Re-implementation of a pharmacist-managed metabolic syndrome clinic in an outpatient mental health clinic setting

2015 ◽  
Vol 5 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Nicole Ganzer ◽  
Brandon Utter ◽  
Beth DeJongh ◽  
Michael Behrens ◽  
Guadalupe Garcia ◽  
...  
Keyword(s):  
Mental Health ◽  
Metabolic Syndrome ◽  
Medical Center ◽  
Primary Care Providers ◽  
Health Clinic ◽  
Quality Improvement Initiative ◽  
Care Providers ◽  
Outpatient Mental Health ◽  
Patient Load ◽  
The Impact

Introduction: Second-generation antipsychotics (SGA) are often prescribed prior to first-generation antipsychotics (FGA) for mental health disorders by reason of proposed improved tolerability. Patients on SGA are not always appropriately screened for metabolic parameters in the clinical setting. A metabolic clinic was previously established for a limited time period at the West Palm Beach Veterans Affairs Medical Center (WPB VAMC) with beneficial outcomes. Re-implementation expanded the clinic to assess the impact when patients were referred from outpatient mental health and primary care providers. The objectives of this quality improvement initiative were to evaluate pharmacologic and nonpharmacologic interventions and compare the patient load preexpansion and postexpansion of the metabolic clinic. Methods: Patients receiving SGA at the WPB VAMC who met the criteria for metabolic syndrome were referred to the metabolic clinic. Preclinic data variables collected include demographics, social history, SGA, and assessment for presence of hypertension, diabetes, or dyslipidemia. Pharmacologic and nonpharmacologic intervention variables were collected throughout clinic involvement. The patient load post clinic expansion was reported. Results: Of the 17 patients evaluated, 88.2% had hypertension, 94.1% had dyslipidemia, and 88.2% had diabetes mellitus. The average number of components of metabolic syndrome was 3.7 out of 5 possible components. Most patients were taking risperidone (47.1%). An average of 1.5 medication interventions were made per patient. Only 28 patients were referred during reimplementation phase. Discussion: Metabolic syndrome commonly occurs in patients receiving SGA. Appropriately trained clinical pharmacists can help fill a gap in care by providing the recommended monitoring criteria and interventions for patients taking SGA.

The impact of working conditions on the health of taxi drivers in an urban metropolis

2020 ◽  
Vol 13 (6) ◽  
pp. 671-686
Author(s):  
Husayn Marani ◽  
Brenda Roche ◽  
Laura Anderson ◽  
Minnie Rai ◽  
Payal Agarwal ◽  
...  
Keyword(s):  
Mental Health ◽  
Working Conditions ◽  
Health Management ◽  
Primary Care Providers ◽  
Care Providers ◽  
Convenience Sample ◽  
Content Type ◽  
Taxi Drivers ◽  
Targeted Interventions ◽  
The Impact

PurposeThis descriptive qualitative study explores how working conditions impact the health of taxi drivers in Toronto, Canada.Design/methodology/approachDrivers were recruited between September 2016 and March 2017. A total of 14 semi-structured qualitative interviews and one focus group (n = 11) were conducted. Transcripts were analyzed inductively through a socioecological lens.FindingsThe findings of this study are as follows: drivers acknowledged that job precariousness (represented by unstable employment, long hours and low wages) and challenging workplace conditions (sitting all day and limited breaks) contribute to poor physical/mental health. Also, these conditions undermine opportunities to engage in health-protective behaviors (healthy eating, regularly exercising and taking breaks). Drivers do not receive health-enabling reinforcements from religious/cultural networks, colleagues or their taxi brokerage. Drivers do seek support from their primary care providers and family for their physical health but remain discreet about their mental health.Research limitations/implicationsAs this study relied on a convenience sample, the sample did not represent all Toronto taxi drivers. All interviews were completed in English and all drivers were male, thus limiting commentary on other experiences and any gender differences in health management approaches among drivers.Practical implicationsGiven the global ubiquity of taxi driving and an evolving workplace environment characterized by growing competition, findings are generalizable across settings and may resonate with other precarious professions, including long-haul truck operators and Uber/Lyft drivers. Findings also expose areas for targeted intervention outside the workplace setting.Originality/valueHealth management among taxi drivers is understudied. A fulsome, socioecological understanding of how working conditions (both within and outside the workplace) impact their health is essential in developing targeted interventions to improve health outcomes.

