Literature Collection

4981

Improving Outcomes of Care for HRSA-Funded Health Center Patients Who Have Mental Health Conditions and Substance Use Disorders

Type: Journal Article

Authors: N. Pourat, X. Chen, C. Lee, W. Zhou, M. Daniel, H. Hoang, A. Sripipatana

Year: 2019

Publication Place: United States

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4982

Improving Outcomes of Care for HRSA-Funded Health Center Patients Who Have Mental Health Conditions and Substance Use Disorders

Type: Journal Article

Authors: N. Pourat, X. Chen, C. Lee, W. Zhou, M. Daniel, H. Hoang, A. Sripipatana

Year: 2020

Publication Place: United States

Abstract:

The rising prevalence of mental health conditions and substance use disorders (MH/SUD) underscores the important role of health centers (HCs) in caring for low-income and uninsured MH/SUD patients. This study used the 2014 Health Center Patient Survey and 2014 Uniform Data System to determine the independent association between delivery of MH/SUD integration and related interventions to patients that reported a MH/SUD condition (n=2714) with the number of HC visits, emergency department (ED) visits, and hospitalizations last year. Results showed that health education was associated with fewer predicted ED visits (1.8 vs. 2.3) and lower likelihood of hospitalizations (16% vs. 24%) among MH patients. Medical enabling services was associated with lower rates of ED visits (0.3 vs.1.9) and hospitalizations (< 1% vs. 13%) among SUD patients. The results indicate the utility of integration and related intervention services in primary care settings to improve service use and reduce ED and hospitalization among MH/SUD patients.

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4983

Improving Outcomes of Care for HRSA-Funded Health Center Patients Who Have Mental Health Conditions and Substance Use Disorders

Type: Journal Article

Authors: Pourat Nadereh, Xiao Chen, Christopher Lee, Zhou Weihao, Marlon Daniel, Hank Hoang, Sripipatana Alek

Year: 2020

Publication Place: New York

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4984

Improving Outcomes of Opioid Overdose: Preparing Nursing Students to Intervene

Type: Journal Article

Authors: K. A. Dion

Year: 2016

Publication Place: United States

Abstract: PROBLEM: Death by overdose has been steadily increasing since 1992 and has become a public health epidemic. With the rise of prescription pain medications for nonmedical use and the highest use of illicit substances by those ages 18-25, the need for action is imperative. PURPOSE: The aim of the study was to determine whether an educational intervention had an effect on nursing students' knowledge and skills regarding administration of intranasal naloxone for opioid overdose. METHOD: A convenience sample of baccalaureate nursing students was recruited for the study. A pretest/posttest design was used to evaluate the educational intervention. A paired t test was used to compare differences in pre- and posttest scores. RESULTS: A total of 49 students completed the study. The majority were women ages 25 and below, 31 (63.2%) had some or no background knowledge of opioid overdose, and 42 (85.7%) had not received previous training on intranasal naloxone. Student knowledge increased significantly (p < .001) following the educational intervention. Twenty-four students requested hands-on training for implementation of the intranasal naloxone and scored 100% accuracy in return demonstration. CONCLUSIONS: Implementation of this brief training was effective for increasing the knowledge of opioid overdose for an at-risk population. The nursing student is in a unique position to educate, train, and intervene for peers, friends, and family members who are at high risk for an opiate overdose. Nursing students have a pronounced advantage to assess for respiratory depression and initiate CPR, thereby interrupting a fatal overdose.

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4985

Improving patient care for attention deficit hyperactivity disorder in children by organizational redesign (Tornado program) and enhanced collaboration between psychiatry and general practice: a controlled before and after study

Type: Journal Article

Authors: M. Janssen, M. Wensing, R. van der Gaag, I. Cornelissen, P. van Deurzen, J. Buitelaar

