scholarly journals Collaborative Care Versus Screening and Follow-up for Patients With Diabetes and Depressive Symptoms: Results of a Primary Care–Based Comparative Effectiveness Trial

Diabetes Care ◽  
2014 ◽  
Vol 37 (12) ◽  
pp. 3220-3226 ◽  
Author(s):  
Jeffrey A. Johnson ◽  
Fatima Al Sayah ◽  
Lisa Wozniak ◽  
Sandra Rees ◽  
Allison Soprovich ◽  
...  
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Collaborative Care ◽  
Comparative Effectiveness ◽  
Effectiveness Trial ◽  
Patients With Diabetes

scholarly journals A physician-pharmacist collaborative care model to prevent opioid misuse

2020 ◽  
Vol 77 (10) ◽  
pp. 771-780 ◽  
Author(s):  
Pooja Lagisetty ◽  
Alex Smith ◽  
Derek Antoku ◽  
Suzanne Winter ◽  
Michael Smith ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Collaborative Care ◽  
Care Physician ◽  
Care Model ◽  
Collaborative Care Model ◽  
Clinical Encounters ◽  
Patients With Diabetes ◽  
Primary Care Practices

Abstract Purpose Clinical pharmacists in primary care clinics can potentially help manage chronic pain and opioid prescriptions by providing services similar to those provided within their scope of practice to patients with diabetes and hypertension. We evaluated the feasibility and acceptability of a pharmacist-physician collaborative care model for patients with chronic pain. Methods The program consisted of an in-person pharmacist consultation and optional follow-up visits over 4 months in 2 primary care practices. Eligible patients had chronic pain and a long-term prescription for opioids or buprenorphine or were referred by their primary care physician (PCP). Pharmacist recommendations were communicated to PCPs via the electronic medical record (EMR) and direct communication. Mixed-methods evaluation included baseline and follow-up surveys with patients, EMR review of opioid-related clinical encounters, and provider interviews. Results Between January and October 2018, 47 of the 182 eligible patients enrolled, with 46 completing all follow-up; 43 patients (91%) had received opioids over the past 6 months. The pharmacist recommended adding or switching to a nonopioid pain medication for 30 patients, switching to buprenorphine for pain and complex persistent opioid dependence for 20 patients, and tapering opioids for 3 patients. All physicians found the intervention acceptable but wanted more guidance on prescribing buprenorphine for pain. Most patients found the intervention helpful, but some reported a lack of physician follow-up on recommended changes. Conclusion The study demonstrated that comanagement of patients with chronic pain is feasible and acceptable. Policy changes to increase pharmacists’ authority to prescribe may increase physician willingness and confidence to carry out opioid tapers and prescribe buprenorphine for pain.

scholarly journals Effects of a work-stress intervention in Swedish primary care versus treatment as usual: RCT-study

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
C Sandheimer ◽  
T Hedenrud ◽  
G Hensing ◽  
K Holmgren
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Work Stress ◽  
Collaborative Care ◽  
High Stress ◽  
Intervention Group ◽  
Treatment As Usual ◽  
Primary Health ◽  
Rehabilitative Measures

Abstract Background Work stress is an increasing burden in society. To identify early symptoms of work stress in primary health care (PHC) could result in earlier and better adjusted care. A work stress questionnaire (WSQ) was developed in PHC for this task. We aimed to evaluate if the use of WSQ, in combination with physician’s feedback, results in differences in health care visits and treatment compared to treatment as usual (TAU) in patients reporting high stress. Our hypothesis was that patients receiving the intervention would generate more visits to rehabilitation providers during follow-up compared to TAU. Methods A two-armed RCT was conducted at seven primary health care centres (PHCC) in Region Västra Götaland, Sweden. One group received the WSQ-intervention and the controls received TAU. Employed not sick-listed persons aged 18-64 that sought care for mental and physical health complaints at the PHCCs participated. Register data on health care visits and treatments 12 months prior inclusion and 12 months after was obtained and analysed with Fisher’s exact test together with questionnaire data (WSQ and background features). Results A total of 271 participants were included in the study, 132 intervention and 139 controls. The proportion that visited psychologists/psychotherapists was higher among the intervention group with high stress (19.5%, n = 87) during follow-up compared to corresponding controls (7.2%, n = 97) (p = 0.048). Collaborative care measures were more common among the stressed intervention participants (23%) post-inclusion compared to the stressed controls (11.3%) (p = 0.048). Conclusions Significant differences were found between the WSQ intervention group and the controls reporting high stress in visits to psychologists and in amount of received collaborative care. This confirms our hypothesis that the WSQ can help physicians to identify work stress and give suitable rehabilitative measures at an earlier stage in the care process compared to TAU. Key messages The use of WSQ with physicians’ feedback generated more visits to psychologists and more received collaborative care compared to treatment as usual. Findings of the study indicate that the WSQ can assist in identifying work stress in primary care and accommodate rehabilitative measures compared to treatment as usual.

