Literature Collection

241

COVID-19, Telehealth, and Pediatric Integrated Primary Care: Disparities in Service Use

Type: Journal Article

Authors: A. Chakawa, L. T. Belzer, T. Perez-Crawford, H. W. Yeh

Year: 2021

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242

COVID-19: A catalyst for change in telehealth service delivery for opioid use disorder management

Type: Journal Article

Authors: N. J. Mehtani, J. T. Ristau, H. Snyder, C. Surlyn, J. Eveland, S. Smith-Bernardin, K. R. Knight

Year: 2021

Publication Place: United States

Abstract: BACKGROUND: COVID-19 has exacerbated income inequality, structural racism, and social isolation-issues that drive addiction and have previously manifested in the epidemic of opioid-associated overdose. The co-existence of these epidemics has necessitated care practice changes, including the use of telehealth-based encounters for the diagnosis and management of opioid use disorder (OUD). METHODS: We describe the development of the "Addiction Telehealth Program" (ATP), a telephone-based program to reduce treatment access barriers for people with substance use disorders staying at San Francisco's COVID-19 Isolation and Quarantine (I&Q) sites. Telehealth encounters were documented in the electronic medical record and an internal tracking system for the San Francisco Department of Public Health (SFDPH) COVID-19 Containment Response. Descriptive statistics were collected on a case series of patients initiated on buprenorphine at I&Q sites and indicators of feasibility were measured. RESULTS: Between April 10 and May 25, 2020, ATP consulted on the management of opioid, alcohol, GHB, marijuana, and stimulant use for 59 I&Q site guests. Twelve patients were identified with untreated OUD and newly prescribed buprenorphine. Of these, all were marginally housed, 67% were Black, and 58% had never previously been prescribed medications for OUD. Four self-directed early discharge from I&Q-1 prior to and 3 after initiating buprenorphine. Of the remaining 8 patients, 7 reported continuing to take buprenorphine at the time of I&Q discharge and 1 discontinued. No patients started on buprenorphine sustained significant adverse effects, required emergency care, or experienced overdose. CONCLUSIONS: ATP demonstrates the feasibility of telephone-based management of OUD among a highly marginalized patient population in San Francisco and supports the implementation of similar programs in areas of the U.S. where access to addiction treatment is limited. Legal changes permitting the prescribing of buprenorphine via telehealth without the requirement of an in-person visit should persist beyond the COVID-19 public health emergency.

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243

Creating medical and drug code lists to identify cases in primary care databases

Type: Journal Article

Authors: S. Dave, I. Petersen

Year: 2009

Publication Place: England

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244

Crossing to RiO grand

Type: Journal Article

Authors: D. Parton

Year: 2009

Publication Place: England

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245

Current evaluation and future needs of a mental health data linkage system in a remote region: a Canadian experience

Type: Journal Article

Authors: L. Squire, M. Bedard, L. Hegge, V. Polischuk

Year: 2002

Publication Place: United States

Abstract: Linking client data across care sectors and agencies is becoming essential to ensure continuity of care, evaluation, and planning of mental health services delivery. The Data Linkage System (DLS), a record-linked, client-based, mental health database in northwestern Ontario, was established in response to this need. It is a voluntary system currently used by 30 of 40 mental health programs. The study surveyed program administrators to determine the system's utilization, perceived value, and future needs regarding data collection. The survey results delineated the perceived usefulness of the DLS in a remote region. The findings will provide direction for continued development of the DLS.

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246

Customized recommendations and reminder text messages for automated, computer-based treatment during methadone

Type: Journal Article

Authors: B. A. Moore, F. D. Buono, D. M. B. Printz, D. P. Lloyd, D. A. Fiellin, C. J. Cutter, R. S. Schottenfeld, D. T. Barry

Year: 2017

Publication Place: United States

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247

Customizing a clinical app to reduce hazardous drinking among veterans in primary care

Type: Journal Article

Authors: D. M. Blonigen, B. Harris-Olenak, J. R. Haber, E. Kuhn, C. Timko, K. Humphreys, P. L. Dulin

Year: 2019

Publication Place: United States

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248

Defining key health information technology terms

Type: Government Report

Authors: National Alliance for Health Information Technology

Year: 2008

Publication Place: Washington, D.C.

