Literature Collection

6901

Management of mental health problems by general practitioners in Quebec

Type: Journal Article

Authors: M. J. Fleury, L. Farand, D. Aube, A. Imboua

Year: 2012

Publication Place: Canada

Abstract: OBJECTIVE: To document the management of mental health problems (MHPs) by general practitioners. DESIGN: A mixed-method study consisting of a self-administered questionnaire and qualitative interviews. An analysis was also performed of Regie de l'assurance maladie du Quebec administrative data on medical procedures. SETTING: Quebec. PARTICIPANTS: Overall, 1415 general practitioners from different practice settings were invited to complete a questionnaire; 970 general practitioners were contacted. A subgroup of 60 general practitioners were contacted to participate in interviews. MAIN OUTCOME MEASURES: The annual frequency of consultations over MHPs, either common (CMHPs) or serious (SMHPs), clinical practices, collaborative practices, factors that either support or interfere with the management of MHPs, and recommendations for improving the health care system. RESULTS: The response rate was 41% (n = 398 general practitioners) for the survey and 63% (n = 60) for the interviews. Approximately 25% of visits to general practitioners are related to MHPs. Nearly all general practitioners manage CMHPs and believed themselves competent to do so; however, the reverse is true for the management of SMHPs. Nearly 20% of patients with CMHPs are referred (mainly to psychosocial professionals), whereas nearly 75% of patients with SMHPs are referred (mostly to psychiatrists and emergency departments). More than 50% of general practitioners say that they do not have any contact with resources in the mental health field. Numerous factors influence the management of MHPs: patients' profiles (the complexity of the MHP, concomitant disorders); individual characteristics of the general practitioner (informal network, training); the professional culture (working in isolation, formal clinical mechanisms); the institutional setting (multidisciplinarity, staff or consultant); organization of services (resources, formal coordination); and environment (policies). CONCLUSION: The key role played by general practitioners and their support of the management of MHPs were evident, especially for CMHPs. For more optimal management of primary mental health care, multicomponent strategies, such as shared care, should be used more often.

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6902

Management of mood and anxiety disorders in patients receiving opioid agonist therapy: Review and meta-analysis

Type: Journal Article

Authors: A. N. Hassan, A. S. Howe, A. V. Samokhvalov, B. Le Foll, T. P. George

Year: 2017

Publication Place: England

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6903

Management of neonatal abstinence syndrome in neonates born to opioid maintained women

Type: Journal Article

Authors: Nina Ebner, Klaudia Rohrmeister, Bernadette Winklbaur, Andjela Baewert, Reinhold Jagsch, Alexandra Peternell, Kenneth Thau, Gabriele Fischer

Year: 2007

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6904

Management of Opioid Misuse and Opioid Use Disorders Among Youth

Type: Journal Article

Authors: Camille A. Robinson, J. D. Wilson

Year: 2020

Publication Place: Chicago, Illinois

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6905

Management of opioid painkiller dependence in primary care: Ongoing recovery with buprenorphine/naloxone

Type: Journal Article

Authors: B. Hard

Year: 2014

Publication Place: England

Abstract: Opioid painkiller dependence is a growing problem and best-practice management is not well defined. We report a case of a young woman exhibiting dependence on codeine, originally prescribed for myalgic encephalopathy, after escalating use over a 10-year period. In 2012, a consultation with a new general practitioner, who had extensive experience of patients with substance abuse, revealed the underlying dependence. After building trust for 6 months, she was able to admit to medication abuse, and was referred to the community drug and alcohol team. On presentation to the team, the patient had no pain issues and the dihydrocodeine use--600 tablets/week--solely reflected her dependence. The patient successfully underwent rapid induction with buprenorphine/naloxone as opioid substitution treatment over 2 days. She is currently stable, engaged with recovery support services and psychosocial counselling, and has just returned to work. She is maintained on a therapeutic dose of buprenorphine 10 mg/naloxone 2.5 mg.

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6906

Management of Opioid Use Disorder Treatment: An Overview

Type: Journal Article

Authors: S. Salmond, V. Allread, R. Marsh

Year: 2019

Publication Place: United States

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6907

Management of out-of-hours calls by a general practice cooperative: A geographical analysis of telephone access and consultation.

