Literature Collection

OBJECTIVE: To evaluate a tech-enabled collaborative care program in an obstetrics and gynecology (OB/GYN) practice for the treatment of perinatal depression and anxiety symptoms. METHODS: We conducted a retrospective cohort chart review from the electronic medical records of N = 185 patients enrolled in a pilot perinatal collaborative care program delivered by a behavioral health company, Family Well Health, in partnership with a large OB/GYN practice in Massachusetes (USA). FamilyWell’s collaborative care model (CoCM) provides telehealth sessions with a certified perinatal behavioral health coach or a licensed therapist, medication management, and implementation assistance to enhance depression screening, assessment, and treatment of perinatal mood and anxiety disorders (PMADs). English-speaking adults aged ≥ 18 years who screened positive for depression (Edinburgh Postnatal Depression Scale [EPDS] score ≥ 10) by their OB/GYN clinician were referred to the FamilyWell program. Enrolled patients received weekly or biweekly telehealth sessions with a certified coach or licensed therapist and completed monthly electronic symptom assessments for anxiety (Generalized Anxiety Disorder 7-item scale [GAD-7]) and depression (Patient Health Questionnaire 9-item scale [PHQ-9]). Assessment scores were monitored by a behavioral care manager. We evaluated three clinical outcomes including change in GAD-7 and PHQ-9 scores, treatment response (50% or greater decrease in GAD-7 or PHQ-9 scores), and symptom remission (follow-up PHQ-9 or GAD-7 score < 5). RESULTS: Over 80% of referred patients enrolled in CoCM and more than 70% completed their intake session within one week. At baseline, 86% had a positive GAD-7 or PHQ-9 score (GAD-7 or PHQ-9 ≥ 10 indicating symptoms of moderate, moderate-severe, or severe depression or anxiety). Patients received services from a certified coach (77%) or therapist (23%). PHQ-9 scores decreased by 1.3 points per month (95% CI [− 1.5, − 1.2], p < .001) and GAD-7 scores decreased by 1.3 points per month (95% CI [− 1.5, − 1.2], p < .001). Forty-seven percent of patients (n = 33) demonstrated depression treatment response and 52% (n = 45) demonstrated anxiety treatment response. In addition, 30% of patients (n = 26) experienced anxiety symptom remission in a mean time of 3.2 months and 31% (n = 22) experienced depression symptom remission in a mean time of 3.5 months. Patients received a mean of 8 sessions with a therapist and 9 sessions with a coach before experiencing symptom remission. CONCLUSION: These data suggest that implementing a tech-enabled, coach-driven perinatal collaborative care program is associated with decreases in depression and anxiety symptoms. Symptom remission occurred within eight sessions with a therapist or nine sessions with a coach. Unlike other psychiatric collaborative care programs described in the literature, this program uniquely addresses the behavioral health workforce shortages by integrating certified coaches as a primary intervention and utilizing telehealth- and text-based support to enable scale. Our results suggest that this integrated behavioral health approach can be implemented outside the research setting.

BACKGROUND: Patients with disorders of gut-brain interaction (DGBIs) presenting to specialist care have a high prevalence of psychiatric morbidity. Psychiatrists can provide effective treatments for these disorders; however, care is rarely delivered in an integrated manner. AIMS: This study aimed to characterise patients seen by psychiatrists in a multidisciplinary gastrointestinal (GI) clinic, describe the treatment provided and examine clinical outcomes. METHODS: In a single-centre multidisciplinary gastroenterology clinic, clinical records were retrospectively evaluated for patients with DGBIs seen by a psychiatrist. Patient demographics, medical and psychiatric history, records of adverse childhood experiences (ACEs) and adult trauma were collected. GI and mental health symptom outcomes were assessed using a five-point scale. RESULTS: Ninety-seven patients (median age, 35 years; 77% female) were seen by the psychiatrist (median treatment duration 2.5 months) between January 2017 and November 2021. Fifty-six per cent had irritable bowel syndrome and 18% had functional dyspepsia. Common psychiatric comorbidities were anxiety (51%) and depression (43%). Seventy-seven per cent had a history of ACEs and 26% had a history of sexual trauma. Seventy-five per cent had previously seen a psychiatrist or psychologist. DGBI-Clinic psychiatrists provided a range of treatments including psychoeducation (64%), insight-oriented psychotherapy (39%), medication changes (27%) and cognitive behavioural therapy (19%). A majority of patients had improvement (46%) or resolution (11%) in GI symptoms. Forty per cent experienced improvement in mental health symptoms. Improvement in GI and mental health symptoms were correlated (P = 0.002). CONCLUSIONS: A majority of patients with DGBI who were seen by psychiatrists within a multidisciplinary clinic demonstrated improvement in GI and mental health symptoms.

Mathematical and computational models are often used to forecast respiratory infectious disease burden, including to inform healthcare capacity. We aimed to characterize pathways of clinical progression associated with SARS-CoV-2, influenza, and respiratory syncytial virus (RSV) infections using data from patients aged 0 to >90 years in an integrated healthcare system, whose encounters were monitored across all levels of acuity spanning virtual, ambulatory, and inpatient care settings. Using parametric survival models, we estimated probabilities of progression and distributions of time to progression from each setting to all higher-acuity settings on a cascade encompassing the following classes of events or encounters: symptoms onset; diagnostic testing; telehealth or other virtual care appointment; outpatient physician office visit; urgent care presentation; emergency department presentation; hospital admission; mechanical ventilation; and death. Our analyses included data from 59,668, 22,705, and 1,668 episodes associated with positive SARS-CoV-2, influenza, and RSV tests, respectively, between 1 April 2023 and 31 March 2024. First clinical encounters occurred in inpatient settings for only 4.7%, 3.4%, and 18.7% of SARS-CoV-2, influenza, and RSV episodes, respectively, with median times (interquartile range) of 6.8 (3.6-13.2), 6.6 (3.5-12.1), and 6.4 (3.8-10.6) days from symptoms onset to admission. Overall, 7.9% of SARS-CoV-2 episodes, 5.8% of influenza episodes, and 33.8% of RSV episodes resulted in inpatient admission, ventilation, or death. Between 40.4-62.1%, 71.6-87.3%, and 47.9-58.7% of SARS-CoV-2, influenza, and RSV infections, respectively, had encounters in lower-acuity virtual care, outpatient, or urgent care settings. For all three viruses, the proportions of cases receiving care at each level of acuity increased with older age and greater numbers of comorbid conditions. Median durations of hospital stay were 4.2 (2.6, 7.3), 4.0 (2.3, 6.8), and 4.3 (2.5, 7.4) days for SARS-CoV-2, influenza, and RSV episodes resulting in admission. These estimates provide a basis for modeling real-world clinical care requirements and the progression of respiratory viral infections.