Year: 2014

Abstract: Implementation of clinical guidelines for diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents is a challenge in practice due to insufficient availability of mental health specialists and lack of effective cooperation with primary care physicians. The Tornado program aims to reduce time between referral and start of treatment in eligible patients. This study aims to assess the effectiveness and efficiency of this program.Methods/designThis is a non-randomized controlled before-after study involving 90 outpatients (6 inverted question mark18 years old) suspected of uncomplicated ADHD, which were recruited by ten mental health teams. The Tornado program, provided by three teams, combines accelerated-track diagnosis and treatment planning. This is followed by psychoeducation at a mental health center and pharmacological treatment by primary care physicians, who received an online e-learning module for this purpose. The control group consists of patients of seven other teams, who receive care as usual. Primary outcome is the patients inverted question mark time between referral to the mental health or pediatric center and start of treatment. Secondary outcomes include severity of ADHD symptoms; functional status; health-related quality of life; treatment adherence; indicators of diagnostic procedures and treatments; patient, parent, and professional experiences and satisfaction with care; and an economic evaluation. The study is powered to detect a difference of 36 days.DiscussionThis study will provide insight into the effectiveness and efficiency of the Tornado program, an accelerated-track program in mental healthcare.Trial registrationNetherlands Trial Register NTR2505. Trial status: active data collection.

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4986

Improving Payment for Collaborative Mental Health Care in Primary Care

Type: Journal Article

Authors: C. B. Wolk, C. L. Alter, R. Kishton, J. Rado, J. A. Atlas, M. J. Press, N. Jordan, M. Grant, C. Livesey, L. J. Rosenthal, J. D. Smith

Year: 2021

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4987

Improving pediatricians’ knowledge and skills in suicide prevention: Opportunities for social work

Type: Journal Article

Authors: Gary U. Behrman, Scott Secrest, Paula Ballew, Monica M. Matthieu, Anne L. Glowinski, Jeffrey F. Scherrer

Year: 2019

Publication Place: London

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4988

Improving PHQ9 Utilization Rates in a Primary Care-Mental Health Integration Setting

Type: Journal Article

Authors: M. J. Brown, S. M. Adams, D. Vanderhoef, R. Schipani, A. Taylor

Year: 2020

Publication Place: United States

Abstract:

INTRODUCTION: Measurement-based care (MBC) uses standardized measurement to systematically monitor treatment response over time. Although MBC is underutilized in mental health settings, primary care-mental health integration (PC-MHI) settings are expected to provide MBC. This article describes a quality improvement (QI) process to increase Patient Health Questionnaire-9 (PHQ9) utilization within a PC-MHI setting. AIMS: Pre-intervention, rates of baseline and follow-up PHQ9 administration for veterans with a depressive disorder were 76% and 35%, respectively. This article describes a QI process to increase PHQ9 utilization rates within a PC-MHI setting, with the goal to improve provider PHQ9 utilization rates at baseline and within 4-week follow-up to 90%. METHOD: An educational intervention and weekly motivational enhancement sessions were implemented in 2017. Chart review data compared PHQ9 utilization rates from fall 2016 and 2017. RESULTS: Following intervention, provider PHQ9 utilization rates increased to 98% and 88% at baseline and follow-up. CONCLUSIONS: These findings demonstrate that a brief education-based intervention can increase clinician use of MBC within a PC-MHI setting. Meaningful use of MBC to inform treatment was not evaluated in this QI project and is an area for future investigation.

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4989

Improving practice in community-based settings: a randomized trial of supervision - study protocol

Type: Journal Article

Authors: S. Dorsey, M. D. Pullmann, E. Deblinger, L. Berliner, S. E. Kerns, K. Thompson, J. Unutzer, J. R. Weisz, A. F. Garland

Year: 2013

Publication Place: England

Abstract: BACKGROUND: Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes 'gold standard' supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes. METHODS/DESIGN: The study has two phases. We will conduct an initial descriptive study (Phase I) of supervision practices within public mental health in Washington State followed by a randomized controlled trial of gold standard supervision strategies (Phase II), with randomization at the clinician level (i.e., supervisors provide both conditions). Study participants will be 35 supervisors and 130 clinicians in community mental health centers. We will enroll one child per clinician in Phase I (N = 130) and three children per clinician in Phase II (N = 390). We use a multi-level mixed within- and between-subjects longitudinal design. Audio recordings of supervision and therapy sessions will be collected and coded throughout both phases. Child outcome data will be collected at the beginning of treatment and at three and six months into treatment. DISCUSSION: This study will provide insight into how supervisors can optimally support clinicians delivering evidence-based treatments. Phase I will provide descriptive information, currently unavailable in the literature, about commonly used supervision strategies in community mental health. The Phase II randomized controlled trial of gold standard supervision strategies is, to our knowledge, the first experimental study of gold standard supervision strategies in community mental health and will yield needed information about how to leverage supervision to improve clinician fidelity and client outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT01800266.