Collaborative Care for Children With ADHD Symptoms: A Randomized Comparative Effectiveness Trial

PEDIATRICS ◽  
2015 ◽  
Vol 135 (4) ◽  
pp. e858-e867 ◽  
Author(s):  
M. Silverstein ◽  
L. K. Hironaka ◽  
H. J. Walter ◽  
E. Feinberg ◽  
J. Sandler ◽  
...  
Keyword(s):  
Collaborative Care ◽  
Comparative Effectiveness ◽  
Effectiveness Trial ◽  
Adhd Symptoms ◽  
Children With Adhd

scholarly journals Impact of Personality Disorder Cluster on Depression Outcomes Within Collaborative Care Management Model of Care

2018 ◽  
Vol 9 ◽  
pp. 215013271877687 ◽  
Author(s):  
Merit P. George ◽  
Gregory M. Garrison ◽  
Zachary Merten ◽  
Dagoberto Heredia ◽  
Cesar Gonzales ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Personality Disorder ◽  
Collaborative Care ◽  
Care Management ◽  
Model Of Care ◽  
Clinical Prognosis ◽  
Increased Risk ◽  
Lower Likelihood ◽  
Cluster A

Background: Previous studies have suggested that having a comorbid personality disorder (PD) along with major depression is associated with poorer depression outcomes relative to those without comorbid PD. However, few studies have examined the influence of specific PD cluster types. The purpose of the current study is to compare depression outcomes between cluster A, cluster B, and cluster C PD patients treated within a collaborative care management (CCM), relative to CCM patients without a PD diagnosis. The overarching goal was to identify cluster types that might confer a worse clinical prognosis. Methods: This retrospective chart review study examined 2826 adult patients with depression enrolled in CCM. The cohort was divided into 4 groups based on the presence of a comorbid PD diagnosis (cluster A/nonspecified, cluster B, cluster C, or no PD). Baseline clinical and demographic variables, along with 6-month follow-up Patient Health Questionnaire–9 (PHQ-9) scores were obtained for all groups. Depression remission was defined as a PHQ-9 score <5 at 6 months, and persistent depressive symptoms (PDS) was defined as a PHQ-9 score ≥10 at 6 months. Adjusted odds ratios (AORs) were determined for both remission and PDS using logistic regression modeling for the 6-month PHQ-9 outcome, while retaining all study variables. Results: A total of 59 patients (2.1%) had a cluster A or nonspecified PD diagnosis, 122 patients (4.3%) had a cluster B diagnosis, 35 patients (1.2%) had a cluster C diagnosis, and 2610 patients (92.4%) did not have any PD diagnosis. The presence of a cluster A/nonspecified PD diagnosis was associated with a 62% lower likelihood of remission at 6 months (AOR = 0.38; 95% CI 0.20-0.70). The presence of a cluster B PD diagnosis was associated with a 71% lower likelihood of remission at 6 months (AOR = 0.29; 95% CI 0.18-0.47). Conversely, having a cluster C diagnosis was not associated with a significantly lower likelihood of remission at 6 months (AOR = 0.83; 95% CI 0.42-1.65). Increased odds of having PDS at 6-month follow-up were seen with cluster A/nonspecified PD patients (AOR = 3.35; 95% CI 1.92-5.84) as well as cluster B patients (AOR = 3.66; 95% CI 2.45-5.47). However, cluster C patents did not have significantly increased odds of experiencing persistent depressive symptoms at 6-month follow-up (AOR = 0.95; 95% CI 0.45-2.00). Conclusions: Out of the 3 clusters, the presence of a cluster B PD diagnosis was most significantly associated with poorer depression outcomes at 6-month follow-up, including reduced remission rates and increased risk for PDS. The cluster A/nonspecified PD group also showed poor outcomes; however, the heterogeneity of this subgroup with regard to PD features must be noted. The development of novel targeted interventions for at-risk clusters may be warranted in order to improve outcomes of these patients within the CCM model of care.

