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McKenzie RE, Hwang LJ, Feng B, Phillips EJ. In-person therapy vs. computer-mediated therapy for college students: Single session outcomes and implications for the patient-therapist relationship. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2025:1-11. [PMID: 40367146 DOI: 10.1080/07448481.2025.2496979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2024] [Revised: 04/17/2025] [Accepted: 04/18/2025] [Indexed: 05/16/2025]
Abstract
OBJECTIVE This study focused on college students to examine if the communication channel of their most recent therapy session influenced the strength of their relationship with their therapist, post-session symptoms of anxiety and depression, and their intentions to adhere to therapist recommendations. PARTICIPANTS 688 college students from a large Californian university. METHODS The online survey took place on the Qualtrics survey platform and the proposed model was tested using structural equation modeling. RESULTS College students' emotional self-disclosure was higher in mediated compared to in-person therapy sessions. Their perceived social presence from the therapist was greater in mediated compared to in-person sessions. Emotional self-disclosure and social presence were positive predictors of the patient-therapist relational bond strength, which subsequently predicted adherence and was associated with reduced post-session depression and anxiety levels. CONCLUSIONS A strong relational bond between patient and therapist is possible in both online and offline environments for college students.
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Affiliation(s)
- Rachel E McKenzie
- Department of Communication, University of California, Davis, California, USA
| | - Lisa Jihyun Hwang
- Department of Communication, University of California, Davis, California, USA
| | - Bo Feng
- Department of Communication, University of California, Davis, California, USA
| | - Emma J Phillips
- Department of Communication, University of California, Davis, California, USA
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2
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Doran S, Ortega M, Whitley GA. The experiences of patients and family members after being discharged at scene following an emergency ambulance attendance. A rapid evidence review. Int Emerg Nurs 2025; 80:101618. [PMID: 40375415 DOI: 10.1016/j.ienj.2025.101618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 03/26/2025] [Accepted: 05/05/2025] [Indexed: 05/18/2025]
Abstract
INTRODUCTION A large proportion of emergency calls to the ambulance service are non-life-threatening, resulting in some patients being discharged by paramedics at the scene. Negative patient and family member experiences during a clinical encounter may have lasting effects. We aimed to explore the experiences of patients and family members who were discharged on scene after ambulance attendance. METHODS A rapid evidence review was conducted. MEDLINE and CINAHL Complete databases were searched simultaneously for all articles published before the 15th March 2024. Study screening and data extraction was performed. The included studies were critically appraised, and a thematic synthesis was conducted. RESULTS Five papers representing patients and family members from Australia, Sweden, Finland, and Denmark were included. Patients and family members experienced: fear and uncertainty at transitional points; reassurance from sharing responsibility; relief from a normal physical assessment; confidence from informative worsening advice; being listened to and validated; reliance on each other; and empowerment through being involved in decision making. CONCLUSION Patients and family members have varied experiences when being discharged at scene. The limited number of available studies highlights the need for further research to be conducted internationally.
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Affiliation(s)
- Sarah Doran
- School of Health and Care Sciences, University of Lincoln, UK
| | | | - Gregory Adam Whitley
- School of Health and Care Sciences, University of Lincoln, UK; Clinical Audit and Research Unit, East Midlands Ambulance Service NHS Trust, UK.
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3
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Maraj A, Ferrari M, MacDonald K, Peters M, Joober R, Shah JL, Iyer SN. Engaging with care in an early intervention for psychosis program: The role of language, communication, and culture. Transcult Psychiatry 2025; 62:135-150. [PMID: 37203146 PMCID: PMC12089677 DOI: 10.1177/13634615231167067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Language is an important aspect of communication and language status is known to impact healthcare accessibility, its perceived suitability, and outcomes. However, its influence on treatment engagement and/or disengagement is unknown. Our study therefore sought to investigate the impact of language on service disengagement in an early intervention psychosis program in Montreal, Quebec (a province with French as the official language). We aimed to compare service disengagement between a linguistic minority group (i.e., English) vis-à-vis those whose preferred language was French and to explore the role of language in service engagement. Using a mixed methods sequential design, we tested preferred language and several sociodemographic characteristics associated with service disengagement in a time-to-event analysis with Cox proportional hazards regression models (N = 338). We then conducted two focus groups with English (seven patients) and French speakers (five patients) to further explore differences between the two linguistic groups. Overall, 24% (n = 82) disengaged from the service before the two-year mark. Those whose preferred language was English were more likely to disengage (n = 47, 31.5%) than those whose preferred language was French (n = 35, 18.5%; χ2 = 9.11, p < .01). This remained significant in the multivariate regression. In focus groups, participants identified language as one aspect of a complex communication process between patients and clinicians and highlighted the importance of culture in the clinical encounter. Language status of patients plays an important role in their engagement with early psychosis services. Our findings underscore the value of establishing communication and cultural understanding in creating clinical/therapeutic alliance.
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Affiliation(s)
- Anika Maraj
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Manuela Ferrari
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Kathleen MacDonald
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | | | - Ridha Joober
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jai L Shah
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Cai S, Li C, Du Z, Liu S, Zhou L, Zhao Y, Li Y, Fu X. "This Is Fate! Nothing We Can Do to Change It": Triggers of Learned Helplessness Among Patients in Maintenance Hemodialysis - A Qualitative Study. QUALITATIVE HEALTH RESEARCH 2024:10497323241301296. [PMID: 39668466 DOI: 10.1177/10497323241301296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2024]
Abstract
As the global population of patients undergoing maintenance hemodialysis continues to grow, more than half are experiencing the psychological distress associated with learned helplessness, a condition potentially linked to adverse outcomes such as depression and suicidal ideation. However, the triggers contributing to learned helplessness in these patients remain poorly understood. This study employs an interpretative phenomenological approach to explore the experiences and triggers of learned helplessness among 26 maintenance hemodialysis patients across five hospitals in China. The analysis of participants' narratives reveals that learned helplessness in these patients is influenced by a combination of physiological, psychological, and social factors. Physical discomfort and psychological changes contribute to their sense of helplessness. Despite seeking support from family and healthcare providers, their distress often goes unnoticed. Additionally, the social stigma of being perceived as a "special group" further exacerbates their learned helplessness. Based on the findings, the following recommendations are provided to effectively mitigate learned helplessness: Healthcare professionals must reduce symptom burden, provide psychological assessment and support, and assist in rebuilding positive patient cognition. It is also crucial to enhance connections between patients, their families, and social support groups, reduce misunderstandings and stigmatization, and strengthen community support systems.
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Affiliation(s)
- Shaona Cai
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Caixia Li
- The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Zhenping Du
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Shengzi Liu
- The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Lifang Zhou
- The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Yina Zhao
- The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Yingying Li
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Xia Fu
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
- The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
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Chapman M, Milte R, Dawson S, Laver K. Patient-reported experience measures for people living with dementia: A scoping review. DEMENTIA 2024; 23:1354-1381. [PMID: 39118041 PMCID: PMC11475968 DOI: 10.1177/14713012241272823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
The prevalence of dementia is increasing globally, with an estimated 139 million people expected to be living with dementia by 2050. Across numerous countries, substandard care for people with dementia is evident, with quality improvement needed. Recently, a focus on patient-reported experience measures (PREMs) has been utilised in healthcare services as a method of evaluating the care experiences provided and determining areas of improvement. The literature is scarce regarding the feasibility and acceptability of implementing PREMs with people with moderate to advanced dementia. This scoping review aimed to identify PREMs that have been used with vulnerable populations including people with cognitive impairment, mental health concerns, and children, outline dimensions included, and determine adaptions made to the PREMs to improve acceptability of the instruments for vulnerable populations. A database search of Medline was conducted to identify 36 studies including 32 PREMs. The PREMs identified covered a range of dimensions, most frequently care effectiveness, care environment, and patient involvement. The most common adaption to the PREMs was simplification of wording and sentence structure. Several measures conflated patient outcomes and patient satisfaction with patient experience, limiting utility for improving patient experience specifically. While several PREMs have been used with people with dementia, challenges in their implementation and their applicability to specific settings limit their use more broadly. Evidently, there is a need for development of a PREM for people with moderate to advanced dementia that is applicable across healthcare settings and is appropriately adapted for varying cognitive and communicative barriers.
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Affiliation(s)
- Madison Chapman
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | - Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | - Suzanne Dawson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | - Kate Laver
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
- Rehabilitation, Aged and Palliative Care Service, Southern Adelaide Local Health Network, Australia
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Borgh M, Bejerholm U, Argentzell E, Lexén A. 'It's like someone is holding your hand, an invisible hand': A grounded theory study of participation and personal recovery in Flexible Assertive Community Treatment. Scand J Occup Ther 2024; 31:2421363. [PMID: 39472152 DOI: 10.1080/11038128.2024.2421363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 09/17/2024] [Accepted: 10/22/2024] [Indexed: 02/18/2025]
Abstract
BACKGROUND Participation in everyday life and personal recovery is often adversely affected for individuals with complex mental health needs. Flexible Assertive Community Treatment (FACT) is a recovery-oriented service targeting participation in everyday life and personal recovery and is thus important to understand from the perspectives of service users. AIM To explore how service users experience the care and support they receive from FACT as facilitating processes of participation in everyday life and in their personal recovery process. MATERIALS AND METHODS A constructivist Grounded Theory approach was employed, involving 14 in-depth interviews conducted from January to November 2023 with FACT service users (9 women, 5 men; 23-55 years) within the Swedish adult general Mental Health Services. RESULTS The process of Building genuine relationships between participants and FACT team members enabled Doing as a way of recovering. This was facilitated by how FACT was organised, promoting continuity and flexibility in care and support. CONCLUSIONS AND SIGNIFICANCE This study contributes to a greater understanding of how genuine relationships between FACT service users and team members provide opportunities for participation and doing as a means for personal recovery. The results underscore the significance of incorporating an occupational therapy perspective into recovery-oriented services.