Topic(s):

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Disclaimer:

This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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249

Delivering On Accountable Care: Lessons From A Behavioral Health Program To Improve Access And Outcomes

Type: Journal Article

Authors: R. M. Clarke, J. Jeffrey, M. Grossman, T. Strouse, M. Gitlin, S. A. Skootsky

Year: 2016

Publication Place: United States

Abstract: Patients with behavioral health disorders often have worse health outcomes and have higher health care utilization than patients with medical diseases alone. As such, people with behavioral health conditions are important populations for accountable care organizations (ACOs) seeking to improve the efficiency of their delivery systems. However, ACOs have historically faced numerous barriers in implementing behavioral health population-based programs, including acquiring reimbursement, recruiting providers, and integrating new services. We developed an evidence-based, all-payer collaborative care program called Behavioral Health Associates (BHA), operated as part of UCLA Health, an integrated academic medical center. Building BHA required several innovations, which included using our enterprise electronic medical record for behavioral health referrals and documentation; registering BHA providers with insurance plans' mental health carve-out products; and embedding BHA providers in primary care practices throughout the UCLA Health system. Since 2012 BHA has more than tripled the number of patients receiving behavioral health services through UCLA Health. After receiving BHA treatment, patients had a 13 percent reduction in emergency department use. Our efforts can serve as a model for other ACOs seeking to integrate behavioral health care into routine practice.

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250

Delivering person-centered care with an electronic health record

Type: Journal Article

Authors: V. Stanhope, E. B. Matthews

Year: 2019

Publication Place: England

Abstract: BACKGROUND: Electronic health records are now widely adopted in medical and behavioral health settings. While they have the potential to improve the quality of care, the research findings on their impact on clinical practice and outcomes have been mixed. This study explores how the electronic health record and its stage of development influenced the implementation of person-centered care planning in community mental health clinics. METHODS: The study was set in five community mental health clinics which utilized an EHR and had been trained in person-centered care planning. Using an objective quantitative measure of fidelity, the study examined fidelity to PCCP across time and by stage of EHR development. Data from focus groups, interviews with clinic leaders and consultant reports was analyzed to explore the process of implementation and the role of the electronic health record. RESULTS: All clinics demonstrated an overall increase in PCCP fidelity at the conclusion of the study period but there were significant differences in PCCP fidelity among clinics with EHRs in different stages of development. Electronic health records emerged as a significant implementation factor in the qualitative data with clinics being unable to individualize service plans and encountering technical difficulties. Barriers to person-centered care included drop-down boxes and pre-determined outcomes. Clinic responses included customizing their record or developing workarounds. CONCLUSIONS: The study demonstrated the need to align the electronic health record with a person-centered approach which includes individualizing information and orienting service plans to personal life goals. The ability of clinics to be able to customize their records and balance the need for unique and aggregate information in the record is critical to improve both the provider experience and the quality of care. TRIAL REGISTRATION: Clinicaltrials.gov , NCT02299492 , registered on November 24, 2014.

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251

Delivering person-centered care with an electronic health record

Type: Journal Article

Authors: V. Stanhope, E. B. Matthews

Year: 2019

Publication Place: England

Abstract: BACKGROUND: Electronic health records are now widely adopted in medical and behavioral health settings. While they have the potential to improve the quality of care, the research findings on their impact on clinical practice and outcomes have been mixed. This study explores how the electronic health record and its stage of development influenced the implementation of person-centered care planning in community mental health clinics. METHODS: The study was set in five community mental health clinics which utilized an EHR and had been trained in person-centered care planning. Using an objective quantitative measure of fidelity, the study examined fidelity to PCCP across time and by stage of EHR development. Data from focus groups, interviews with clinic leaders and consultant reports was analyzed to explore the process of implementation and the role of the electronic health record. RESULTS: All clinics demonstrated an overall increase in PCCP fidelity at the conclusion of the study period but there were significant differences in PCCP fidelity among clinics with EHRs in different stages of development. Electronic health records emerged as a significant implementation factor in the qualitative data with clinics being unable to individualize service plans and encountering technical difficulties. Barriers to person-centered care included drop-down boxes and pre-determined outcomes. Clinic responses included customizing their record or developing workarounds. CONCLUSIONS: The study demonstrated the need to align the electronic health record with a person-centered approach which includes individualizing information and orienting service plans to personal life goals. The ability of clinics to be able to customize their records and balance the need for unique and aggregate information in the record is critical to improve both the provider experience and the quality of care. TRIAL REGISTRATION: Clinicaltrials.gov , NCT02299492 , registered on November 24, 2014.

