usual care. There was no significant difference in both mean PHQ-9 scores at 6 months and antidepressant utilization between the 2 groups among patients aged 65 years and older.

scholarly journals Update on advances in psychiatric treatment in primary care

2016 ◽  
Vol 22 (2) ◽  
pp. 99-107
Author(s):  
Christopher Dowrick
Keyword(s):  
Primary Care ◽  
Collaborative Care ◽  
Best Practice ◽  
Psychiatric Treatment ◽  
Antidepressant Medication ◽  
Mental Healthcare ◽  
Physical Symptoms ◽  
Care Quality ◽  
Middle Income ◽  
Care Assessment

SummaryThis article updates previous evidence on the role of primary care in the management of depression and related disorders, unexplained physical symptoms, and severe and enduring mental illness. Regarding depression and related disorders, there is now evidence for the benefits of non-medical interventions and collaborative care, providing alternatives to the simplistic over prescription of antidepressant medication. For severe and enduring illness, the emphasis in primary care is now on the effective management of comorbid physical health problems. The article also summarises best practice for the primary care assessment and management of dementia, including the need for holistic review of care quality and the potential benefits of collaborative care. Finally, it notes the growing emphasis on primary mental healthcare in low- and middle-income countries (LMIC).

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

BMJ Open ◽  
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.

Effects of Staffing Choices on Collaborative Care for Depression at Primary Care Clinics in Minnesota

2015 ◽  
Vol 66 (1) ◽  
pp. 101-103 ◽  
Author(s):  
Pamela B. Pietruszewski ◽  
Marlon P. Mundt ◽  
Senka Hadzic ◽  
Richard L. Brown
Keyword(s):  
Primary Care ◽  
Collaborative Care ◽  
Primary Care Clinics

scholarly journals A Remote Collaborative Care Program for Patients with Depression Living in Rural Areas: Open-Label Trial (Preprint)

2017 ◽  
Author(s):  
Graciela Rojas ◽  
Viviana Guajardo ◽  
Pablo Martínez ◽  
Ariel Castro ◽  
Rosemarie Fritsch ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Usual Care ◽  
Collaborative Care ◽  
Rural Areas ◽  
Care Program ◽  
Open Label ◽  
Rural Primary Care ◽  
Primary Care Teams ◽  
Clinical Records

BACKGROUND In the treatment of depression, primary care teams have an essential role, but they are most effective when inserted into a collaborative care model for disease management. In rural areas, the shortage of specialized mental health resources may hamper management of depressed patients. OBJECTIVE The aim was to test the feasibility, acceptability, and effectiveness of a remote collaborative care program for patients with depression living in rural areas. METHODS In a nonrandomized, open-label (blinded outcome assessor), two-arm clinical trial, physicians from 15 rural community hospitals recruited 250 patients aged 18 to 70 years with a major depressive episode (DSM-IV criteria). Patients were assigned to the remote collaborative care program (n=111) or to usual care (n=139). The remote collaborative care program used Web-based shared clinical records between rural primary care teams and a specialized/centralized mental health team, telephone monitoring of patients, and remote supervision by psychiatrists through the Web-based shared clinical records and/or telephone. Depressive symptoms, health-related quality of life, service use, and patient satisfaction were measured 3 and 6 months after baseline assessment. RESULTS Six-month follow-up assessments were completed by 84.4% (221/250) of patients. The remote collaborative care program achieved higher user satisfaction (odds ratio [OR] 1.94, 95% CI 1.25-3.00) and better treatment adherence rates (OR 1.81, 95% CI 1.02-3.19) at 6 months compared to usual care. There were no statically significant differences in depressive symptoms between the remote collaborative care program and usual care. Significant differences between groups in favor of remote collaborative care program were observed at 3 months for mental health-related quality of life (beta 3.11, 95% CI 0.19-6.02). CONCLUSIONS Higher rates of treatment adherence in the remote collaborative care program suggest that technology-assisted interventions may help rural primary care teams in the management of depressive patients. Future cost-effectiveness studies are needed. CLINICALTRIAL Clinicaltrials.gov NCT02200367; https://clinicaltrials.gov/ct2/show/NCT02200367 (Archived by WebCite at http://www.webcitation.org/6xtZ7OijZ)

scholarly journals The Impact of Pharmacist Care on Diabetes Outcomes in Primary Care Settings: An Umbrella Review of Systematic Reviews