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Affiliation(s)
- Madeleine Borgh
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
| | - Ulrika Bejerholm
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
- Department of Psychiatry, Habilitation and Aids, Region Skåne, Lund, Sweden
| | - Elisabeth Argentzell
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
- Department of Psychiatry, Habilitation and Aids, Region Skåne, Lund, Sweden
| | - Annika Lexén
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
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7
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Sercu L. Hospital brochures in mental healthcare. how patient-centered are they? J Eval Clin Pract 2024. [PMID: 39434456 DOI: 10.1111/jep.14210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 08/06/2024] [Accepted: 10/08/2024] [Indexed: 10/23/2024]
Abstract
CONTEXT From the results of the 2020 Flemish survey looking into psychiatric patients' views of the in-patient care they have received, it appeared that hospital communication is experienced as not sufficiently patient-centered. In communication research, the quality of written patient materials in physical healthcare has been scrutinized and suggestions for the enhancement of their patient-centeredness, comprehensibility, and actionability have been made. Yet, a similar research interest in the quality of health communication in mental healthcare has failed to materialize. OBJECTIVE AND DESIGN Against a definition of patient-centeredness in mental healthcare, this study investigated the quality of 30 psychiatric hospital brochures from a triangulated linguistic and content perspective, using readability formulas as well as the CCI and PEMAT-P instruments. RESULTS It appeared that none of the brochures are sufficiently patient-centered, as they fail to take appropriate and full account of mental health patients' specific concerns and difficulties. DISCUSSION The lack of quality brochures hampers patients' understanding of their mental health condition and participation in their recovery process, especially when they have a low (mental) health literacy. CONCLUSION Together, hospitals and patient organizations, should remedy this situation and thus fortify the public's trust in the evidence-based and high-quality patient-centered care psychiatric hospitals offer.
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Affiliation(s)
- Lies Sercu
- Katholieke Universiteit Leuven (KU Leuven), Leuven, Belgium
- Faculty of Arts, Leuven, Belgium
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8
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Yu SV, Åkerlind GS. Being a Doctor: From Treating Individual Patients to Maximising Community Health and Social Justice. HEALTH CARE ANALYSIS 2024; 32:224-242. [PMID: 38780875 DOI: 10.1007/s10728-024-00484-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/25/2024]
Abstract
This study examined variation in medical practitioners' practice-based conceptions of what it means to be a doctor, based on interviews with 30 clinicians who were also medical educators. Participants included general practitioners, surgeons and physicians (non-surgical specialists). Participants were asked to draw a concept map of 'being a doctor', followed by semi-structured interviews using a phenomenographic research design. Three conceptions were identified, varyingly focused on (1) treating patients' medical problems; (2) maximising patients' well-being; and (3) maximising community health. Each conception was distinguished by variation in awareness of six underlying dimensions of being a doctor: (1) doctors' actions; (2) treatment success; (3) patients' actions; (4) patients' well-being; (5) community needs; and (6) social justice. Whilst all participants included dimensions 1 and 2 in their described practice, numerous participants did not include dimensions 3 and 4, i.e. did not take the patients' role and the impact of patients' psychosocial context into account in their practice. This is concerning, especially amongst medical educators, given the widely acknowledged importance of patient-centred care in medical practice. Similarly, only some of the participants considered community health needs and felt a broader social responsibility beyond their responsibility to individual patients. These findings highlight aspects of the medical profession that need to be further emphasised in medical training and continuing professional development.
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Affiliation(s)
- Suet Voon Yu
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Gerlese S Åkerlind
- Emeritus Faculty, Centre for Educational Development and Academic Methods, Australian National University, Building 1c, 24 Balmain Crescent, Acton, 2601, Australia.
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Fisher L, Davey A, Wong G, Morgan-Trimmer S, Howard LM, Sharp H, Atmore KH, Brook J, Collins G, Domoney J, Makinde E, McCree C, O'Mahen HA. Women's engagement with community perinatal mental health services: a realist evaluation. BMC Psychiatry 2024; 24:492. [PMID: 38977965 PMCID: PMC11232178 DOI: 10.1186/s12888-024-05804-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/30/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND In recognition of the burden of Perinatal Mental Health problems, NHS England invested £365 million to transform women's access to mental health care, including investment in Community Perinatal Mental Health Services. This study examined how elements of provider care affected women's engagement with these services. METHODS Semi-structured interviews were conducted with 139 women and explored their experiences of care from 10 different Community Perinatal Mental Health Teams; including which service components participants believed made a difference to their initial and continued engagement. Realist analysis was used to create context-mechanism-outcome configurations (CMOCs) across interviews, since not all parts of the configurations were always articulated within singular interviews. RESULTS Four key pillars for engagement were identified: perinatal competence, relationship building, accurate reassurance, and reliability. The way perinatal competencies were relayed to women mattered; compassion, understanding and consistency were critical interactional styles. The extent to which these factors affected women's engagement varied by their context and personal characteristics. CONCLUSIONS As mental health problems increase, disproportionately affecting vulnerable populations, it is critical to continue to ensure support is not only available, but appropriately meets the needs of those individuals. Our findings suggest that key staff behaviours applied at the right time can support women's engagement and potentially contribute to better treatment outcomes.
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Affiliation(s)
- L Fisher
- Department of Primary Care and Mental Health, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - A Davey
- Mood Disorders Centre, Psychology Department, Faculty of Health and Life Sciences, University of Exeter, Washington Singer Laboratories, Perry Road, Exeter, EX4 4QG, UK
| | - G Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - S Morgan-Trimmer
- Department of Health and Community Sciences, University of Exeter Medical School, Exeter, UK
| | - L M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - H Sharp
- Department of Primary Care and Mental Health, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - K H Atmore
- Department of Global Health and Social Medicine, School of Global Affairs, King's College London, London, UK
| | - J Brook
- The Tavistock and Portman NHS Foundation Trust, London, UK
| | - G Collins
- Mood Disorders Centre, Psychology Department, Faculty of Health and Life Sciences, University of Exeter, Washington Singer Laboratories, Perry Road, Exeter, EX4 4QG, UK
| | - J Domoney
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - E Makinde
- Mood Disorders Centre, Psychology Department, Faculty of Health and Life Sciences, University of Exeter, Washington Singer Laboratories, Perry Road, Exeter, EX4 4QG, UK
| | - C McCree
- Centre for Parent and Child Support and Community Perinatal services, South London and Maudsley NHS Foundation Trust, London, UK
| | - Heather A O'Mahen
- Mood Disorders Centre, Psychology Department, Faculty of Health and Life Sciences, University of Exeter, Washington Singer Laboratories, Perry Road, Exeter, EX4 4QG, UK.
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Mat Lazim NH, Syed A, Lee C, Ahmed Abousheishaa A, Chong Guan N. Using decision support tools for treatment decision making about antidepressants in outpatient psychiatric consultations. PATIENT EDUCATION AND COUNSELING 2024; 124:108266. [PMID: 38565074 DOI: 10.1016/j.pec.2024.108266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To examine the use of decision support tools in decision making about antidepressants during conversations between patients with major depressive disorder (MDD) and their psychiatrists. METHODS Theme-oriented discourse analysis of two psychiatric consultation groups: control (n = 17) and intervention (n = 16). In the control group, only a doctor's conversation guide was used; in the intervention group, the conversation guide and a patient decision aid (PDA) were used. RESULTS Psychiatrists mainly dominated conversations in both consultation groups. They were less likely to elicit patient treatment-related perspectives in the intervention group as they focused more on delivering the information than obtaining patient perspectives. However, using PDA in the intervention group slightly encouraged patients to participate in decisional talk. CONCLUSION The decision support tools did promote SDM performance. Using the conversation guide in both consultation groups encouraged the elicitation of patient perspectives, which helped the psychiatrists in tailoring their recommendations of options based on patient preferences and concerns. Using the PDA in the intervention group created space for treatment discussion and fostered active collaboration in treatment decision making. PRACTICE IMPLICATIONS Our findings have implications for SDM communication skills training and critical reflection on SDM practice.
