Provider behaviors or consumer participation: How should we measure person-centered care?

2017 ◽  
Vol 7 (1) ◽  
pp. 14-20
Author(s):  
Samantha M. Hack ◽  
Anjana Muralidharan ◽  
Clayton H. Brown ◽  
Alicia A. Lucksted ◽  
Jennifer Patterson

Current research has found that higher rates of patient-centered care (PCC) are associated with greater treatment adherence and positive treatment outcomes. However, the instruments used to access PCC primarily collect data on provider behavior, rather than consumer participation in PCC, despite the necessary co-equal and collaborative nature of PCC interactions.Cross-sectional survey data was collected from 82 mental health care consumers receiving services at two Veterans Health Administration (VHA) facilities. Participants completed surveys on perceptions of PCC, consumer involvement in care, therapeutic alliance, medication adherence, and mental health care system mistrust.Pearson correlations examined associations between scales. Multiple regression analyses were used to test whether person-centeredness and consumer involvement in care are significant independent explanatory predictors of the identified outcome variables. Significant correlation between the consumer participation and PCC subscales was mixed. Higher levels of PCC were associated with greater therapeutic alliance, less suspicion of mental health care systems, less perception of lack of support from providers, and less beliefs about group disparities in care. Consumer involvement was only significantly related to suspicion of mental health care systems.Perceived PCC was a better explanatory variable than consumer involvement in care for most of the dependent variables. This may be a function of the locus of each outcome variable. When selecting PCC measures, researchers may wish to consider whether the variables of interest are related to the consumer-/provider-as-person or the consumer-provider relationship in order to inform instrument selection.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18680-e18680
Author(s):  
Phoebe A. Tsao ◽  
Jennifer A. Burns ◽  
Shami Entenman ◽  
Kyle Kumbier ◽  
Jordan Sparks ◽  
...  

e18680 Background: Abiraterone and enzalutamide are oral therapies widely used to treat men with castration-resistant prostate cancer (CRPC). Recent data have suggested potentially worsened quality of life and depression with use of enzalutamide compared to abiraterone. Because Veterans are at a higher risk for mental health conditions, we sought to compare mental health service utilization in Veterans with CRPC receiving enzalutamide to those receiving abiraterone. Methods: The Veterans Health Administration Corporate Data Warehouse was used to identify men with CRPC who received abiraterone or enzalutamide for ≥ 30 days as first-line treatment between 2010-2017. We compared the rate of mental health visits per 100 patient-months for men on abiraterone versus enzalutamide using an exact rate ratio test, assuming Poisson counts. Results: Among 2902 male Veterans, 68.6% (n=1992) received abiraterone and 31.4% (n=910) enzalutamide as first-line therapy. Men who received enzalutamide were older (76 vs 74, p<0.01) and had a higher comorbidity burden (Charlson Comorbidity Index [CCI] ≥ 2 in 28.7% vs 21.6%, p<0.01); no differences were noted in race or prevalence of preexisting documented mental health diagnoses. Median time on drug was 8 months for both medications. There was no difference in the rate of mental health visits per 100 patients-months on enzalutamide versus abiraterone (6.6 v. 6.7, p=0.66). However, within patient sub-groups, men who were age 75 or older, not married, or without notable comorbidities had lower rates of mental health visits with enzalutamide compared to abiraterone; whereas those who were younger than 75, married, had higher comorbidities, or a preexisting mental health diagnosis had higher rates of mental health visits with enzalutamide (Table). Conclusions: Among Veterans with CRPC who received a novel antiandrogen therapy first-line, there was no difference in engagement in mental health care between those who received abiraterone versus enzalutamide. Sub-group analysis revealed significant differences between patients on the two medications in demographic and diagnostic characteristics associated with number of visits, suggesting that vulnerability for mental health symptoms may vary by medication type. Further work in understanding the long-term impact of novel antiandrogens on mental health is needed.[Table: see text]


JAMIA Open ◽  
2018 ◽  
Vol 1 (1) ◽  
pp. 122-127 ◽  
Author(s):  
Steven K Dobscha ◽  
Lauren M Denneson ◽  
Maura K Pisciotta ◽  
Donald S Bourne ◽  
Jason I Chen ◽  
...  