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252

Delivery of self training and education for stressful situations (DESTRESS-PC): A randomized trial of nurse assisted online self-management for PTSD in primary care

Type: Journal Article

Authors: C. C. Engel, B. Litz, K. M. Magruder, E. Harper, K. Gore, N. Stein, D. Yeager, X. Liu, T. R. Coe

Year: 2015

Publication Place: United States

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253

Dementia risk reduction in primary care: what Australian initiatives can teach us

Type: Journal Article

Authors: C. M. Travers, M. G. Martin-Khan, D. C. Lie

Year: 2009

Publication Place: Australia

Abstract: Only limited research has been undertaken to identify factors that impede or facilitate the implementation of evidence-based health promotion, prevention and early intervention (PPEI) activities within primary practice. We examined recent Australian initiatives that encouraged primary care practitioners to implement PPEI activities to reduce the risk of chronic disease, particularly those that have focused on lifestyle risk factors. The aim was to identify barriers and facilitators to the uptake of these activities to inform the Australian National Dementia Prevention Strategy. Barriers that were consistently reported across evaluations and that appear to be of most concern to Australian general practitioners include the issues of financial remuneration and time constraints secondary to heavy work commitments. Factors that were effective in overcoming barriers included the integration of interventions within existing activities, the specification of a clear, funded role for practice nurses and the support of the Australian General Practice Network. It was concluded that these factors should be considered if PPEI activities for dementia are to be successfully incorporated within primary care.

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254

Demographic Predictors of Telehealth Use for Integrated Psychological Services in Primary Care During the COVID-19 Pandemic

Type: Journal Article

Authors: Erin T. Tobin, Ashley Hadwiger, Alexander DiChiara, Abigail Entz, Lisa R. Miller-Matero

Year: 2023

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255

Depression diagnoses and antidepressant use in primary care practices: a study from the Practice Partner Research Network (PPRNet)

Type: Journal Article

Authors: S. Ornstein, G. Stuart, R. Jenkins

Year: 2000

Publication Place: UNITED STATES

Abstract: BACKGROUND: We examined the pharmacologic management and follow-up of adults with newly diagnosed depression, and the use of antidepressants among patients not diagnosed with depression in primary care practice. A total of 389 physicians in 39 practices in the Practice Partner Research Network (PPRNet), a national network of primary care physicians provided data for the study. METHODS: We performed a retrospective cohort study for the year 1996 using demographic, contact, diagnosis, and prescription data available in the December 1997 PPRNet database. We identified patients with new diagnoses of depression from the problem lists in the electronic medical record. Psychopharmacologic agents prescribed within 5 days of the diagnosis, follow-up contacts within 6 months of the diagnosis, and diagnoses of patients prescribed antidepressants without a new diagnosis of depression were also identified. We performed descriptive analyses for all practices and for individual practices. RESULTS: During 1996, there were 149,327 active adult patients in the 39 participating practices. Of the 131,141 patients without a history of depression or antidepressant prescription, 2103 (1.6%) had a new diagnosis of depression in 1996. Incidence among the 39 practices ranged from 0.4% to 4.0%. Forty-nine percent of the newly diagnosed patients received an antidepressant prescription within 5 days of diagnosis; 81% of the prescriptions were for selective serotonin reuptake inhibitors. Ninety percent of the patients prescribed antidepressants had at least one contact in the 6 months after diagnosis (mean = 5.3 contacts). One third of the patients who had not begun antidepressants within 5 days of their diagnoses started taking one by the end of 1996. Among the 149,327 active patients, 6.3% received a prescription for an antidepressant in 1996. More than 40% of these patients had never been diagnosed with depression. CONCLUSIONS: Our study highlights the high prevalence and wide interpractice variations of diagnosing depression and prescribing antidepressants in primary care. Follow-up of patients newly diagnosed with depression was common and consistent with published guidelines. Opportunities for increased detection and treatment of depression exist in approximately half of the study practices.