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Affiliation(s)
- Nor Hazila Mat Lazim
- Department of English Language, Faculty of Languages and Linguistics, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ayeshah Syed
- Department of English Language, Faculty of Languages and Linguistics, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Charity Lee
- Department of Asian and European Languages, Faculty of Languages and Linguistics, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Aya Ahmed Abousheishaa
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ng Chong Guan
- Department of Psychological Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Abdallah S, Church E, Levin JB, Chela A, McVoy M. Short- and Long-Term Outcomes of Suboptimal Medication Adherence in Adolescents with Attention-Deficit/Hyperactivity Disorder: A Systematic Literature Review. J Child Adolesc Psychopharmacol 2024; 34:183-193. [PMID: 38700276 PMCID: PMC11238837 DOI: 10.1089/cap.2024.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition with severe and life-long consequences. Adolescents and young adults represent a particularly vulnerable subgroup because of the unique demands of their developmental stage. Despite the well-known efficacy of medication treatment for ADHD, there remains a notable concern regarding poor medication adherence in this population. Objectives: This systematic literature review aimed to synthesize the existing empirical evidence on the outcomes and consequences of medication nonadherence among adolescents and young adults with ADHD. Methods: An extensive database search was conducted on September 26, 2022, with no time limits applied. The databases included Scopus, PubMed, CINAHL, Cochrane, and PsycINFO. Results: Six studies met the inclusion criteria. Each study revealed that medication nonadherence was associated with a range of adverse outcomes, including decreased academic performance, heightened familial, and psychological stress, and an increased likelihood of substance use, pregnancy, obesity, and injury. Conversely, adherence led to improvements in at least one ADHD-related outcome. Conclusions: Research exploring the consequences of suboptimal medication adherence in adolescents and young adults with ADHD is currently limited, and effective strategies to address this issue remain scarce. A thorough understanding of such consequences is critical for developing interventions aimed at improving medication adherence and mitigating the risk of adverse outcomes, especially considering the susceptibility of this population.
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Affiliation(s)
- Salayna Abdallah
- Department of Psychiatry, University Hospitals of Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Psychology, Cleveland State University, Cleveland, Ohio, USA
| | - Emma Church
- Department of Psychiatry, University Hospitals of Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Psychology, Cleveland State University, Cleveland, Ohio, USA
| | - Jennifer B. Levin
- Department of Psychiatry, University Hospitals of Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Amarpreet Chela
- Department of Psychiatry, University Hospitals of Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Molly McVoy
- Department of Psychiatry, University Hospitals of Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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12
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Azad GF, Taormina I, Herrera V, Zhang Y. Communication Training within Partners in School: Feasibility, Acceptability, and Usability. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2024; 34:239-264. [PMID: 39148644 PMCID: PMC11323131 DOI: 10.1080/10474412.2024.2341382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/29/2024] [Accepted: 04/07/2024] [Indexed: 08/17/2024]
Abstract
Partners in School is a consultation model adapted from Conjoint Behavioral Consultation where parents and teachers identify a mutual concern for children with Autism and then implement the same evidence-based practices (EBPs) across home and school. Adding parent-teacher communication training (School Talk) may bolster the effects of this consultation approach. The purpose of this study was to explore parents' and teachers' experiences with School Talk, as well as examine the clinical outcomes of Partners in School plus School Talk. Participants were 21 parents and 21 teachers (n=21 dyads, N=42 participants) of preschool to first-grade children with Autism. Results indicated that parents and teachers both rated School Talk as feasible and acceptable, but parents rated it as more usable. There was preliminary evidence that Partners in School with School Talk may be associated with improvements in parent-teacher communication, as well as reductions in the frequency of child concerns.
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Affiliation(s)
- Gazi F Azad
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center
- Center for Autism and the Developing Brain, Columbia University Medical Center & Weill Cornell Medicine
| | | | - Victoria Herrera
- Division of Child and Adolescent Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute
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13
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Shah N, O'Keeffe S, Hayward S, Suzuki M, McCabe R. Re-imagining crisis care: experiences of delivering and receiving the Assured brief psychological intervention for people presenting to Emergency Departments with self-harm. Front Psychiatry 2024; 15:1271674. [PMID: 38600980 PMCID: PMC11004764 DOI: 10.3389/fpsyt.2024.1271674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/12/2024] [Indexed: 04/12/2024] Open
Abstract
Background Risk of suicide is increased immediately following emergency department (ED) attendance for self-harm. Evidence suggests that brief psychological interventions delivered in EDs are effective for self-harm. The Assured intervention comprises an enhanced biopsychosocial assessment in the ED, collaborative safety planning and three rapid solution focused follow-up sessions. Aim We addressed the following research questions: What were ED mental health liaison practitioners' and patients' experiences of the Assured intervention? What were the barriers and facilitators? What might the mechanisms be for improving experiences and outcomes? Methods We conducted a feasibility study of the Assured intervention in four EDs in Southeast England. Semi-structured interviews were conducted with 13 practitioners and 27 patients. Interviews were transcribed, coded line-by-line in Nvivo and thematically analysed using an inductive approach. Inter-rater reliability was calculated with a kappa coefficient of 0.744.
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Affiliation(s)
- Neha Shah
- School of Health and Psychological Science, City, University of London, London, United Kingdom
| | - Sally O'Keeffe
- Population Health Sciences Institute, Newcastle University, Newcastle-Upon-Tyne, United Kingdom
| | - Sam Hayward
- School of Health and Psychological Science, City, University of London, London, United Kingdom
| | - Mimi Suzuki
- School of Health and Psychological Science, City, University of London, London, United Kingdom
| | - Rose McCabe
- School of Health and Psychological Science, City, University of London, London, United Kingdom
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Stark JE, Cole J. Evaluation of Author Instructions for Inclusive Language Guidance in Highly Cited English Language Medical Journals. J Gen Intern Med 2024; 39:272-276. [PMID: 37670067 PMCID: PMC10853092 DOI: 10.1007/s11606-023-08390-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/21/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Diversity, equity, and inclusion (DEI) are at the core of publication ethics, and language around DEI has been shown to affect patient outcomes. Inclusive language is an important piece of effective communication and is one way to demonstrate and foster a welcoming, respectful, and accessible environment. Non-inclusive terminology in research may represent implicit bias, which is not typically corrected through introspection; thus, a systematic approach is needed in scientific writing. The prevalence of inclusive language guidance in leading medical journals is currently unknown. OBJECTIVE Investigators assess the prevalence and quality of inclusive language guidelines in author instructions in highly cited English language medical journals. DESIGN A cross-sectional review of author instructions from a convenience sample of 100 highly cited medical journals was completed in January 2023. SUBJECTS Each journal's author instructions were reviewed for presence of inclusive language guidelines for manuscript submissions. MAIN MEASURES Guidelines that included specific examples of inclusive language were defined as "strong." Author instructions were also reviewed for the Sex and Gender Equity in Research (SAGER) checklist, and each journal's publisher and impact factor (IF) were recorded. KEY RESULTS The 100 journals reviewed had an IF range of 3.0-202.7 with a median IF = 19.5 (IQR 11.95, 38.68), and 28 unique publishers were represented. Inclusive language guidance was provided in 23% of medical journals reviewed. Of those, 20 (86.9%) provided strong guidance. Seven journals also recommended use of the SAGER checklist. CONCLUSION Significant gaps still exist in ensuring use of inclusive language in medical journals.
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Affiliation(s)
- Jennifer E Stark
- Veterans Healthcare System of the Ozarks, 1100 North College Avenue, Fayetteville, AR, 72703, USA.
| | - Jennifer Cole
- Veterans Healthcare System of the Ozarks, 1100 North College Avenue, Fayetteville, AR, 72703, USA
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15
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Jenstad LM, Howe T, Breau G, Abel J, Colozzo P, Halas G, Mason G, Rieger C, Simon L, Strachan S. Communication between healthcare providers and communicatively-vulnerable patients with associated health outcomes: A scoping review of knowledge syntheses. PATIENT EDUCATION AND COUNSELING 2024; 119:108040. [PMID: 37951163 DOI: 10.1016/j.pec.2023.108040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/30/2023] [Accepted: 10/26/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVE Summarize literature on provider-patient communication linked to health outcomes in communicatively-vulnerable patient populations. METHODS Scoping review of reviews: systematically searched six databases. INCLUSION CRITERIA systematic searches and syntheses of literature; one or more providers and communicatively-vulnerable patients; synchronous in-person communication; intermediate or health outcome linked to communication. RESULTS The search yielded 14,615 citations; 47 reviews - with wide range of providers, communication vulnerabilities, communication practices, and health outcomes - met inclusion criteria. Methodology included qualitative, quantitative, and mixed approaches. Quality ranged from very low to high. Six categories of communication practices linked to health outcomes were identified: 1) motivation-based; 2) accommodation of language, culture, gender, sexual identity, and other concordance with the patient; 3) cultural adaptations of interventions; 4) use of interpreters; 5) other provider-patient communication practices; 6) patient communication practices. CONCLUSION Communication practices were studied in a wide range of providers, with common themes regarding best practices. A unique finding is the role of the patient's communication practices. The specificity of communication practices studied is heterogeneous, with many reviews providing insufficient details. PRACTICE IMPLICATIONS Motivation-based practices and culturally- and linguistically-appropriate care have impacts on patient outcomes across a range of settings with different professions and communicatively-vulnerable groups.