Type: Journal Article

Authors: Joanne Turnbull, Catherine Pope, David Martin, Valerie Lattimer

Year: 2011

Publication Place: United Kingdom

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6908

Management of patients with issues related to opioid safety, efficacy and/or misuse: a case series from an integrated, interdisciplinary clinic

Type: Journal Article

Authors: W. C. Becker, J. S. Merlin, A. Manhapra, E. L. Edens

Year: 2016

Publication Place: England

Abstract: BACKGROUND: Patients, providers, communities and health systems have struggled to achieve balance between access to opioid treatment for chronic pain and its potential harmful consequences: especially misuse, addiction and overdose. We developed an interdisciplinary clinic embedded within primary care (the Opioid Reassessment Clinic-ORC) with the goal of improving the quality of care of patients with co-occurring chronic pain and issues related to opioid safety, efficacy and/or misuse. CASE DESCRIPTIONS: We present three cases referred to the ORC that highlight complex clinical scenarios related to assessment and treatment of patients with chronic pain and issues related to opioid safety, efficacy and misuse. DISCUSSION AND EVALUATION: In the context of the three cases, with respect to assessment, we discuss: making the diagnosis of opioid use disorder; allowing the patient space to endorse lack of efficacy; identification of co-occurring hazardous alcohol use; and recognizing barriers to multimodal pain care. With respect to treatment, we discuss: making a change in treatment with which the patient may not agree; effectiveness of buprenorphine/naloxone for the treatment of chronic pain; responding to low efficacy; and making continued opioid therapy contingent on engagement with substance abuse treatment. CONCLUSIONS: The core components of our approach-biopsychosocial assessment and multimodal treatment planning with an emphasis on promoting functional goals and safety using clear communication and a patient-centered stance-should guide providers in the management of similar clinical scenarios. More evidence is needed to definitively guide specific interventions and points of clinical equipoise.

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6909

Management of postnatal depression in primary care: A window of opportunity

Type: Journal Article

Authors: L. Tait, J. Heron

Year: 2010

Publication Place: England

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6910

Management of Psychiatric and Somatic Comorbidity in Primary-care-based Stepped-care Models: A Systematic Review

Type: Journal Article

Authors: K. Maehder, B. Lowe, A. Weigel

Year: 2018

Publication Place: London

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6911

Management or missed opportunity? Mental health care planning in Australian general practice

Type: Journal Article

Authors: Michelle Banfield, Louise M. Farrer, Christopher Harrison

Year: 2019

Publication Place: Clayton, VIC, <Blank>

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6912

Managing Adolescent Depression: The Complete Guide for Primary Care Clinicians

Type: Book

Authors: R. A. Zuckerbrot, A. Cheung, R. E. Stein, P. S. Jensen

Year: 2012

Publication Place: Kingston, NJ

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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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6913

Managing alcohol use in primary care

Type: Journal Article

Authors: J. McCambridge, D. Stewart

Year: 2020

Publication Place: England

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6914

Managing Behavioral Health Concerns in Early Childhood: The Role of Child Psychiatry Access Programs

Type: Journal Article

Authors: L. Stavisky, G. S. McIlmoyle, R. A. Ferro, Crosby Budinger, R. Platt, A. Girard, S. Edwards, D. Appleby, S. P. Reinblatt, K. Coble, A. F. Bettencourt

Year: 2026

Abstract:

INTRODUCTION: Child Psychiatry Access Programs (CPAPs), like Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP), help address the behavioral health treatment gap. This study examined demographic and clinical characteristics of children aged 0-5 years for whom primary care providers (PCPs) and/or families sought BHIPP services, and recommendations provided by BHIPP. METHOD: Descriptive and chi-square statistics were used to examine BHIPP services received, patient demographics, presenting problems, diagnostic impressions, clinical severity, treatments the patient was receiving before BHIPP contact, and BHIPP's treatment recommendations and referrals from 1,671 unique patient-specific contacts between October 2012 and June 2023. RESULTS: Older children in this sample presented to BHIPP as more complex and severe. The most common treatment recommendation and referral made by BHIPP were referral to a community behavioral health provider and outpatient psychotherapy, respectively. DISCUSSION: This study highlights the important role of PCPs in addressing early childhood behavioral health concerns and CPAPs' role in supporting PCPs and improving access to early childhood behavioral health care.