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256

Depression screening in a VA primary care clinic

Type: Journal Article

Authors: R. D. Kirkcaldy, L. L. Tynes

Year: 2006

Publication Place: United States

Abstract: In 1998 the U.S. Department of Veterans Affairs (VA) mandated annual depression screening at all VA primary care clinics. The VA Medical Center, New Orleans, implemented a four-item screening tool. The authors report on an evaluation of the screening program. Of 1,100 patients visiting the clinic during a one-month period, 1,068 (97 percent) were screened at that visit or at some point in the previous 12 months. Of the 70 patients who screened positive for depression, 50 (71 percent) were offered at least one treatment modality or psychiatric referral. The findings establish benchmarks for screening administration and for follow-through on positive screens. The authors describe features of the electronic medical record that contributed to the successful implementation of this best practice.

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257

Design and implementation of a computer decision support system for the diagnosis and management of dementia syndromes in primary care

Type: Journal Article

Authors: S. Iliffe, T. Austin, J. Wilcock, M. Bryans, S. Turner, M. Downs

Year: 2002

Publication Place: Germany

Abstract: BACKGROUND: Diagnosis and management of dementia is a complex process and primary care physicians are under-equipped to deal with uncertainties in the provision of optimal care for the patient. OBJECTIVE: To develop a computer decision support system (CDSS) which could assist physicians with diagnosis and management and improve patient care. METHODS: A design group including general practitioners derived logic pathways for diagnosis and management of dementia and validated them with a multiprofessional expert group. Logic pathways were used to construct a comprehensive CDSS rendered as a series of expert consultations. The CDSS was inserted into commercially available GP systems and bench and field-tested. RESULTS: The complexity of dementia diagnosis and management can be captured in logic pathways which can be expressed as decision trees within existing electronic patient records. The resulting CDSS appears useable in routine practice. CONCLUSION: The impact of this CDSS will be evaluated in a randomised controlled trial of educational interventions in primary care.

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258

Design and implementation of the telemedicine-enhanced antidepressant management study

Type: Journal Article

Authors: J. C. Fortney, J. M. Pyne, M. J. Edlund, D. E. Robinson, D. Mittal, K. L. Henderson

Year: 2006

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259

Designing and Evaluating COVID-19 Protocols for an Office-Based Opioid Treatment Program in an Urban Underserved Setting

Type: Journal Article

Authors: D. T. O'Gurek

Year: 2021

Publication Place: United States

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260

Designing and implementing research on a statewide quality improvement initiative: the DIAMOND study and initiative

Type: Journal Article

Authors: Lauren Crain, L. I. Solberg, J. Unutzer, K. A. Ohnsorg, M. V. Maciosek, R. R. Whitebird, A. Beck, B. A. Molitor

Year: 2013

Publication Place: United States

Abstract: OBJECTIVE: To demonstrate a rigorous methodology that optimally balanced internal validity with generalizability to evaluate a statewide collaborative that implemented an evidence-based, collaborative care model for depression management in primary care. STUDY DESIGN AND SETTING: Several operational features of the DIAMOND (Depression Improvement Across Minnesota, Offering a New Direction) Initiative suggested that the DIAMOND Study use a staggered implementation design with repeated cross-sections of patients across clinical settings. A multilevel recruitment strategy elicited virtually complete study participation from the medical groups, clinics, and health plans that coordinated efforts to deliver and reimburse DIAMOND care. Patient identification capitalized on large health plan claims databases to rapidly identify the population of patients newly treated for depression in DIAMOND clinics. RESULTS: The staggered implementation design and multilevel recruitment strategy made it possible to evaluate DIAMOND by holding confounding factors constant and accurately identifying an intent-to-treat population of patients treated for depression without intruding on or requiring effort from their clinics. CONCLUSIONS: Recruitment and data collection from health plans, medical groups and clinics, and patients ensured a representative, intent-to-treat sample of study-enrolled patients. Separating patient identification from care delivery reduced threats of selection bias and enabled comparisons between the treated population and study sample. A key challenge is that intent-to-treat patients may not be exposed to DIAMOND which dilutes the effect size but offers realistic expectations of the impact of quality improvement in a population of treated patients.

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