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Affiliation(s)
- Lorienne M Jenstad
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Tami Howe
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Genevieve Breau
- School of Human Sciences, Faculty of Education, Health, and Human Sciences, University of Greenwich, Old Royal Naval College, Park Row, London SE10 9LS, UK.
| | - Jennifer Abel
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Paola Colozzo
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Gayle Halas
- Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Glenda Mason
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Caroline Rieger
- Department of Central, Eastern and Northern European Studies, University of British Columbia, Vancouver, Canada
| | - Leora Simon
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Shaelyn Strachan
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada
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16
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Andersson H, Svensson E, Magnusson A, Holmqvist R, Zetterqvist M. Young adults looking back at their experiences of treatment and care for nonsuicidal self-injury during adolescence: a qualitative study. Child Adolesc Psychiatry Ment Health 2024; 18:16. [PMID: 38245758 PMCID: PMC10800066 DOI: 10.1186/s13034-024-00706-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is associated with stigma, and negative attitudes among healthcare professionals toward NSSI have been reported. A person-centered approach that focuses on how individuals with lived experience of NSSI perceive the treatment and care they receive is invaluable in reducing barriers to help-seeking and improving treatment and mental healthcare services. The aim of the current qualitative study was to explore the perceptions of young adults when they look back upon their experiences of psychiatric treatment for NSSI during adolescence. METHODS Twenty-six individuals with lived experience of NSSI who were in contact with child and adolescent psychiatry during adolescence were interviewed. The interviews were analyzed using thematic analysis. RESULTS Three main themes were developed: Changed perceptions in retrospect, The importance of a collaborative conceptualization and Lasting impression of the relationship. Participants' perception of themselves as well as the treatment changed over time. The importance of a joint understanding of NSSI and an agreed-upon treatment focus was emphasized. The relationship to the mental health professionals, and experiences of how NSSI was communicated, were salient several years later. CONCLUSIONS Healthcare professionals need to communicate about NSSI in a respectful manner and include the perspective of the adolescent with lived experience of NSSI in a joint conceptualization of NSSI and treatment focus.
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Affiliation(s)
- H Andersson
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping university, Linköping, Sweden
| | - E Svensson
- Department of Behavioural Sciences and Learning, Linköping university, Linköping, Sweden
| | - A Magnusson
- Department of Behavioural Sciences and Learning, Linköping university, Linköping, Sweden
| | - R Holmqvist
- Department of Behavioural Sciences and Learning, Linköping university, Linköping, Sweden
| | - M Zetterqvist
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping university, Linköping, Sweden.
- Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden.
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Igarashi M, Kawaguchi T, Shiozawa T, Yamaguchi S. Conversation topics in psychiatric consultations conducted with and without a shared decision-making tool: A qualitative content analysis. PATIENT EDUCATION AND COUNSELING 2024; 118:108045. [PMID: 37925974 DOI: 10.1016/j.pec.2023.108045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/25/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To identify 1) conversation topics, 2) who initiated the topics, and 3) differences in topics with and without the use of a shared decision-making (SDM) tool in psychiatric outpatient consultations. METHODS We conducted qualitative content analysis of audio-recorded and transcribed data of psychiatric outpatient consultations. We included 52 participants - 25 in the SDM group and 27 in the treatment as usual (TAU) group - and 104 consultations were analyzed, two per participant. The word count per topic was calculated using the transcripts. RESULTS Five categories for 28 topics were generated. The categories and percentages of word count were: (1) symptoms: 26.1%, (2) life: 37.4%, (3) treatment/service use: 16.3%, (4) global state/goal: 7.3%, and (5) others: 12.9%. The SDM tool significantly increased the overall conversation word count and consultation time. No significant difference was observed for the topic distribution between the two groups. CONCLUSION Daily life issues - especially those related to work - were the main topics discussed in psychiatric consultations. The SDM tool seems to facilitate discussion of patients' concerns, but the topic distribution is likely to be similar regardless of whether or not the SDM tool was used. PRACTICE IMPLICATIONS Outpatient psychiatrists are expected to effectively address life-related issues.
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Affiliation(s)
- Momoka Igarashi
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan
| | - Takayuki Kawaguchi
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan
| | - Takuma Shiozawa
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan; Nursing Innovation Research Center, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Sosei Yamaguchi
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan.
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McMahon D, Dixon D, Quinn T, Gallacher KI. The Acceptability of post-stroke cognitive testing through the lens of the theory of acceptability, a qualitative study. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 6:100197. [PMID: 38226361 PMCID: PMC10788191 DOI: 10.1016/j.cccb.2023.100197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/09/2023] [Accepted: 12/18/2023] [Indexed: 01/17/2024]
Abstract
Background Cognitive impairment is common after stroke and screening is recommended. However, there is a lack of evidence on the best way to assess cognition after stroke and a tendency to focus on the clinician rather than stroke survivor. The Theoretical Framework of Acceptability (TFA) was developed to better understand the factors that contribute to the acceptability of healthcare interventions from the patient perspective. We aimed to explore the acceptability of post-stroke cognitive assessment from the stroke survivor perspective, using the TFA as a lens. Methods We analysed interviews conducted with people admitted to hospital after stroke. Inclusion criteria: ≥18 years, able to provide informed consent. Semi-structured interviews were conducted 1-3 weeks after discharge from hospital in the participant's home to explore the experience of cognitive assessment in hospital. Interviews were audio recorded and transcribed verbatim. Data were analysed using framework analysis, with a framework underpinned by the TFA. Results Of the 13 participants interviewed, 8 were male, 6 lived in the most deprived SIMD quintile. Ages were 62-84 years. Five themes were identified that describe the factors that influence acceptability of cognitive screening from the patient perspective: (1) participation motives; (2) trust in health professionals; (3) perceived risks of harm; (4) information provision; (5) burden of testing. Conclusion Clinical teams should be confident that stroke survivors expect cognitive testing and understand its rational. However, the provision of information and results of cognitive testing should be person-centred.
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Affiliation(s)
- David McMahon
- Institute of Cardiovascular and Metabolic Health, Glasgow Royal Infirmary, University of Glasgow, G4 OSF, United Kingdom
| | - Diane Dixon
- Napier University, Craiglockhart Campus, Glenlockhart Road, Edinburgh EH14 1D, United Kingdom
| | - Terry Quinn
- Institute of Cardiovascular and Metabolic Health, Glasgow Royal Infirmary, University of Glasgow, G4 OSF, United Kingdom
| | - Katie I Gallacher
- Institute of Health and Welbeing, University of Glasgow, Clarice Pears Building G12 8TB, United Kingdom
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19
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Song M, Song YM. The Effect of Shared Decision-Making by Mental Health Nurses on Medication Adherence in Patients with Alcohol Use Disorders: Provider-Patient Communication Pathway Model. JOURNAL OF HEALTH COMMUNICATION 2023; 28:777-788. [PMID: 37823392 DOI: 10.1080/10810730.2023.2268561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
The involvement of patients with mental health issues in their own treatment decision-making has often been overlooked. This study aimed to investigate the impact of shared decision-making between mental health nurses and patients with alcohol use disorders (AUD) on medication adherence. The provider-patient communication pathway model was utilized to examine the ways in which therapeutic communication strategies employed by mental health nurses positively influence medication adherence. The study employed a percentile bootstrap method and pairwise comparison tests in structural equation modeling. The results revealed that shared decision-making between AUD patients and mental health nurses directly enhanced medication adherence, as well as indirectly influenced adherence through the mediating factors of therapeutic alliance and alcohol abstinence self-efficacy. These findings hold both theoretical and practical implications for involving patients with AUD in therapeutic decision-making within psychiatric and mental health nursing settings, as well as for improving medication adherence among this patient population.
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Affiliation(s)
- MoonJU Song
- Division of Admission Management and Policy Development, National Center for Mental Health, Seoul, Republic of Korea
- College of Nursing, Korea University, Seoul, Republic of Korea
| | - Yul-Mai Song
- Department of Nursing, Honam University, Gwangju, Republic of Korea
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20
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Eliacin J, Matthias MS, Cameron KA, Burgess DJ. Veterans' views of PARTNER-MH, a peer-led patient navigation intervention, to improve patient engagement in care and patient-clinician communication: A qualitative study. PATIENT EDUCATION AND COUNSELING 2023; 114:107847. [PMID: 37331280 PMCID: PMC11184508 DOI: 10.1016/j.pec.2023.107847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE In this study, we report on participants' experiences of PARTNER-MH, a peer-led, patient-navigation intervention for racially and ethnically minoritized patients in Veterans Health Administration mental health services aimed at improving patient engagement in care and patient-clinician communication. Participants described their views of PARTNER-MH, barriers and facilitators to the intervention's implementation, and their application of varied intervention concepts to improve engagement in care and communication with their mental health clinicians. METHODS This is a qualitative analysis of the PARTNER-MH pilot randomized controlled trial. Participants participated in semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR). Rapid data analysis approach was used to analyze the data. RESULTS Participants (n = 13) perceived PARTNER-MH as an acceptable intervention, and viewed use of peers as interventionists, long-term outreach and engagement efforts, and navigation services favorably. Barriers to implementation included limited flexibility in peers' schedules and lack of peer/participant gender concordance, as well as limited options for program delivery modality. Three main themes summarized participants' views and perceived benefits of PARTNER-MH that contributed to improved patient-clinician communication: 1) increased patient engagement, 2) improved patient-clinician relationship, and 3) enhanced communication self-efficacy. CONCLUSIONS Participants viewed PARTNER-MH as beneficial and identified several intervention components that contributed to improved engagement in care, communication self-efficacy, and patient-clinician communication. PRACTICE IMPLICATION Some patients, especially minoritized patients and those who have been disenfranchised from healthcare systems may benefit from peer-led interventions that facilitate engagement in care and communication self-efficacy to improve patient-clinician communication and healthcare outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT04515771.