Is the Far West Mental Health Integration Project Making a Difference? The General Practitioner Perspective

2005 ◽  
Vol 11 (3) ◽  
pp. 32 ◽  
Author(s):  
David Perkins ◽  
David Lyle
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Primary Care Providers ◽  
Care Staff ◽  
Care Providers ◽  
Community Based ◽  
Mental Health Integration ◽  
Integration Project ◽  
The Impact

This paper reports on the evaluation of an Australian Government and NSW State funded Mental Health Integration Project in remote far western NSW. The project was part of the Mental Health Integration Program, developed from the Second National Mental Health Plan. The project implemented a model of community-based mental health services and used innovative financing arrangements to allow the provision of community-based specialist mental health teams to remote communities and to recruit visiting psychiatrists to support the local primary care providers. The evaluation strategy included a survey of general practitioners (GPs) in the Upper Western Sector and Broken Hill, designed to investigate their level and type of contact with psychiatrists and community-based specialist mental health care teams, their perceptions about the impact of the new services, and their interest in further professional development in mental health care.The project has shown that visiting specialists can be deployed in a primary care setting with a focus on meeting the needs of local GPs, primary health care staff and their patients.

Bridging Music and Military Mental Health: A Pilot Study Examining Music Interventions in the Military Outpatient Mental Health Waiting Room Environment

2017 ◽  
Vol 9 (2) ◽  
pp. 105
Author(s):  
Thomas Michael Christian ◽  
Ayesha Edwards ◽  
Amanda Stickler ◽  
Eric Henderson ◽  
Rachel Markwald ◽  
...  
Keyword(s):  
Mental Health ◽  
Pilot Study ◽  
Medical Center ◽  
Health Clinic ◽  
Control Group ◽  
Waiting Room ◽  
Outpatient Mental Health ◽  
Military Mental Health ◽  
The Military ◽  
Experimental Group

 Abstract Music is shown to assist in reducing patient anxiety and distress in civilian medical environments. There is a dearth of research, however, examining how music therapeutics impacts patients in a military context. As such, researchers at Naval Medical Center San Diego performed a pilot study examining the effect of music on patients at a military out-patient mental health clinic. Using a quasi-experimental design, with quantitative and qualitative measures, the researchers assessed patient perceived “pleasantness” apropos of an alternating waiting room environment, with the control group being exposed to daytime television and the experimental group being exposed to relaxing music with nature scenes. In total, 149 participants completed the pilot study; 76 participants formed the control group, while 73 formed the experimental group. The results indicate that military out-patient mental health patients are positively impacted by music interventions in their waiting room experience, as revealed by an increase in reported “pleasantness” in the experimental group as compared to the control group. The researchers recommend that further work be performed in comprehending the salubrious effects of music interventions in the military clinical setting. Keywords: military mental health, waiting room experience, music and                     Outpatient mental health setting. 

Metabolic monitoring and management among clozapine users

2016 ◽  
Vol 25 (1) ◽  
pp. 48-52 ◽  
Author(s):  
Grace Tso ◽  
Puja Kumar ◽  
Thilini Jayasooriya ◽  
Steve Kisely ◽  
Dan Siskind
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Metabolic Syndrome ◽  
Healthy Lifestyle ◽  
Collaborative Work ◽  
International Diabetes Federation ◽  
Primary Care Providers ◽  
Care Providers ◽  
Metabolic Monitoring ◽  
Community Mental Health Clinics