Abstract Objective Consistent with the OpenNotes movement, the Veterans Health Administration (VHA) offers patients online access to their clinical notes through the Blue Button feature in its electronic patient health portal, My HealtheVet. We identified demographic, diagnostic, and knowledge-related predictors of viewing clinical notes among veterans receiving VHA mental health care who recently used My HealtheVet. Materials and Methods Three hundred and thirty-eight patients receiving mental health care from 1 VHA medical center who had logged into My HealtheVet in the prior 6 months completed self-report questionnaires assessing their viewing of clinical notes. Additional data were extracted from VHA’s Patient Care Database. Multivariable logistic regression was used to examine predictors of viewing notes. Results Fifty percent of respondents reported having read their notes. In the final multivariable model, post-traumatic stress disorder (PTSD) diagnosis [odds ratio (OR) = 2.30 (1.31–4.07)], speaking with their mental health clinician about their ability to view notes [OR = 3.84 (1.69–8.72)], and being very or extremely confident in understanding the purpose and uses of Blue Button [OR = 9.80 (2.23–43.07) and OR = 13.36 (2.74–65.20), respectively] were associated with viewing notes. Discussion Patient recall of mental health clinicians speaking to them about their ability to view notes, and confidence in understanding the use and purposes of Blue Button, were stronger predictors of viewing notes than demographic variables. PTSD diagnosis was the only clinical characteristic associated with viewing notes. Conclusion The findings support the value of mental health clinicians openly discussing the availability of notes with patients if they wish to help them take advantage of their potential benefits.


Author(s):  
Lisa V. Rubenstein

The Veterans Health Administration, part of the U.S. Department of Veterans Affairs (VA), is responsible for the largest integrated health care system in the United States and is committed historically and by statute to provide mental and physical health care for veterans. The evolution of integrated mental and physical health care in the VA serves as an in-depth, real-world example of large-scale implementation of integrated care models. The VA’s ongoing national primary care/mental health care integration initiative is the foundation for the system’s efforts in this regard. The challenges and opportunities VA implementers faced in promoting integrated mental health care show the feasibility and importance of providing integrated care and the fundamental changes required for achievement. This chapter discusses the drivers and resources, as well as the barriers, involved in the development of an integrated physical and mental health care model.


2013 ◽  
Vol 8 (3) ◽  
pp. 240-248 ◽  
Author(s):  
Jessica A. Turchik ◽  
Samantha Rafie ◽  
Craig S. Rosen ◽  
Rachel Kimerling

No prior research has examined men’s opinions or preferences regarding receiving health education materials related to sexual violence. The objective of the current study was to investigate whether male veteran patients who have experienced military sexual trauma (MST) prefer gender-targeted versus gender-neutral printed health information and whether receipt of this information increased utilization of outpatient mental health services in the following 6-month period. In-person 45-minute interviews were conducted with 20 male veterans receiving health care services at a large Veterans Health Administration facility to evaluate opinions on a gender-targeted and a gender-neutral brochure about MST. An additional 153 veterans received psychoeducational materials through the mail and participated in the completion of a survey as part of a psychoeducational intervention. Our results demonstrate that male veterans prefer gender-targeted information about sexual trauma compared to gender-neutral information. Whereas veterans in the study had clear preferences for gender-targeted materials, receipt of information about MST (whether gender-targeted or gender-neutral) did not increase utilization of mental health care in the 6 months following receipt of these materials. These results demonstrated that materials about sexual trauma are acceptable to men and should be gender-targeted. Further research is needed to examine strategies to increase access to mental health care among male Veterans who have experienced MST.


Nursing ◽  
2021 ◽  
Vol 51 (10) ◽  
pp. 56-60
Author(s):  
Angel Johann Solorzano Martinez

2010 ◽  
Vol 34 (1) ◽  
pp. 65-67 ◽  
Author(s):  
Nicole H. J. van Erp ◽  
Annemieke I. Hendriksen-Favier ◽  
Marjo Boer

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