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Affiliation(s)
- Johanne Eliacin
- National Center for PTSD, VA Boston Healthcare System, Boston, USA; HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, USA; Regenstrief Institute, Indianapolis, USA; Indiana University School of Medicine, Department of General Internal Medicine and Geriatrics, Indianapolis, USA.
| | - Marianne S Matthias
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, USA; Regenstrief Institute, Indianapolis, USA; Indiana University School of Medicine, Department of General Internal Medicine and Geriatrics, Indianapolis, USA
| | - Kenzie A Cameron
- Northwestern University, Feinberg School of Medicine, Division of General Internal Medicine, Chicago, USA
| | - Diana J Burgess
- Minneapolis VA Healthcare System, Center for Care Delivery and Outcomes Research, Minneapolis, USA; University of Minnesota, Department of Medicine, Minneapolis, USA
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21
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McCue M, Khatib R, Kabir C, Blair C, Fehnert B, King J, Spalding A, Zaki L, Chrones L, Roy A, Kemp DE. User-Centered Design of a Digitally Enabled Care Pathway in a Large Health System: Qualitative Interview Study. JMIR Hum Factors 2023; 10:e42768. [PMID: 37494099 PMCID: PMC10413250 DOI: 10.2196/42768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 05/10/2023] [Accepted: 05/25/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a leading cause of disability worldwide. Management of chronic conditions such as MDD can be improved by enhanced patient engagement, measurement-based care (MBC), and shared decision-making (SDM). A user-centered design approach can improve the understanding of the patient journey and care team workflows and thus aid the development of digital health care innovations optimized for the needs of patients living with MDD and their primary care teams. OBJECTIVE This study aims to use qualitative research methods for the user-centered design of a digitally enabled MDD care platform, PathwayPlatform, intended to enhance patient engagement, MBC, and SDM. METHODS Insights were gathered through 2 stages of qualitative interviews by a study team with expertise in qualitative research and user-centered design methods. Thematic analysis was used to generate an overarching understanding of a set of shared experiences, thoughts, or behaviors across a broad qualitative data set, including transcripts of interviews, to allow both inductive and deductive insights to emerge. Thematic analysis of interviews was supported by Dedoose (SocioCultural Research Consultants, LLC), a qualitative data analysis software tool that enables systematized coding. Findings and insights were presented based on code frequency, salience, and relevance to the research project. RESULTS In stage 1, interviews were conducted with 20 patients living with MDD and 15 health care providers from September 2018 to January 2019 to understand the experiences with and perceptions about the initial functionality of the Pathway app while also exploring the perceptions about potential additional features and functionality. Feedback about care team workflows and treatment approaches was collected in stage-2 interviews with 36 health care providers at 8 primary care sites. Inductive and deductive thematic analyses revealed several themes related to app functionality, patient-provider engagement, workflow integration, and patient education. Both patients and their care teams perceived the remote tracking of patient-reported outcomes via digital tools to be clinically useful and reliable and to promote MBC and SDM. However, there was emphasis on the need to enhance the flow of real-time data shared with the care team, improve trend visualizations, and integrate the data within the existing clinical workflow and educational programs for patients and their care teams. User feedback was incorporated into the iterative development of the Pathway app. CONCLUSIONS Ongoing communication with patients living with MDD and their care teams provided an opportunity for user-centric developmental iterations of the Pathway Platform. Key insights led to further development of the patient-facing and care team-facing visit preparation features, collaborative goal-setting and goal-tracking features, patient-reported outcome summaries, and trend visualizations. The result is an enhanced digital platform with the potential to improve treatment outcomes and provide patients living with MDD additional support throughout their treatment journey.
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Affiliation(s)
- Maggie McCue
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - Rasha Khatib
- Advocate Aurora Research Institute, Advocate Health Care, Downers Grove, IL, United States
| | - Christopher Kabir
- Advocate Aurora Research Institute, Advocate Health Care, Downers Grove, IL, United States
| | - Chris Blair
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - Ben Fehnert
- Cognition Kit, Cambridge, United Kingdom
- Ctrl Group / Fora Health, London, United Kingdom
| | - James King
- Ctrl Group / Fora Health, London, United Kingdom
| | | | - Lara Zaki
- Ctrl Group / Fora Health, London, United Kingdom
| | - Lambros Chrones
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - Anit Roy
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - David E Kemp
- Advocate Aurora Health, Downers Grove, IL, United States
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Durocher K, Shin HD, Lo B, Chen S, Ma C, Strudwick G. Understanding the Role of Patient Portals in Fostering Interprofessional Collaboration Within Mental Health Care Settings: Mixed Methods Study. JMIR Hum Factors 2023; 10:e44747. [PMID: 37467024 PMCID: PMC10398557 DOI: 10.2196/44747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/06/2023] [Accepted: 06/17/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Patient portals are web-based systems through which patients can access their personal health information and communicate with their clinicians. The integration of patient portals into mental health care settings has been evolving over the past decade, as cumulated research to date has highlighted the potential role of portals in facilitating positive health outcomes. However, it is currently unknown whether portal use can foster interprofessional collaboration between clinicians and patients or whether the portal is a tool to support an already established collaborative relationship. OBJECTIVE This mixed methods study aimed to understand how the use of a patient portal within mental health settings can impact the level of interprofessional collaboration between clinicians and patients. METHODS This study was conducted in a large mental health care organization in Ontario, Canada. A convergent mixed methods design was used, where the primary data collection methods included questionnaires and semistructured interviews with patients who had experience using a portal for their mental health care. For the quantitative strand, participants completed the Health Care Communication Questionnaire and the Self-Empowerment subscale of the Mental Health Recovery Measure at 3 time points (baseline, 3 months of use, and 6 months of use) to measure changes in scores over time. For the qualitative strand, semistructured interviews were conducted at the 3-month time point to assess the elements of interprofessional collaboration associated with the portal. RESULTS For the quantitative strand, 113 participants completed the questionnaire. For the Health Care Communication Questionnaire scores, the raw means of the total scores at the 3 time points were as follows: baseline, 43.01 (SD 7.28); three months, 43.19 (SD 6.65); and 6 months, 42.74 (SD 6.84). In the univariate model with time as the only independent variable, the scores did not differ significantly across the 3 time points (P=.70). For the Mental Health Recovery Measure scores, the raw mean total scores at the 3 time points were as follows: baseline, 10.77 (SD 3.63); three months, 11.09 (SD 3.81); and 6 months, 11.10 (SD 3.33). In the univariate model with time as the only independent variable, the scores did not differ significantly across the 3 time points (P=.34). For the qualitative strand, 10 participants were interviewed and identified various elements of how interprofessional collaboration can be supplemented through the use of a patient portal, including improved team functioning, communication, and conflict resolution. CONCLUSIONS Although the quantitative data produced nonsignificant findings in interprofessional collaboration scores over time, the patients' narrative accounts described how the portal can support various interprofessional collaboration concepts, such as communication, leadership, and conflict resolution. This provides useful information for clinicians to support the interprofessional relationship when using a portal within a mental health setting. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-025508.
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Affiliation(s)
- Keri Durocher
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
- School of Health, Community Services, and Creative Design, Lambton College, Sarnia, ON, Canada
| | - Hwayeon Danielle Shin
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Brian Lo
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sheng Chen
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Clement Ma
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gillian Strudwick
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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23
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Mariani R, Di Monte C, Caricati L, Bastianini T, Ferruta A, Christopher C, Speranza AM, Guerrini degli Innocenti B, Musetti A. Free-Association Session Scale: factor structure and preliminary validity test. Front Psychol 2023; 14:1169372. [PMID: 37325758 PMCID: PMC10267350 DOI: 10.3389/fpsyg.2023.1169372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
One of the main concepts of the psychoanalytic method postulated by Freud in 1912 is the fundamental rule, which involves asking the patient to say whatever comes to mind as the analyst follows the patient's speech with fluctuating attention. Despite different theoretical models, this concept has remained an invariant element that characterizes the psychoanalytic method. For this reason, the purpose of the current study is to present a new instrument that measures this process based on the clinician's assessment. The Free-Association Session Scale (FASS) has been designed according to the psychoanalytic framework. Study 1 presented the preliminary validation of the FASS factor structure. Experienced Italian psychoanalysts (N = 281; 196 women) completed the FASS and sociodemographic questionnaire. The following two factors were identified using exploratory factor analysis: (1) Perturbing, and (2) Associativity. Study 2 cross-validated the two factors using an independent sample (N = 259; 187 women) of experienced psychoanalysts and confirmatory factor analysis (CFA). The FASS has been tested for concurrent validity using the Session Evaluation Questionnaire (SEQ) and Linguistic measures of the Referential process. The two-factor model achieved a close-fit test, and the FASS items were found to measure the corresponding factors with good reliability. The Perturbing factor is negatively associated with three SEQ factors (Depth, Smoothness, and Positivity) and negatively correlated with symbolization (IWRAD and IWRAD_IWRRL), confirming a more complex and unexpected session. The Associativity factor is positively associated with all four SEQ factors (Depth, Smoothness, Positivity, and Arousal). In conclusion, the FASS is a promising new questionnaire for assessing psychoanalytic session quality processes with satisfactory validity and reliability.