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4990

Improving prevention in primary care: Evaluating the effectiveness of outreach facilitation

Type: Journal Article

Authors: W. Hogg, J. Lemelin, I. D. Graham, J. Grimshaw, C. Martin, L. Moore, E. Soto, K. O'Rourke

Year: 2008

Publication Place: United Kingdom: Oxford Univ Press

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4991

Improving Primary Care Behavioral Health Integration in an Academic Internal Medicine Practice: 2-Year Follow-Up

Type: Journal Article

Authors: I. Yin, E. M. Staab, N. Beckman, L. M. Vinci, M. Ari, F. S. Araújo, D. Yohanna, N. Laiteerapong

Year: 2021

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4992

Improving primary care for depression in late life: the design of a multicenter randomized trial

Type: Journal Article

Authors: J. Unutzer, W. Katon, J. Williams, C. M. Callahan, L. Harpole, E. M. Hunkeler, M. Hoffing, P. Arean, M. T. Hegel, M. Schoenbaum, S. M. Oishi, C. A. Langston

Year: 2001

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4993

Improving primary care for older adults with cancer and depression

Type: Journal Article

Authors: J. R. Fann, M. Fan, J. Unutzer

Year: 2009

Abstract: Abstract.Background: Depression is common among older cancer patients, but little is known about the optimal approach to caring for this population. This analysis evaluates the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) program, a stepped care management program for depression in primary care patients who had an ICD-9 cancer diagnosis. Methods: Two hundred fifteen cancer patients were identified from the 1,801 participants in the parent study. Subjects were 60 years or older with major depression (18%), dysthymic disorder (33%), or both (49%), recruited from 18 primary care clinics belonging to 8 health-care organizations in 5 states. Patients were randomly assigned to the IMPACT intervention (n=112) or usual care (n=103). Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care provider and who offered education, care management, support of antidepressant management, and brief, structured psychosocial interventions including behavioral activation and problem-solving treatment. Results: At 6 and 12 months, 55% and 39% of intervention patients had a 50% or greater reduction in depressive symptoms (SCL-20) from baseline compared to 34% and 20% of usual care participants (P=0.003 and P=0.029). Intervention patients also experienced greater remission rates (P=0.031), more depression-free days (P<0.001), less functional impairment (P=0.011), and greater quality of life (P=0.039) at 12 months than usual care participants. Conclusions: The IMPACT collaborative care program appears to be feasible and effective for depression among older cancer patients in diverse primary care settings.

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4994

Improving primary care mental health: Survey evaluation of an innovative workforce development in England

Type: Journal Article

Authors: E. F. Harkness, P. Bower, L. Gask, B. Sibbald

Year: 2005

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4995

Improving primary care treatment of depression among patients with diabetes mellitus: the design of the pathways study

Type: Journal Article

Authors: W. Katon, M. Von Korff, E. Lin, G. Simon, E. Ludman, T. Bush, E. Walker, P. Ciechanowski, C. Rutter

Year: 2003

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4996

Improving primary health care services for young people experiencing psychological distress and mental health problems: a personal reflection on lessons learnt from Australia and England

