Literature Collection

Interventional psychiatric procedures (IPPs) such as electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and ketamine intravenous treatments (KIT) are widely used for treatment resistant depression (TRD), but we lack studies of their real-world impact compared to standard outpatient medication management (MM). Longitudinal electronic health records of 22,481 patients in a large integrated healthcare system during 2018-2022 were examined to describe depression improvement via 9-item Patient Health Questionnaire (PHQ-9), changes in psychiatric admissions, and use of continuation/maintenance (C/M) treatments. Overall, each IPP group had significantly greater depression improvement at 6 weeks compared to MM: adjusted estimates TMS:1.64 (p < 0.001), KIT:2.02 (p < 0.001), and ECT:2.16 (p < 0.001). Patient characteristics were associated with symptom worsening within treatment groups, for example: (1) non-white race for ECT (2.33, p < 0.01) and MM (0.29, p < 0.001); (2) anxiety disorder for TMS (1.73, p < 0.001); and (3) personality disorder for all treatment groups, with significant coefficients found for KIT (3.27, p < 0.05) and MM (1.27, p < 0.001). Some examples of correlations with improved symptom response include: (1) psychotic disorder for ECT (-3.57, p < 0.01); and (2) bipolar disorder for KIT (-2.19; p < 0.05). For the KIT group, C/M treatment versus no C/M treatment was associated with lower risk for 12-month psychiatric hospitalization (adjusted relative risk: 0.25). This is the first study to show a protective association for maintenance ketamine on psychiatric hospitalization risk. Treatment-specific predictors of response should be confirmed in future comparative effectiveness studies.

BACKGROUND: Unmet social needs are common among individuals with multiple chronic health conditions (MCC). OBJECTIVE: To evaluate the acceptability of proactive outreach to assess and follow up on social health needs among patients with MCC. DESIGN: Qualitative study using semi-structured interviews. PARTICIPANTS: We interviewed 25 patients with 2 or more chronic health conditions in three integrated care settings in Washington, Colorado, and California that experienced proactive outreach offering assessment and follow-up for social health risks. All patients had a higher likelihood of social health risks based on a predictive model using health plan and electronic health record data. Patients received initial outreach from clinical pharmacists at the Northern California site, licensed practical nurses in primary care at the Washington site, and Community Specialists at the Colorado site. APPROACH: Transcripts were analyzed using a mixed deductive and inductive thematic approach informed by the Theoretical Framework of Acceptability. KEY RESULTS: Mean age across the groups was 66 years. We identified five themes common across all three healthcare sites. Participants appreciated the outreach, stating they felt understood and cared for by their providers; recognized how their social needs were intertwined with their physical and mental health; and found that uncomfortable social health conversations were easier with known healthcare providers. Assessment of social health needs and referral to community resources provided some participants with hope that their needs would be met, while others felt discouraged by prior experience. Following referral to community resources, participants had uneven experiences receiving resources to address their needs. CONCLUSIONS: Our results suggest proactive outreach by healthcare team members to assess and address social health needs is valued by patients with MCC despite challenges with accessing some social health resources. Future work is needed to support access to community resources and evaluate the outcomes of outreach to those with MCC who have social needs.