Objective: To assess, among clozapine users, the rates of monitoring, presence and treatment of metabolic syndrome and its components. Methods: A chart review was conducted of all clozapine users who were followed up in community mental health clinics at two Metro South Health Hospitals over a 1-year period. Metabolic syndrome was diagnosed according to the International Diabetes Federation criteria. Results: We included 251 clozapine users. Only 43.4% (109/251) had data collected for all five metabolic syndrome parameters. Among these people, 45.0% (49/109) met criteria for metabolic syndrome, while 61.2% (30/49) of those with metabolic syndrome were offered appropriate treatments. Correspondence with primary care providers occurred in only 18.7% ( n = 47). Non-pharmacological interventions, such as motivational interviewing and education about healthy lifestyle alternatives, occurred in 49.8% ( n = 125). Conclusions: There is growing awareness of the importance of metabolic monitoring, however, there remain specific gaps in the collaborative work among mental health services, primary care providers and clozapine users, to ensure appropriate physical health interventions.

scholarly journals Can mindfulness-based interventions delivered by primary care providers in the office setting improve negative symptoms in adolescents with anxiety?

2021 ◽  
Author(s):  
◽  
Kayla Switlishoff
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Negative Symptoms ◽  
Protective Factor ◽  
Primary Care Providers ◽  
Health Condition ◽  
Care Providers ◽  
Adolescent Anxiety ◽  
Outpatient Mental Health ◽  
Positive Effects

Anxiety is a mental health condition affecting adolescents with negative side effects and consequences. Primary care providers are faced with a growing number of visits related to adolescent mental health and must be comfortable in assessing and treating the negative symptoms associated with anxiety. With the potential for anxiety to begin in adolescence and worsen in adulthood, a thorough search of the literature was completed to determine ways to help adolescents manage negative symptoms associated with anxiety and improve their coping skills. Mindfulness has been gaining popularity within the mental health community and therefore was chosen as the area of focus to determine how the implementation of mindfulness-based interventions in primary care could alleviate negative symptoms associated with adolescent anxiety. Upon completing the literature review, eight studies were chosen that highlighted how various care providers effectively delivered mindfulness interventions for adolescents experiencing anxiety, primarily within school and outpatient mental health settings. These studies showed trends related to positive effects including improving adolescent anxiety and improvements in other areas of the adolescents’ lives. Additionally, it was found that it was important for primary care providers to reinforce the importance of using a supportive approach including parents or caretakers as this was shown as a protective factor. Although there were no specific studies introducing mindfulness within adolescent primary care, a list of recommendations was developed to provide evidence-based rationale towards integrating mindfulness-based interventions within primary care. By doing so, this provides a foundation for mindfulness-based interventions that primary care providers can utilize to support adolescents in managing their negative symptoms associated with anxiety.

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

The Bridge Program: A Model for Delivering Mental Health Services to Asian Americans through Primary Care

2005 ◽  
Vol 3 (1) ◽  
pp. 13-29 ◽  
Author(s):  
Hongtu Chen ◽  
Elizabeth Kramer ◽  
Teddy Chen ◽  
Jianping Chen ◽  
Henry Chung
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Asian Americans ◽  
Mental Health Professionals ◽  
Primary Care Providers ◽  
Care Providers ◽  
Bridge Program ◽  
Community Awareness

Compared to all other racial and ethnic groups, Asian Americans have the lowest utilization of mental health services. Contributing factors include extremely low community awareness about mental health, a lack of culturally competent Asian American mental health professionals, and severe stigma associated with mental illness. This manuscript describes an innovative program that bridges the gap between primary care and mental health services. The Bridge Program, cited in the supplement to the Surgeon’s General’s Report on Mental Health: Culture, Race, and Ethnicity as a model for delivery of mental health services through primary care; (2) to improve capacity by enhancing the skills of primary care providers to identify and treat mental disorders commonly seen in primary care; and (3) to raise community awareness by providing health education on mental health and illness. Results are presented and the potential for replication is addressed.