Type: Journal Article

Authors: J. H. Roberts

Year: 2012

Publication Place: England

Abstract: BACKGROUND: Australia and England show high rates of psychological distress and mental health problems in young people. Both are high-income countries and have stated their intention to improve the delivery of health care to young people in primary care settings. Australia has an international reputation for improving care through innovative services and educational initiatives. England has taken a different direction and has concentrated more on developing policy and making recommendations to improve access for young people. AIM: To describe a Churchill Fellowship visit to Australia to observe initiatives in primary care based youth-friendly mental health care and to reflect upon the observations, comparing and contrasting with the English model. METHODS: The observations and reflections presented draw on field notes from site visits and meeting with key players, accessing web resources and referring to the literature, both grey and published. FINDINGS: Australia offers plurality in health care delivery and innovative responses to addressing youth mental health. There are two key approaches. The first is the development of services specializing in youth mental health. The second approach is to build capacity of existing primary care services to recognize the particular bio-psychosocial needs of adolescents (and their families). In contrast, England has tended to focus primarily on policy development and improving youth access. CONCLUSIONS: The paper draws attention to a number of political, clinical and educational developments in both Australia and England. Both countries demonstrate different strategies in response to the high levels of psychological distress in young people. Learning from colleagues in other settings can inform our own practice. Ultimately responding to young people's mental health needs is best served by youth-friendly policy which prepares clinicians for effective practice, informed by applied research and supported by adequate resources. Investment in young people's health must be a priority for us all.

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4997

Improving Provider Communication to Improve Transitions in Patient Care [Video]

Type: Web Resource

Authors: Elizabeth Ciemins

Year: 2014

Abstract:

The Depart Process system, which included an electronic discharge checklist, standardized the hospital discharge process to improve care management of patients as they transition from a hospital to a primary care setting.

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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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4998

Improving public health through access to and utilization of medication assisted treatment

Type: Journal Article

Authors: T. F. Kresina, R. Lubran

Year: 2011

Publication Place: Switzerland

Abstract: Providing access to and utilization of medication assisted treatment (MAT) for the treatment of opioid abuse and dependence provides an important opportunity to improve public health. Access to health services comprising MAT in the community is fundamental to achieve broad service coverage. The type and placement of the health services comprising MAT and integration with primary medical care including human immunodeficiency virus (HIV) prevention, care and treatment services are optimal for addressing both substance abuse and co-occurring infectious diseases. As an HIV prevention intervention, integrated (same medical record for HIV services and MAT services) MAT with HIV prevention, care and treatment programs provides the best "one stop shopping" approach for health service utilization. Alternatively, MAT, medical and HIV services can be separately managed but co-located to allow convenient utilization of primary care, MAT and HIV services. A third approach is coordinated care and treatment, where primary care, MAT and HIV services are provided at distinct locations and case managers, peer facilitators, or others promote direct service utilization at the various locations. Developing a continuum of care for patients with opioid dependence throughout the stages MAT enhances the public health and Recovery from opioid dependence. As a stigmatized and medical disenfranchised population with multiple medical, psychological and social needs, people who inject drugs and are opioid dependent have difficulty accessing services and navigating medical systems of coordinated care. MAT programs that offer comprehensive services and medical care options can best contribute to improving the health of these individuals thereby enhancing the health of the community.

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4999

Improving quality of care for mental illness in an uninsured, low-income primary care population

Type: Journal Article

Authors: Larry B. Mauksch, Randall Reitz, Suzanne Tucker, Steve Hurd, Joan Russo, Wayne J. Katon

Year: 2007

Publication Place: Netherlands: Elsevier Science

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5000

Improving Quality of Emergency Care Through Integration of Mental Health

Type: Journal Article

Authors: M. Okafor, G. Wrenn, V. Ede, N. Wilson, W. Custer, E. Risby, M. Claeys, F. E. Shelp, H. Atallah, G. Mattox, D. Satcher

Year: 2016

Publication Place: United States

Abstract: The goal of this study was to better integrate emergency medical and psychiatric care at a large urban public hospital, identify impact on quality improvement metrics, and reduce healthcare cost. A psychiatric fast track service was implemented as a quality improvement initiative. Data on disposition from the emergency department from January 2011 to May 2012 for patients impacted by the pilot were analyzed. 4329 patients from January 2011 to August 2011 (pre-intervention) were compared with 4867 patients from September 2011 to May 2012 (intervention). There was a trend of decline on overall quality metrics of time to triage and time from disposition to discharge. The trend analysis of the psychiatric length of stay and use of restraints showed significant reductions. Integrated emergency care models are evidence-based approach to ensuring that patients with mental health needs receive proper and efficient treatment. Results suggest that this may also improve overall emergency department's throughput.

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