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Affiliation(s)
- Rachele Mariani
- Department of Dynamic and Clinical Psychology and Health Studies “Sapienza”, University of Rome, Rome, Italy
| | - Cinzia Di Monte
- Department of Dynamic and Clinical Psychology and Health Studies “Sapienza”, University of Rome, Rome, Italy
| | - Luca Caricati
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Italy
| | - Tiziana Bastianini
- Società Psicoanalitica Italiana, International Psychoanalytical Association, Rome, Italy
| | - Anna Ferruta
- Società Psicoanalitica Italiana, International Psychoanalytical Association, Rome, Italy
| | - Christian Christopher
- Department of Psychology, City College, City University of New York, New York, NY, United States
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology and Health Studies “Sapienza”, University of Rome, Rome, Italy
| | | | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Italy
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Pérez-Toribio A, Moreno-Poyato AR, Lluch-Canut MT, Nash M, Cañabate-Ros M, Myklebust KK, Bjørkly S, Puig-Llobet M, Roldán-Merino JF. Transcultural adaptation and assessment of psychometric properties of the Spanish version of the Scale for the Evaluation of Staff-Patient Interactions in Progress Notes. PLoS One 2023; 18:e0281832. [PMID: 36976796 PMCID: PMC10047521 DOI: 10.1371/journal.pone.0281832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/02/2023] [Indexed: 03/29/2023] Open
Abstract
PURPOSE To adapt the Scale for the Evaluation of Staff Patient Interactions in Progress Notes to Spanish and to test the psychometric properties. DESIGN AND METHODS The study was conducted in two phases: (1) Adaptation of the instrument to Spanish following the Standards for Educational and Psychological Testing. (2) Psychometric study in a sample of mental health nurses. FINDINGS The Cronbach's alpha values were 0.97 for the total scale and 0.83 to 0.81 for each dimension. The inter-rater reliability values were between 0.94 and 0.97. PRACTICE IMPLICATIONS The scale is a reliable tool for assessing nurses' clinical notes in relation to the quality of nurse-patient interactions.
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Affiliation(s)
- Alonso Pérez-Toribio
- Unitat de Salut Mental de l’Hospitalet, Servei d’Atenció Primària Delta de Llobregat, Direcció d’Atenció Primària Costa de Ponent, Institut Català de la Salut, Barcelona, Spain
| | - Antonio R. Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L´Hospitalet de Llobregat, Spain
| | - María Teresa Lluch-Canut
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L´Hospitalet de Llobregat, Spain
| | - Michael Nash
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Montserrat Cañabate-Ros
- TXP Research Groups, Universidad Cardenal Herrera-CEU, Valencia, Spain
- Hospital Clínico Universitario, Valencia, Spain
| | | | - Stål Bjørkly
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
- Centre for Forensic Psychiatry, University Hospital, Oslo, Norway
| | - Montserrat Puig-Llobet
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L´Hospitalet de Llobregat, Spain
| | - Juan F. Roldán-Merino
- Campus Docent Sant Joan de Déu Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
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Yao X, Zhang X. Treatment decision making in psychiatry: Formulating patients’ perspectives in outpatient psychiatric consultations. Front Psychol 2023; 14:1144500. [PMID: 37051608 PMCID: PMC10083260 DOI: 10.3389/fpsyg.2023.1144500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/06/2023] [Indexed: 03/28/2023] Open
Abstract
Seeking and understanding patients’ values and preferences is one of the essential elements in shared decision making, which is associated with treatment adherence in psychiatry. However, negotiating treatment in psychiatric contexts can be challenging with patients whose ability to evaluate treatment recommendations rationally may be impaired. This article attempts to examine a conversational practice that psychiatrists use to deal with patients’ views and perspectives by formulating what the patients have said related to treatment. Taking the naturally occurring, face-to-face outpatient psychiatric consultations as the data, the present study uses conversation analysis (CA) as a method to demonstrate in a fine-grained detail what functions formulations of patients’ perspectives serve in psychiatric contexts. We found that by eliciting patients’ views and perspectives toward treatment, this type of formulation is not only used to achieve mutual understanding and establish the grounds for treatment decisions, but may also be used to challenge the legitimacy of patients’ position, steering treatment decision to the direction preferred by the psychiatrists. We argue that in the process of treatment decision making, psychiatrists do not simply impose their perspectives upon the patients, instead, they attempt to achieve consensus with patients by balancing their institutional authority and orientation to the patients’ perspectives. Data are in Chinese with English translation.
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Affiliation(s)
- Xueli Yao
- School of Foreign Languages, Qingdao Agricultural University, Qingdao, China
| | - Xiaoning Zhang
- Shandong Provincial Medical Association, Jinan, China
- *Correspondence: Xiaoning Zhang,
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26
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Andelic N, Feeney A. Poor mental health is associated with the exacerbation of personal debt problems: A study of debt advice adherence. Int J Soc Psychiatry 2023; 69:286-293. [PMID: 35240881 PMCID: PMC9983051 DOI: 10.1177/00207640221083205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is known that there is an association between debt and poor mental health. However, much of the literature is observational and focuses on how debt may lead to poor mental health. Here, we are interested in how poor mental health may be associated with debt advice adherence. AIMS The aim of the study was to investigate the relationship between mental health and debt advice adherence in individuals applying for a formal debt resolution mechanism (an Individual Voluntary Arrangement, IVA). METHOD Eighty-six participants completed a survey measuring mental health (MHI-5), memory for information discussed during the appointment, attitudes towards IVAs, and trust in the advisor shortly after having a debt advice appointment. Adherence to the advice (whether participants completed the IVA application) was measured 10 weeks later. RESULTS The study found that the sample demonstrated poor levels of mental health overall but that non-adherent participants had significantly poorer mental health than those who adhered to the advice. CONCLUSION These results suggest that (a) mental health needs to be considered when advising people with problem debt and (b) future research might examine if mental health support should coincide with important decision points in the debtor's journey out of debt.
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Emsley R. The future of psychopharmacology: challenges beyond efficacy and tolerability. World Psychiatry 2023; 22:82-83. [PMID: 36640389 PMCID: PMC9840489 DOI: 10.1002/wps.21065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- Robin Emsley
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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28
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Vita A, Fagiolini A, Maina G, Mencacci C, Spina E, Galderisi S. Achieving long-term goals through early personalized management of schizophrenia: expert opinion on the role of a new fast-onset long-acting injectable antipsychotic. Ann Gen Psychiatry 2023; 22:1. [PMID: 36650545 PMCID: PMC9843844 DOI: 10.1186/s12991-022-00430-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/29/2022] [Indexed: 01/18/2023] Open
Abstract
Definition of an appropriate and personalized treatment plan focused on long-term outcomes is crucial in the management of schizophrenia. Following review of the literature, a panel of six leading psychiatrists discussed the importance of clear and shared long-term goals when initiating antipsychotic treatment in light of their clinical experience. The importance of establishing shared and progressive treatment objectives was stressed, which should be tailored based on the patient's characteristics, goals, and preferences. Consensus emerged on the key role that therapeutic alliance and patient empowerment play throughout the course of treatment. Reduction in symptoms in the acute phase along with good efficacy and tolerability in the maintenance phase emerged as essential features of a therapy that can favor achievement of long-term outcomes. Long-acting injectable (LAI) antipsychotics enhance adherence to treatment compared to oral formulations and have been shown to be effective in the maintenance phase. Currently available LAIs are characterized by a delayed onset of action and require a loading dose or oral supplementation to achieve therapeutic concentrations. Risperidone ISM® is a novel LAI antipsychotic with fast and sustained release of antipsychotic, reaching therapeutic plasma levels within a few hours after administration without oral supplementation or loading doses. Risperidone ISM® has been shown to rapidly control symptoms in patients with an acute exacerbation of schizophrenia and to be effective and well tolerated as maintenance treatment irrespective of the severity of initial symptoms. It thus represents a valuable and novel therapeutic option in management of schizophrenia.
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Affiliation(s)
- Antonio Vita
- Department of Mental Health and Addiction Services, Spedali Civili of Brescia, University of Brescia, Brescia, Italy.
| | | | - Giuseppe Maina
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy
| | | | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
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29
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Rost N, Binder EB, Brückl TM. Predicting treatment outcome in depression: an introduction into current concepts and challenges. Eur Arch Psychiatry Clin Neurosci 2023; 273:113-127. [PMID: 35587279 PMCID: PMC9957888 DOI: 10.1007/s00406-022-01418-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/11/2022] [Indexed: 12/19/2022]
Abstract
Improving response and remission rates in major depressive disorder (MDD) remains an important challenge. Matching patients to the treatment they will most likely respond to should be the ultimate goal. Even though numerous studies have investigated patient-specific indicators of treatment efficacy, no (bio)markers or empirical tests for use in clinical practice have resulted as of now. Therefore, clinical decisions regarding the treatment of MDD still have to be made on the basis of questionnaire- or interview-based assessments and general guidelines without the support of a (laboratory) test. We conducted a narrative review of current approaches to characterize and predict outcome to pharmacological treatments in MDD. We particularly focused on findings from newer computational studies using machine learning and on the resulting implementation into clinical decision support systems. The main issues seem to rest upon the unavailability of robust predictive variables and the lacking application of empirical findings and predictive models in clinical practice. We outline several challenges that need to be tackled on different stages of the translational process, from current concepts and definitions to generalizable prediction models and their successful implementation into digital support systems. By bridging the addressed gaps in translational psychiatric research, advances in data quantity and new technologies may enable the next steps toward precision psychiatry.
