The post COVID-19 healthcare landscape and the use of long-acting injectable antipsychotics for individuals with schizophrenia and bipolar I disorder: the importance of an integrated collaborative-care approach

Background Long-acting injectable antipsychotics (LAIs) are an essential maintenance treatment option for individuals with schizophrenia or bipolar I disorder (BP-I). This report summarizes a roundtable discussion on the impact of COVID-19 on the mental healthcare landscape and use of LAIs for individuals with schizophrenia or BP-I. Methods Ten experts and stakeholders from diverse fields of healthcare participated in a roundtable discussion on the impact of the COVID-19 pandemic, treatment challenges, and gaps in healthcare for individuals with schizophrenia or BP-I, informed by a literature search. Results Individuals with schizophrenia or BP-I are at increased risk of COVID-19 infection and increased risk of mortality after COVID-19 diagnosis. LAI prescriptions decreased early on in the pandemic, driven by a decrease in face-to-face consultations. Mental healthcare services are adapting with increased use of telehealth and home-based treatment. Clinical workflows to provide consistent, in-person LAI services include screening for COVID-19 exposure and infection, minimizing contact, and ensuring mask-wearing by individuals and staff. The importance of continued in-person visits for LAIs needs to be discussed so that staff can share that information with patients, their caregivers, and families. A fully integrated, collaborative-care model is the most important aspect of care for individuals with schizophrenia or BP-I during and after the COVID-19 pandemic. Conclusions The COVID-19 pandemic has highlighted the importance of a fully integrated collaborative-care model to ensure regular, routine healthcare contact and access to prescribed treatments and services for individuals with schizophrenia and BP-I.

Interprofessional, Interdisciplinary, or Multidisciplinary?

As a longtime researcher in interprofessional collaborative care and deputy editor-in-chief of the Journal of Interprofessional Care, I was dismayed by the imprecise use of language in the article by Colbenson et al.1 The title says “interprofessional,” the first sentence of the abstract says “interdisciplinary,” and the abstract also uses the word “multidisciplinary.” These words have different meanings and are not interchangeable. The first implies collaborative interactions, the second is often used by physicians to imply physicians with different specialties interacting (eg, oncologist and pathologist), and the third simply means that persons from different professions are in the same space per- haps working in parallel, perhaps sequentially. Another term the authors use, “ICU [intensive care unit] teams,” may or may not actually be working as teams, but the terms are not defined. The theme “interdisciplinary dynamics” is really about multidisciplinary interactions and is minimally described. If nurses feel devalued and not involved in decision-making, the dynamics are not interprofessional or even interdisciplinary.

Mobile Health Platform to Augment Integrated Behavioral Health Care: Pilot in a Large Health System (Preprint)

BACKGROUND Digital and mobile technologies have potential to improve the delivery and scale of integrated care models. OBJECTIVE We aimed to assess acceptability and feasibility, preliminary clinical outcomes, and implementation barriers of a mobile health platform used to augment an existing integrated behavioral health program. METHODS The mobile platform was used by three behavioral health care managers responsible for coordinating disease management in six primary care practices. 89 of 245 individuals (36%) who were referred by their PCP for behavioral health services consented to app-augmented behavioral health care. The mobile health platform functions included chat communication, monthly depression self-report assessments, and psychoeducational content. RESULTS The clinical improvement rate in our sample was 72% although follow-up assessments were only available for 49% of participants. At least one action in the mobile app was completed by 87% of participants (n=78; median=7; IQR=12, 0-130). Behavioral health care managers cited increased documentation burden and language as barriers to use. CONCLUSIONS Our pilot of mobile technology in collaborative care highlights important implementation barriers. Future research should systematically evaluate the implementation of digital and mobile health technology in collaborative care.