Literature Collection

BACKGROUND: Shared decision-making (SDM) is a process in which healthcare providers (HCPs) and patients make health-related decisions collaboratively, guided by the best available evidence. Previous research suggests that emerging adults (aged 18-29) with mental health concerns might prefer SDM over traditional approaches; however, it remains unclear whether prevalent symptoms of anxiety, depression, or health-related quality of life (HRQL) are associated with the level of SDM that occurs during a clinical encounter. OBJECTIVE: This study explored whether prevalent symptoms of anxiety, depression or HRQL among emerging adults were associated with the perceived level of SDM involvement during a single clinic visit at a primary care or community addiction and mental health (AMH) setting. METHODS: A cross-sectional survey was conducted using a subset of data (emerging adults and their HCPs) obtained from an overarching study on SDM in adults (18-64 years) in Alberta, Canada. Sociodemographic data were collected and reported descriptively. SDM was the primary outcome variable and was measured dyadically (i.e., the mean score between HCPs and patients) using the Alberta Shared Decision-Making Instrument (ASK-MI). Symptoms of patient anxiety/depression and HRQL were measured using the Hospital Anxiety and Depression Scale (HADS) and the EQ-5D-5L. Pearson R correlation matrices were conducted to explore relationships between SDM, anxiety/depression, HRQL, and demographic variables. RESULTS: Forty-two emerging adult patients and 31 HCP dyads were recruited from six community AMH settings and eight primary care settings. The mean SDM dyad rating was 8.69 (SD, ± 2.01), indicating an "excellent" level of SDM. Symptoms of anxiety, depression, and HRQL were not significantly correlated with SDM dyad ratings during the clinic visit. Post hoc analyses showed that patient age was inversely related to SDM dyad ratings; R = -0.34, p = 0.03. DISCUSSION: In this study, emerging adults reported high levels of perceived engagement in SDM, regardless of their HRQL or symptoms of anxiety and depression. However, several limitations, such as the risk of performance bias, should be considered when interpreting these findings. To strengthen the evidence base, future research should aim to address these limitations.

OBJECTIVE: This study aimed to determine predictors of long-term collaborative care reach and effectiveness. METHODS: The authors conducted a cross-sectional observational study of the New York State Collaborative Care Medicaid Program (CCMP). Subjects included clinics participating in CCMP from 2012 to 2019 with a ≥0.5 full-time-equivalent (FTE) care manager and data from 2021, 2022, or both. Main measures included clinic and fidelity characteristics. Outcomes were reach and effectiveness. Multilevel negative binomial regression models were used, with analyses adjusting for clustering by health care system and county. RESULTS: Of 157 eligible clinics, 71% were Federally Qualified Health Centers (FQHCs); the median caseload per care manager FTE was 55; reach, 13%; and effectiveness, 42%. In multivariable analyses, CCMP factors associated with reach included more engagement (adjusted rate ratio [aRR]=1.15), higher care manager FTE (aRR=1.06), larger caseload per care manager FTE (aRR=1.23), smaller clinic size (aRR=0.60), earlier adoption (aRR=0.40 in 2017-2019 vs. 2012-2014), and fewer academic or private clinics (vs. FQHCs) (aRR=0.66). Higher caseload per care manager FTE (aRR=1.05), more psychiatric consultations (aRR=1.04), greater early implementation effectiveness (aRR=1.07), and more FQHCs (aRR=1.15) were associated with greater effectiveness. CONCLUSIONS: Despite ongoing fiscal and technical assistance strategies, the CCMP struggles to achieve long-term reach. This study provides potential targets for optimizing implementation settings and pace of sustainability and is among the first to suggest a reciprocal relationship between effectiveness and reach and that an optimal caseload may promote both.