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Affiliation(s)
- Nicolas Rost
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany. .,International Max Planck Research School for Translational Psychiatry, Munich, Germany.
| | - Elisabeth B. Binder
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, Germany
| | - Tanja M. Brückl
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, Germany
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30
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Wang Y, Xiang L, Chen J, Cui Y, Wang F, Zhang X. The downward referral experiences of stroke caregivers in the regional medical alliance in China: A phenomenological study. Medicine (Baltimore) 2022; 101:e31151. [PMID: 36281175 PMCID: PMC9592511 DOI: 10.1097/md.0000000000031151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The downward referral platform in the regional medical alliance has provided more possibilities to follow-up rehabilitation and transitional care for increasing stroke survivors, which also has the most contributions in the rational use of resources and health promotion of stroke survivors. However the downward referral rate is low compared to upward referral. At present, no scholars have explored the downward referral experiences of medical demanders from the perspective of qualitative study, and these experiences may also most truly reflect the influencing factors of their unwillingness to downward referral. Therefore, this study explored the subjective experiences of stroke caregivers who had experienced the downward referral, because stroke attacks often lead to lack of autonomy of patients themselves, making it difficult to complete interviews with them. A descriptive phenomenological study was adopted. A purposive sampling strategy was used to recruit 13 stroke caregivers. Interviews were guided by a semi-structured interview-guide encouraging interviewees to reflect on their experiences with downward referral. Coliazzi's data analysis process was applied. The analysis of the data revealed 4 themes: coping challenges; disrupted information; gaps in medical and nursing transition, and potential enabling factors. The results of this study showed that the lack of knowledge of medical alliance, non-sharing of medical information and non-homogeneousness of medical quality were identified to be impeding positive attitude towards downward referral and be factors of bad experiences. Of course, the interviewees had positive experiences such as smooth referral and comfortable environment. These may be potential enabling factors to their attitude towards downward referral. The challenges and needs of medical demanders after downward referral are worthy of attention, and these should be solved by corresponding measures to improve the downward referral rate and referral experiences.
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Affiliation(s)
- Yuan Wang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Lijun Xiang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jian Chen
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Yanli Cui
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Fengwen Wang
- Baiyun Branch, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaomei Zhang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- *Correspondence: Xiaomei Zhang, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou City, Guangdong Province 510515, China (e-mail: )
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31
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Mianji F, Kirmayer LJ. Help-seeking strategies and treatment experiences among individuals diagnosed with Bipolar Spectrum Disorder in Iran: A qualitative study. Transcult Psychiatry 2022; 60:201-214. [PMID: 36245238 PMCID: PMC10150414 DOI: 10.1177/13634615221127855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Social, cultural, and structural factors are associated with delays in seeking help from mental health professionals and poor treatment adherence among patients with mood disorders. This qualitative study examined the perspectives on the services and response to treatments of individuals diagnosed with Bipolar Spectrum Disorder (BSD) in Iran through 37 in-depth semi-structured interviews with patients who had received BSD diagnosis and treatment (excluding Bipolar-I). Interviews explored two broad areas: 1) coping and help-seeking strategies; and 2) barriers to treatment and expectations of outcomes from treatment. Multiple factors influenced the help-seeking strategies and trajectories of patients with BSD diagnoses in Iran, including: structural limitations of the mental healthcare system; modes of practice of biological psychiatry; characteristics of the official psychology and counseling services permitted by Iran's government; popular psychology and consultation (offered through social media from the diaspora) by Iranian psychologists and counsellors in the diaspora; and alternative spiritual and cult-based groups. To improve the quality and accessibility of mental health services, it is essential to have structural changes in the healthcare system that prioritize human rights and individuals' values over the political and ideological values of the state and changes in the professions that promote secular training of mental healthcare providers and an ecosocial model of care.
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Affiliation(s)
- Fahimeh Mianji
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, 5620McGill University, Canada
| | - Laurence J Kirmayer
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, 5620McGill University, Canada.,Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Canada
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Association between Patient-Provider Communication and Self-Perceived Mental Health in US Adults with Cancer: Real-World Evidence through Medical Expenditure Panel Survey. Diseases 2022; 10:diseases10040088. [PMID: 36278587 PMCID: PMC9590007 DOI: 10.3390/diseases10040088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/15/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022] Open
Abstract
Using real-world data, this retrospective cross-sectional study aimed to analyze the association between patient–physician communication and self-reported mental health from cancer patients using publicly available 2019 Medical Expenditure Panel Survey (MEPS) household component data. Four adjusted logistic regression models were conducted to analyze the association between patient–physician communication and self-perceived mental health among United States adult cancer patients, with each model assessing different aspects of patient–physician communication: being respected (respect), being listened to (listen), spending enough time (time), and being explained (explain). The main finding from this study was that only the time model showed a statistical significance, where patients who reported that their physician always spent enough time perceived their mental health as good. Other covariates that showed statistical significance with self-perceived mental health in cancer patients included age, income level, physical limitation, and limitation from pain. In conclusion, there were generally no statistically significant associations between patient–physician communication and mental health among cancer patients.
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Abstract
INTRODUCTION Involuntary hospitalisation denies autonomy and freedom of decision-making and is frequent in psychiatric clinical practice. However, there is still a lack of knowledge of long-term compliance after Involuntary commitment. METHODS We conducted a systematic review of published studies reporting people compliance after involuntary hospitalisation and people compliance after voluntary admission. Two investigators independently searched PubMed, PsycINFO, EMBASE and CINAHL up to December 17th, 2021 to identify eligible studies. The study is registered with PROSPERO number CRD42022299437. RESULTS Ten independent studies analysing the main indicators of compliance, engagement with services and medication adherence, were included. Three studies show that compliance is worse in people that have been involuntary hospitalised and in the others no association is found. Just two of the ten studies show an association with improved compliance. Outcomes are assessed from the first follow-up appointment after discharge up to 96 months. CONCLUSIONS Although evidences carried out so far are weak, the data do not show a trend of improvements and do not seem to exclude the possibility of worse compliance after compulsory hospitalisation. More appropriate methodologies and reliable assessment are needed in future research to provide scientific evidence on involuntary admission health effects.
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Shin G, Jang B, Bae G, Jeon HL, Bae S. The Impact of Payment Scheme Changes on Medication Adherence and Persistence of Patients Diagnosed with Depression in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11100. [PMID: 36078819 PMCID: PMC9517799 DOI: 10.3390/ijerph191711100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
As of 1 July 2018, the Korean National Health Insurance Service (NHIS) changed the fee schedule for individual psychotherapy (IP). We sought to analyze the impact of the IP payment scheme changes on the medication adherence and persistence of patients diagnosed with depression in Korea. We utilized the NHIS claims database from 2017 to 2019. Patients who were newly diagnosed with depression and utilized IP and were prescribed antidepressants during the study period were included. Adherence was measured using the medication possession ratio (MPR), and persistence was measured using the length of therapy (LOT) during the follow-up period. Adherence and persistence during the pre-policy period (before the change of the payment scheme, from January 2018 until June 2018) and the post-policy period (after the change, from July 2018 until December 2019) were compared. During the study period, a total of 176,740 patients with depression were identified. The average MPR significantly increased from 0.20 to 0.33 in the pre- and post-policy periods, respectively (p < 0.001). The average LOT of the patients improved considerably from 36 to 56 days in the pre- and post-policy periods, respectively (p < 0.001). Poisson regression analysis showed that patients with depression who were female, 19-34 years of age (vs. 50-64 years or over 64 years), and in the post-policy period were significantly associated with greater adherence and persistence rates. Payment scheme changes were associated with an increased adherence and persistence of medication use among patients diagnosed with depression.
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Affiliation(s)
- Gyeongseon Shin
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea
| | - Bohwa Jang
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea
| | - Green Bae
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea
| | - Ha-Lim Jeon
- School of Pharmacy, Jeonbuk National University, Jeonju 54896, Korea
| | - SeungJin Bae
- College of Pharmacy, Ewha Womans University, Seoul 03760, Korea
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Azad G, Sridhar A, Taormina I, Roter DL. Parent–teacher communication for children on the autism spectrum: An examination of communication skill use and problematic communication. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Gazi Azad
- Division of Child and Adolescent Psychiatry New York State Psychiatric Institute (NYSPI) and Columbia University Medical Center New York New York USA
| | - Aksheya Sridhar
- Department of Psychology Michigan State University East Lansing Michigan USA
| | - Isabella Taormina
- Division of Child and Adolescent Psychiatry New York State Psychiatric Institute (NYSPI) and Columbia University Medical Center New York New York USA
| | - Debra L. Roter
- Department of Health, Behavior, and Society Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
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Lauder K, McDowall A, Tenenbaum HR. A systematic review of interventions to support adults with ADHD at work—Implications from the paucity of context-specific research for theory and practice. Front Psychol 2022; 13:893469. [PMID: 36072032 PMCID: PMC9443814 DOI: 10.3389/fpsyg.2022.893469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is estimated to affect 3.5% of the global workforce. Despite the high prevalence rate, little is known about how best to support adults with ADHD (ADHDers) at work. Relevant research is dispersed across different disciplines such as medicine, health studies and psychology. Therefore, it is important to synthesize interventions aimed at ADHDers to examine what learning can be gleaned for effective workplace support. We conducted a systematic review of relevant interventions framed by realist evaluation and the Context-Intervention-Mechanism-Outcome classification to identify key mechanisms of effectiveness for workplace interventions. We searched 10 databases including a range of journals from medical science to business management applying predetermined inclusion criteria and quality appraisal through a risk of bias assessment for quantitative and qualitative methods. We synthesized 143 studies with realist evaluation. Most studies evaluated the effectiveness of pharmacological interventions highlighting the dominance of the medical approach to supporting ADHDers. Key mechanisms of effectiveness were identified from psychosocial interventions including group therapy, involvement of people in the ADHDers network, and the importance of the client-patient relationship. Overall, there is limited research that examines the effectiveness of workplace interventions for ADHDers. Furthermore, much of the existing research evaluates pharmacological interventions which is difficult to transfer to the workplace context. It is recommended that future research and practice consider the key mechanisms identified in this review when designing interventions as well as barriers to accessing support such as disclosure and self-awareness.