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6915

Managing behavioral health needs of veterans with Traumatic brain injury (TBI) in primary care

Type: Journal Article

Authors: P. R. King, L. O. Wray

Year: 2012

Publication Place: United States

Abstract: Traumatic brain injury (TBI) is a frequent occurrence in the United States, and has been given particular attention in the veteran population. Recent accounts have estimated TBI incidence rates as high as 20 % among US veterans who served in Afghanistan or Iraq, and many of these veterans experience a host of co-morbid concerns, including psychiatric complaints (such as depression and post-traumatic stress disorder), sleep disturbance, and substance abuse which may warrant referral to behavioral health specialists working in primary care settings. This paper reviews many common behavioral health concerns co-morbid with TBI, and suggests areas in which behavioral health specialists may assess, intervene, and help to facilitate holistic patient care beyond the acute phase of injury. The primary focus is on sequelae common to mild and moderate TBI which may more readily present in primary care clinics.

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6916

Managing Bipolar Disorder in the Primary Care Setting: A Perspective for Mental Health Professionals

Type: Journal Article

Authors: R. A. Sansone, L. A. Sansone

Year: 2011

Abstract: Bipolar disorder affects between 1.3 percent and 1.6 percent of the general population. According to available evidence, prevalence rates appear to be even higher in primary care settings. The diagnosis and management of patients with bipolar disorder are potentially complicated by a number of factors, including underdiagnosis due to the predominance of depressive symptoms; high levels of psychiatric comorbidity; a comparatively high suicide rate; continuing controversies in the pharmacological management of the disorder; and a potentially elevated cost-of-care contributed by the prescription of brand-name medications as well as laboratory monitoring at baseline and intermittently for lithium and atypical antipsychotics and serum levels for lithium and some anticonvulsants. All of these factors seem to result in an understandable hesitancy on the behalf of primary care clinicians to diagnose and assume care for these complex patients. Mental health professionals need to remain mindful of these issues when arranging dispositions for patients.

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6917

Managing borderline personality disorder and substance use - an integrated approach

Type: Journal Article

Authors: D. I. Lubman, K. Hall, A. Pennay, S. Rao

Year: 2011

Publication Place: Australia

Abstract: BACKGROUND Although substance use is a common feature of borderline personality disorder, regular use is associated with greater levels of psychosocial impairment, psychopathology, self harm and suicidal behaviour and leads to poorer treatment outcomes. Management of co-occurring substance use disorder and borderline personality disorder within primary care is further compounded by negative attitudes and practices in responding to people with these conditions, which can lead to a fractured patient-doctor relationship. OBJECTIVE This article provides an overview of how the general practitioner can provide effective support for patients with co-occurring borderline personality disorder and substance use disorder, including approaches to assessment and treatment, the therapeutic relationship, referral pathways and managing risk and chronic suicidality. DISCUSSION Despite the complexities associated with this population, GPs are ideally placed to engage patients with co-occurring borderline personality disorder and substance use disorder in a long term therapeutic relationship, while also ensuring timely referral to other key services and health professionals. To provide the most effective responses to this patient group, GPs need to understand borderline personality disorder and its relationship to substance use, develop an 'explanatory framework' for challenging behaviours, implement mechanisms for reflective practice to manage negative countertransference, as well as learn skills to respond adequately to behaviours which jeopardise treatment retention.

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6918

Managing care for patients with substance abuse disorders at community health centers.

Type: Journal Article

Authors: Deborah Gurewich, Jeffrey Prottas, Jenna T. Sirkin

Year: 2014

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6919

Managing child and adolescent mental health problems in primary care: taking the leap from knowledge to practice

Type: Journal Article

Authors: A. K. Vallance, T. Kramer, D. Churchill, M. E. Garralda

Year: 2011

Publication Place: England

Abstract: In 2009, a conference at Imperial College London brought together experts on the primary care provision of child and adolescent mental health. The following paper highlights various themes from the conference, and particularly focuses on general practice. Despite international and national guidance, child and adolescent mental health provision in primary care is limited in the UK and globally. We argue that primary care services are in fact well placed to assess, diagnose, and manage child and adolescent mental health problems. The barriers to such provision are considered from the perspective of both service users and providers, and the possible ways to overcome such challenges are discussed. The paper is informed by various epidemiological and intervention studies and comparisons between different countries and health systems are explored.

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6920

Managing Chronic Illness: Physician Practices Increased The Use Of Care Management And Medical Home Processes [Primary Care]

Type: Journal Article

Authors: J. A. Wiley, D. R. Rittenhouse, S. M. Shortell, L. P. Casalino, P. P. Ramsay, S. Bibi, A. M. Ryan, K. R. Copeland, J. A. Alexander

Year: 2015

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