Literature Collection

Physicians and advanced practice providers often lack structured opportunities to develop personal and professional skills, critical for reducing burnout and enhancing job satisfaction. To address this, Brown Medicine's Division of General Internal Medicine introduced the Personal Development Empowerment Series, a cost- effective faculty development initiative integrated into the existing schedule. The series includes sessions that focus on topics like imposter syndrome, assertiveness, and time management, blending education with interactive activities to promote practical application. Facilitated by psychologists and motivated peers, the lectures have been well received, with faculty appreciating its emphasis on reflection and cognitive-behavioral strategies. This replicable initiative fosters a supportive work culture, boosts morale, and highlights the importance of personal growth. This program demonstrates that affordable, home-grown interventions can significantly impact well-being and organizational culture.

OBJECTIVES: Primary care behavioral health (PCBH) is a patient care model in which a behavioral health consultant (BHC) works alongside the primary care provider to address behavioral components of health conditions. PCBH is well received in the primary care setting; however, little is known about acceptability of the service among prenatal patients. The study was designed to explore the acceptability of PCBH among pregnant patients in a resident obstetrics and gynecology clinic. METHODS: A survey designed to assess different components of acceptability was administered to eligible pregnant patients who received prenatal care at the resident obstetrics and gynecology clinic. RESULTS: The majority of patients wanted to receive education on pregnancy-relevant topics from the BHC: healthy weight gain (68.4%), healthy eating (70.4%), healthy exercise (73.5%), and mood disorders (63.3%). The majority of participants wanted help from the BHC in managing coexisting conditions affecting pregnancy: stress (63.3%), depression (75.5%), or anxiety (73%). The majority of patients (55.6%) preferred to work with a BHC for mental health concerns rather than an outside psychiatrist or counselor. PCBH service was perceived to be easy to understand (78%). Barriers to engaging in the PCBH service included time (41.4%), lack of perceived need (13.8%), unavailability (6.9%), and others (13.8%). Despite the perceived benefit, there was an implication of stigma among prenatal patients seeking PCBH or mental health care. CONCLUSIONS: Overall, the PCBH model had high acceptability among a prenatal care population in a resident obstetrics and gynecology clinic and offers potential to improve prenatal outcomes.

BACKGROUND: Depression is pervasive, and rates are rising in the United States. Most people with depression receive care from primary care clinicians, but gaps in the quality of care exist. Team-based approaches to depression care have been shown to aid in treatment and management; yet, challenges exist in implementation. Digital health apps have been shown to be effective in improving depression symptoms and enhancing patient engagement in some populations. Many, however, do not share data with clinical care teams. OBJECTIVE: This study aimed to understand the barriers to and facilitators for implementation of a digital health program that supports coordinated use by clinical care teams and patients, via a mobile app and care team-facing web interface, for depression in primary care. METHODS: This study was part of a larger intervention study that included 4 primary care practices: 2 intervention and 2 control sites. The intervention sites used a patient-facing mobile app and a care team-facing web interface, and the control sites continued usual care. The study team conducted interviews from May to October 2021. Patient and care team participants were recruited toward the end of their study involvement. Separate semistructured interview guides were developed for patient and care team participants. Interviews were recorded and transcribed. Data were coded using Atlas.ti.9, and data analysis was completed using a grounded theory approach. RESULTS: Interviews with patient (n=8) and care team (n=8) participants revealed 3 main topics for program implementation: app/interface usability, tracking, and program recommendations. For app/interface usability, overall, navigation for both patient and care team participants was simple and straightforward. Although app content was relevant, patient participants desired additional educational resources and information to aid in their depression treatment and management. In terms of tracking, care team participants indicated that data obtained via the interface enabled them to monitor patients in between visits; and in some circumstances, these data facilitated conversations with patients about treatment plans. Tracking medication adherence differed among patient participants due to established routines of taking medications consistently, lack of motivation to track, or lack of interest in tracking. Care team participants reported the ability to respond more quickly to side effects. Patients commented on tracking difficulties: confusing response options, insufficient goal attainment response options, not being able to provide details or write notes, and no ability to change goals. Some patient and care team participants perceived that tracking encouraged communication with one another; others perceived tracking as having no impact on shared decision-making. CONCLUSIONS: Results suggest implementation of a digital health program for depression treatment and management in primary care practices could impact patient medication adherence, produce faster turnaround time for medication optimization, encourage goal setting, and foster communication between patients and care team members. Program enhancements could optimize patient and care team member engagement.

OBJECTIVE: To assess patient and family outcomes of psychological interventions provided by behavioral health clinicians (BHCs) integrated into community-based pediatric primary care practices. Little is known about the feasibility, acceptability, and effectiveness of this treatment strategy in real-world settings. METHODS: The sample comprised 5487 patients in ∼80 practices who received psychological interventions from ∼100 integrated BHCs over 2 years. Patients of all ages identified by universal screening or verbal patient/family report as having a developmental or behavioral health (BH) problem of any kind were eligible for intervention. Post-intervention patient clinical improvement was assessed using a clinician-completed standardized clinical global impressions scale. Family satisfaction was assessed using a family-completed standardized patient experience survey. RESULTS: Patients receiving intervention were predominantly >age 7 and had BH problems (predominantly stress-related, anxiety, depressive, attention, or behavior) that were predominantly mild-moderate in severity. The mean number of intervention visits was 5.6 (range: 3-41; mode: 3). Post-intervention, 72.9% of patients with >3 intervention visits were improved and 28.9% were much or very much improved. After adjusting for potential moderators, lesser odds of improvement were significantly associated with age <7 or 12 to 15 years; symptomatic illness at initial presentation; a disorder other than anxiety; SSRI medication; complex chronic medical disease; and only 3 BHC visits. Overall, 79.3% of families responding to a survey were highly likely to recommend the services to family/friends. CONCLUSION: The findings suggest that psychological interventions delivered in the context of integrated BH in a community-based pediatric primary care setting were feasible, valued, and effective.