2020 ◽  
Author(s):  
Sara Hamdi Abdulrhim ◽  
Sownd Sankaralingam ◽  
Mohamed Izham
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
Systematic Reviews ◽  
Diabetes Care ◽  
Economic Outcomes ◽  
Diabetes Outcomes ◽  
Primary Care Settings ◽  
Pharmacist Interventions ◽  
The Impact ◽  
Pharmacist Care

Objective: To systematically review published systematic reviews (SRs) examining the impact of pharmacist interventions in multidisciplinary diabetes care teams on diabetes-related clinical, humanistic, and economic outcomes in primary care settings. Methods: PubMed, EMBASE, Scopus, Database of Abstracts of Reviews of Effects, Cochrane Library, Joanna Briggs Institute (JBI) Database, Google Scholar, and PROSPERO were searched from inception to 2018. Studies published in English evaluating the effect of pharmacist interventions on diabetes outcomes were included. Two independent reviewers were involved in the screening of titles and abstracts, selection of studies, and methodological quality assessment. Results: Seven SRs were included in the study. Three of them included only randomized controlled trials, while the rest involved other study designs. Educational interventions by clinical pharmacists within the healthcare team were the most common types of interventions reported across all SRs. Pharmacist’s interventions compared to usual care resulted in favorable significant improvements in hemoglobin A1c (HbA1c), fasting blood glucose, blood pressure, body mass index, total cholesterol, lowdensity lipoprotein, high-density lipoprotein and triglycerides in more than 50% of the SRs. Improvement in HbA1c was the mostly reported clinical outcome of pharmacist intervention in the literature (reported in six SRs). Pharmacist’s interventions led to significant cost-saving ($8–$85,000 per person per year), cost-utility, and cost-benefit (benefit-to-cost ratio range from 1:1 to 8.5:1) versus usual care. Pharmacist’s interventions improved patients’ quality of life (QoL) in three SRs; however, no conclusion can be drawn due to the use of diverse QoL assessment tools. Conclusion: Most SRs support the benefit of pharmacist care on diabetes-related clinical, humanistic, and economic outcomes in primary care settings. Improvements in diabetes outcomes can significantly reduce the burden of diabetes on the healthcare system. Hence, the incorporation of pharmacists into multidisciplinary diabetes care teams is beneficial and should be strongly considered by clinicians and health policymakers.

scholarly journals Collaborative care clinician perceptions of computerized cognitive behavioral therapy for depression in primary care

2020 ◽  
Vol 10 (3) ◽  
pp. 565-572
Author(s):  
Lucinda B Leung ◽  
Karen E Dyer ◽  
Elizabeth M Yano ◽  
Alexander S Young ◽  
Lisa V Rubenstein ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Cognitive Behavioral Therapy ◽  
Collaborative Care ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Mental Health Clinicians ◽  
Depression Care ◽  
Care Managers ◽  
Primary Care Patients

Abstract In Veterans Health Administration’s (VA) Primary Care–Mental Health Integration (PC-MHI) models, primary care providers, care managers, and mental health clinicians collaboratively provide depression care. Primary care patients, however, still lack timely, sufficient access to psychotherapy treatment. Adapting PC-MHI collaborative care to improve uptake of evidence-based computerized cognitive behavioral therapy (cCBT) may be a potential solution. Understanding primary care-based mental health clinician perspectives is crucial for facilitating adoption of cCBT as part of collaborative depression care. We examined PC-MHI mental health clinicians’ perspectives on adapting collaborative care models to support cCBT for VA primary care patients. We conducted 16 semi-structured interviews with PC-MHI nurse care managers, licensed social workers, psychologists, and psychiatrists in one VA health-care system. Interviews were audio-recorded, transcribed, coded using the constant comparative method, and analyzed for overarching themes. Although cCBT awareness and knowledge were not widespread, participants were highly accepting of enhancing PC-MHI models with cCBT for depression treatment. Participants supported cCBT delivery by a PC-MHI care manager or clinician and saw it as an additional tool to engage patients, particularly younger Veterans, in mental health treatment. They commented that current VA PC-MHI models did not facilitate, and had barriers to, use of online and mobile treatments. If effectively implemented, however, respondents thought it had potential to increase the number of patients they could treat. There is widespread interest in modernizing health systems. VA PC-MHI mental health clinicians appear open to adapting collaborative care to increase uptake of cCBT to improve psychotherapy access.

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