A Randomized Effectiveness Trial of Collaborative Care for Patients With Panic Disorder in Primary Care

2001 ◽  
Vol 58 (9) ◽  
pp. 869 ◽  
Author(s):  
Peter P. Roy-Byrne ◽  
Wayne Katon ◽  
Deborah S. Cowley ◽  
Joan Russo
Keyword(s):  
Primary Care ◽  
Panic Disorder ◽  
Collaborative Care ◽  
Effectiveness Trial

Change in Pain Severity With Open Label Venlafaxine Use in Patients With a Depressive Symptomatology: An Observational Study in Primary Care

2008 ◽  
Vol 23 (3) ◽  
pp. 178-186 ◽  
Author(s):  
Stefan Begré ◽  
Martin Traber ◽  
Martin Gerber ◽  
Roland von Känel
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Depressive Symptoms ◽  
Observational Study ◽  
Primary Care Physicians ◽  
Depressive Symptomatology ◽  
Dose Finding ◽  
Open Label ◽  
Treatment Of Depression

AbstractPurpose.Venlafaxine has shown benefit in the treatment of depression and pain. Worldwide data are extensively lacking investigating the outcome of chronic pain patients with depressive symptoms treated by venlafaxine in the primary care setting. This observational study aimed to elucidate the efficacy of venlafaxine and its prescription by Swiss primary care physicians and psychiatrists in patients with chronic pain and depressive symptomatology.Subjects and methods.We studied 505 patients with depressive symptoms suffering from chronic pain in a prospective naturalistic Swiss community based observational trial with venlafaxine in primary care. These patients have been treated with venlafaxine by 122 physicians, namely psychiatrists, general practitioners, and internists.Results.On average, patients were treated with 143 ± 75 mg (0–450 mg) venlafaxine daily for a follow-up of three months. Venlafaxine proved to be beneficial in the treatment of both depressive symptoms and chronic pain.Discussion.Although side effects were absent in most patients, physicians might have frequently omitted satisfactory response rate of depression by underdosing venlafaxine. Our results reflect the complexity in the treatment of chronic pain in patients with depressive symptoms in primary care.Conclusion.Further randomized dose-finding studies are needed to learn more about the appropriate dosage in treating depression and comorbid pain with venlafaxine.

Collaborative Care for Children With ADHD Symptoms: A Randomized Comparative Effectiveness Trial

2019 ◽  
pp. 158-167
Author(s):  
Michael Silverstein ◽  
L. Kari Hironaka ◽  
Heather J. Walter ◽  
Emily Feinberg ◽  
Jenna Sandler ◽  
...  
Keyword(s):  
Collaborative Care ◽  
Comparative Effectiveness ◽  
Effectiveness Trial ◽  
Adhd Symptoms ◽  
Children With Adhd

scholarly journals Response style and severity and chronicity of depressive disorders in primary health care

2016 ◽  
Vol 33 (1) ◽  
pp. 1-8
Author(s):  
K. Riihimäki ◽  
M. Vuorilehto ◽  
P. Jylhä ◽  
E. Isometsä
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Rating Scale ◽  
Response Styles ◽  
Related Phenomenon ◽  
Eysenck Personality Inventory ◽  
Primary Care Patients ◽  
Depressive Episodes

AbstractBackgroundResponse styles theory of depression postulates that rumination is a central factor in occurrence, severity and maintaining of depression. High neuroticism has been associated with tendency to ruminate. We investigated associations of response styles and neuroticism with severity and chronicity of depression in a primary care cohort study.MethodsIn the Vantaa Primary Care Depression Study, a stratified random sample of 1119 adult patients was screened for depression using the Prime-MD. Depressive and comorbid psychiatric disorders were diagnosed using SCID-I/P and SCID-II interviews. Of the 137 patients with depressive disorders, 82% completed the prospective five-year follow-up with a graphic life chart enabling evaluation of the longitudinal course of episodes. Neuroticism was measured with the Eysenck Personality Inventory (EPI-Q). Response styles were investigated at five years using the Response Styles Questionnaire (RSQ-43).ResultsAt five years, rumination correlated significantly with scores of Hamilton Depression Rating Scale (r = 0.54), Beck Depression Inventory (r = 0.61), Beck Anxiety Inventory (r = 0.50), Beck Hopelessness Scale (r = 0.51) and Neuroticism (r = 0.58). Rumination correlated also with proportion of follow-up time spent depressed (r = 0.38). In multivariate regression, high rumination was significantly predicted by current depressive symptoms and neuroticism, but not by anxiety symptoms or preceding duration of depressive episodes.ConclusionsAmong primary care patients with depression, rumination correlated with current severity of depressive symptoms, but the association with preceding episode duration remained uncertain. The association between neuroticism and rumination was strong. The findings are consistent with rumination as a state-related phenomenon, which is also strongly intertwined with traits predisposing to depression.

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