754 Insomnia and Depression Symptoms in Primary Care Patients Referred for Mental Health Care

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A294-A294
Author(s):  
Ivan Vargas ◽  
Alexandria Muench ◽  
Mark Seewald ◽  
Cecilia Livesey ◽  
Matthew Press ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Primary Care Providers ◽  
Depression Symptoms ◽  
Care Providers ◽  
Mild Depression ◽  
Significant Depression ◽  
Clinically Significant

Abstract Introduction Past epidemiological research indicates that insomnia and depression are both highly prevalent and tend to co-occur in the general population. The present study further assesses this association by estimating: (1) the concurrence rates of insomnia and depression in outpatients referred by their primary care providers for mental health care; and (2) whether the association between depression and insomnia varies by insomnia subtype (initial, middle, and late). Methods Data were collected from 3,174 patients (mean age=42.7; 74% women; 50% Black) who were referred to the integrated care program for assessment of mental health symptoms (2018–2020). All patients completed an Insomnia Severity Index (ISI) and a Patient Health Questionnaire (PHQ-9) during their evaluations. Total scores for the ISI and PHQ-9 were computed. These scores were used to categorize patients into diagnostic groups for insomnia (no-insomnia [ISI < 8], subthreshold-insomnia [ISI 8–14], and clinically-significant-insomnia [ISI>14]) and depression (no-depression [PHQ-914]). Items 1–3 of the ISI were also used to assess the association between depression and subtypes of insomnia. Results Rates of insomnia were as follows: 34.6% for subthreshold-insomnia, 35.5% for clinically-significant insomnia, and 28.9% for mild-depression and 26.9% for clinically-significant-depression. 92% of patients with clinically significant depression reported at least subthreshold levels of insomnia. While the majority of patients with clinical depression reported having insomnia, the proportion of patients that endorsed these symptoms were comparable across insomnia subtypes (percent by subtype: initial insomnia 63%; middle insomnia 61%; late insomnia 59%). Conclusion According to these data, the proportion of outpatients referred for mental health evaluations that endorse treatable levels of insomnia is very high (approximately 70%). This naturally gives rise to at least two questions: how will such symptomatology be addressed (within primary or specialty care) and what affect might targeted treatment for insomnia have on health were it a focus of treatment in general? Support (if any) Vargas: K23HL141581; Perlis: K24AG055602

scholarly journals Teaching Family Nurse Practitioner Students to Provide Mental Health Care to Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 10-11
Author(s):  
Victoria Grando ◽  
Roy Grando
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Treatment Plan ◽  
Primary Care Providers ◽  
Neurocognitive Disorders ◽  
Mental Condition ◽  
Care Providers

Abstract In recent years, FNPs have been challenged to deliver mental health services in the primary care setting. Over half of mental health services are provided in primary care, and one-quarter of all primary care patients have a mental disorder. Moreover, 20% of older adults have a mental or neurological disorder often not diagnosed. Nationally, it is estimated that 17% of older adults commit suicide, 15% have a mental condition, 11% have dementia, and 5% have a serious mental condition. There is a paucity of adequately prepared primary care providers trained in geropsychiatric treatment. A didactic course was developed to instruct FNP students in the skills needed to provide mental health treatment in primary care. We discuss mental illness in the context of culture to ensure that treatment is congruent with a patient’s unique cultural background and experiences. This shapes the patients’ beliefs and behaviors that influence the way they view their condition and what they perceive as acceptable solutions. We then go into detail about the common mental conditions that older adults exhibit. Through the case study method, students learn to identify the presenting problem, protocols for analyzing the case, which includes making differential diagnoses and a treatment plan including initial medications, non-medical treatments, and referral. Students are introduced to the DMS-5 to learn the criteria for mental health diagnosis with an emphasis on suicide, depressive disorders, anxiety disorders, bipolar disorders, substance use disorders, and neurocognitive disorders. We have found that students most often misdiagnose neurocognitive disorders.

Sign in / Sign up

Export Citation Format

Share Document