Literature Collection

BACKGROUND: Primary care patients with depression or anxiety are at higher risk for cardiovascular disease. Those who engage in integrated mental health treatment may also improve their cardiovascular health. METHODS: We conducted secondary analysis of electronic health record-extracted data related to a pragmatic, implementation trial of the collaborative care model for depression and anxiety (CoCM; NCT04321876). Primary care patients with elevated depressive/anxiety symptoms (N = 3252) in 11 primary care clinics were classified as CoCM Patients (n = 718), Not Referred to CoCM (n = 1348), or Not Engaged in CoCM (n = 1459). Cardiovascular health measures included blood pressure (BP; mmHg), total cholesterol (mg/dL), HbA1c (%), and body mass index (BMI; kg/m(2)). Primary analyses were linear regressions evaluating associations of CoCM treatment (vs. Not Referred, vs. Not Engaged) with changes in cardiovascular health, adjusted for demographics, cardiovascular diagnoses, and medications. RESULTS: At baseline, CoCM Patients had poorer cardiovascular health than Not Referred (higher systolic BP, total cholesterol, BMI) and better cardiovascular health than Not Engaged (lower total cholesterol, HbA1c). CoCM Patients, vs. Not Referred, had small decreases in total cholesterol (B = -0.44, 95 % CI: -0.72, -0.17) and increases in BMI (B = 0.18, 95 % CI: 0.03, 0.34). CoCM Patients did not differ from Not Engaged patients on cardiovascular health outcomes (all ps > 0.05). DISCUSSION: Differences in cardiovascular health profiles were evident prior to treatment. Patients who bengaged in CoCM treatment, compared to patients not referred to CoCM, evidenced small improvements in total cholesterol and increases in BMI. Widespread implementation of integrated mental health treatment may have implications for population cardiovascular health.

OBJECTIVE: People with serious mental illness (i.e., disabling psychotic, mood, and other disorders) develop chronic medical diseases early in life. This study aimed to examine the effects of integrating primary care into community mental health centers (CMHCs; reverse integrated care) on service use among young adults with serious mental illness who may benefit from early intervention. METHODS: This retrospective cohort analysis used Medicaid claims of 945 people with serious mental illness (ages 18-40) in CMHC care from 2020 to 2022-315 in reverse integrated care and 630 propensity score matched participants in comparison care (i.e., not reverse integrated care). Logistic regression, adjusted for participant characteristics, enrollment quarter, and past service use, assessed outcomes in the 6 months after enrollment. RESULTS: Participants' mean±SD age was 32.56 ± 7.84 years; 29% had a diagnosis of schizophrenia, 40% had a co-occurring substance use disorder, 33% had a medical emergency department (ED) visit in the 6 months before enrollment, and all were enrolled in CMHC care at baseline. During follow-up, participants in reverse integrated care were more likely to have an outpatient medical visit (65% vs. 58%; adjusted odds ratio [AOR]=1.54, p=0.005) and were less likely to have a medical ED visit (26% vs. 33%; AOR=0.70, p=0.035) than those in comparison care. CONCLUSIONS: Integrating primary care into CMHC services may increase access to outpatient medical care and reduce ED visits for medical reasons among young adults with serious mental illness. Future research should confirm these findings, assess longer-term outcomes, and examine implementation facilitators and barriers.

OBJECTIVES: The COVID-19 pandemic stimulated an unprecedented expansion in use of video and telephone visits (televisits) for routine specialty care as a substitute for in-person clinic visits. However, the sustainability of televisit use for specialty care delivery following the pandemic is unclear. STUDY DESIGN/METHODS: In this descriptive, retro-spective study of national Veterans Health Administration (VHA) data, we assessed total outpatient visit volume by month in 9 specialties (cardiology, dermatology, eye care, gastroenterology [GI]/hepatology, neurosurgery, orthopedics, podiatry, substance use disorder [SUD], and urology) at all VHA facilities in the US between January 2019 (pre-COVID-19) and September 2023 (representing late phases of health system recovery post COVID-19). We also categorized outpatient visits by modality (in person, telephone, video) and assessed time trends in the proportion of total outpatient visits in each specialty delivered by televisit. Descriptive statistics were used to summarize the study findings. RESULTS: Although total visit volumes in most VHA specialties had returned to pre-COVID-19 baselines by the end of the study period, they did not fully rebound in others, suggesting persistent care gaps. Televisit use increased from a mean of 7% in quarter 1 (Q1) 2019 to 54% in Q2 2020, then decreased modestly to 27% of all specialty visits by Q3 2023. The specialties with the highest sustained televisit use in Q3 2023 were SUD and GI, despite restored in-person visit availability. The use of telephone visits exceeded the use of video visits throughout the study period. CONCLUSIONS: Our findings suggest that televisits will likely remain an important visit modality for patients in the postpandemic era.

OBJECTIVE: This study aimed to assess the impact of curricular content reduction in a 3-year integrated course sequence in a Doctor of Pharmacy curriculum on student-reported mental and physical health. METHODS: A 3-hour, 5-days-a-week integrated course sequence spanning 3 years of a curriculum was transitioned to a 3-hour, 4-days-a-week course, representing 207 h of reduced in-class time. After implementation, first- through third-year student pharmacists were asked to complete a 23-item voluntary survey regarding the impact of the curricular change on their mental and physical health, how they spent time on the non-Integrated Learning Experience course day, and additional demographic and social characteristics. Respondents were asked to participate in follow-up focus group sessions to elucidate the findings of the survey. RESULTS: A total of 197 students (50.3% response rate) representing the classes of 2024, 2025, and 2026 responded to the survey, and 15 students participated in 1 of 4 focus group sessions. Most students indicated a preference for the 4-days-a-week over the 5-days-a-week course and reported improvement in mental and physical health during the 4-days-a-week course. Most students used the additional time to study or complete assignments, while many third-year students used it to work, but many also used it to complete personal errands and activities, which led to a positive impact on their well-being. CONCLUSION: Student self-reported mental and physical health improved with a reduction in curricular content by 1 course session (3 h) per week.