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Affiliation(s)
- Kirsty Lauder
- Centre for Neurodiversity Research at Work, Birkbeck College, London, United Kingdom
- *Correspondence: Kirsty Lauder
| | - Almuth McDowall
- Centre for Neurodiversity Research at Work, Birkbeck College, London, United Kingdom
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Qin X, Huckfeldt P, Abraham J, Yee D, Virnig BA. Hormonal Therapy Drug Switching, Out-of-Pocket Costs, and Adherence Among Older Women With Breast Cancer. J Natl Cancer Inst 2022; 114:1029-1035. [PMID: 35333338 PMCID: PMC9275769 DOI: 10.1093/jnci/djac062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/26/2022] [Accepted: 03/17/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Adherence to aromatase inhibitors (AIs) and tamoxifen has considerable survival benefits for postmenopausal women diagnosed with hormone receptor-positive breast cancer. Reduced out-of-pocket costs and treatment-related side effects could increase therapy adherence. Given that individuals' side effect profiles could differ across AIs, generic AI entry could facilitate switching between AIs to manage side effects and improve adherence. METHODS From Surveillance, Epidemiology, and End Results-Medicare, we selected women first diagnosed with hormone receptor-positive breast cancer at age 65+ years and initiated an AI within 1 year of diagnosis between January 1, 2007, and May 31, 2008, or June 1, 2011, and December 31, 2012, and followed them for up to 2 years (N = 20 677). We estimated changes in probabilities of adherence with and without switching for Part D enrollees with and without the low-income subsidy (LIS vs non-LIS) before and after generic entry using linear probability models. Tests of statistical significance are 2-sided. RESULTS After generic entry reduced out-of-pocket costs of AIs (larger reduction for non-LIS), the percentage of women who ever switched from one AI to another AI increased from 8.8% to 14.6% for non-LIS and from 7.3% to 12.5% for LIS. Adherence without switching increased by 8.0 percentage points (pp) for non-LIS (P < .001) but decreased by 4.9 pp (P < .001) for LIS. Adherence with switching increased for both non-LIS (6.4 pp, P < .001) and LIS (4.4 pp, P < .001). CONCLUSIONS Increased switching after generic entry contributed to increased adherence, suggesting switching allowed better management of treatment-related side effects. Subsidized women also experienced increased adherence with switching after generic entry, suggesting that patients and physicians might not understand Part D benefit design when making decisions.
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Affiliation(s)
- Xuanzi Qin
- Correspondence to: Xuanzi Qin, PhD, MSPH, Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End Ave, Ste 1250, Nashville, TN 37203, USA (e-mail: )
| | - Peter Huckfeldt
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jean Abraham
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Douglas Yee
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Beth A Virnig
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Kumar R, Chakrabarti S, Ghosh A. Composition of treatment alliance in bipolar disorder: A cross-sectional study of patients’ perspectives. World J Psychiatry 2022; 12:814-826. [PMID: 35978971 PMCID: PMC9258269 DOI: 10.5498/wjp.v12.i6.814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/08/2021] [Accepted: 05/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Treatment alliance has an impact on several key patient outcomes in all psychiatric disorders, including bipolar disorder (BD). It has been suggested that the construct of treatment alliance is different among patients from routine psychiatric settings compared to psychotherapeutic settings. However, research on the composition of treatment alliance in psychiatric disorders, such as BD, is relatively limited.
AIM To determine whether a broader construct of treatment alliance was prevalent among outpatients with BD.
METHODS This is a cross-sectional study, conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo (September 2018 to September 2019). A consecutive sample of 160 remitted adult outpatients with BD on mood stabilizers for at least a year were selected. The principal instrument to assess treatment alliance was the Working Alliance Inventory-client version (WAI-Client). Other potential constituents of the alliance explored were perceived trust in clinicians assessed by the Trust in Physicians (TRIP) scale, perceived support from clinicians assessed by the Psychosocial Care by Physicians (PCP) scale, and perceived treatment satisfaction assessed by the Patient Satisfaction Questionnaire (PSQ). Associations between scores on all scales were determined by correlational and multiple regression analyses. Exploratory factor analysis of combined items of all scales was conducted using a principal components analysis.
RESULTS Scores on all the three WAI-Client subscales were significantly correlated with each other (r = 0.66-0.81; P < 0.0001). The total TRIP scores were associated with the total WAI-Client scores (r = 0.28; P < 0.01). The total TRIP scores and the total PCP scores were also significantly associated with the WAI-Client scores on the Task subscale (r = 0.28-0.29; P < 0.01). The total TRIP scores were significantly associated with the total PSQ scores (r = 0.45; P < 0.0001). Factor analysis yielded two independent and coherent factors, which explained 69% of the variance in data. Factor-1 (“alliance and support”), which explained about 41% of the variance, was comprised of a combined WAI-Client goal-task-bond component as well as the PCP support items. Factor-2 (“trust and satisfaction”), which explained about 28% of the variance, consisted of all the TRIP trust and the PSQ treatment satisfaction items.
CONCLUSION A broader construct of treatment alliance in BD was found. Apart from collaborative components, this construct included patients’ perceptions regarding trust in clinicians, support from clinicians, and treatment satisfaction.
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Affiliation(s)
- Rajeet Kumar
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Abhishek Ghosh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Ruggiero F, Lombi L, Molisso MT, Fiore G, Zirone E, Ferrucci R, Pirola E, Locatelli M, Barbieri S, Mameli F. The Impact of Telemedicine on Parkinson's Care during the COVID-19 Pandemic: An Italian Online Survey. Healthcare (Basel) 2022; 10:healthcare10061065. [PMID: 35742116 PMCID: PMC9222237 DOI: 10.3390/healthcare10061065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 12/26/2022] Open
Abstract
Traditionally, medical care and research in Parkinson’s disease (PD) have been conducted through in-person visit. The recent Coronavirus Disease 2019 (COVID-19) pandemic has profoundly impacted the delivery of in-person clinical care. We conducted an online survey to investigate the impact of COVID-19 on access to telehealth care, interviewing both PD patients and neurologists. Survey responses were collected from 1 March to 31 May 2021 through an anonymous, self-reported questionnaire, on the ‘Qualtrics’ platform. In total, 197 patients and 42 neurologists completed the survey. In our sample, 37.56% of PD patients and 88.10% of neurologists reported having used alternatives to in-person visits, while 13.70% of PD patients and 40.48% of neurologists used telemedicine. Data showed that respondents were generally satisfied with the use of telemedicine during the COVID-19 pandemic. The relational dimension between patient and neurologist seems to be the factor that most positively affected the telemedicine experience, contributing greatly to a more patient-centred care. Current findings suggest the need to improve the access to telehealth services for patients with PD. The technology has the potential to improve the care of frail patients, especially when availability of face-to-face visits is limited.
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Affiliation(s)
- Fabiana Ruggiero
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.T.M.); (G.F.); (E.Z.); (E.P.); (M.L.); (S.B.); (F.M.)
- Correspondence: ; Tel.: +39-02-5503-3621
| | - Linda Lombi
- Department of Sociology, Università Cattolica del Sacro Cuore, 20125 Milan, Italy;
| | - Maria Takeko Molisso
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.T.M.); (G.F.); (E.Z.); (E.P.); (M.L.); (S.B.); (F.M.)
| | - Giorgio Fiore
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.T.M.); (G.F.); (E.Z.); (E.P.); (M.L.); (S.B.); (F.M.)
| | - Eleonora Zirone
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.T.M.); (G.F.); (E.Z.); (E.P.); (M.L.); (S.B.); (F.M.)
| | - Roberta Ferrucci
- Department of Health Sciences, “Aldo Ravelli” Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, 20142 Milan, Italy;
| | - Elena Pirola
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.T.M.); (G.F.); (E.Z.); (E.P.); (M.L.); (S.B.); (F.M.)
| | - Marco Locatelli
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.T.M.); (G.F.); (E.Z.); (E.P.); (M.L.); (S.B.); (F.M.)
| | - Sergio Barbieri
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.T.M.); (G.F.); (E.Z.); (E.P.); (M.L.); (S.B.); (F.M.)
| | - Francesca Mameli
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.T.M.); (G.F.); (E.Z.); (E.P.); (M.L.); (S.B.); (F.M.)
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Kessler RC, Kazdin AE, Aguilar‐Gaxiola S, Al‐Hamzawi A, Alonso J, Altwaijri YA, Andrade LH, Benjet C, Bharat C, Borges G, Bruffaerts R, Bunting B, de Almeida JMC, Cardoso G, Chiu WT, Cía A, Ciutan M, Degenhardt L, de Girolamo G, de Jonge P, de Vries Y, Florescu S, Gureje O, Haro JM, Harris MG, Hu C, Karam AN, Karam EG, Karam G, Kawakami N, Kiejna A, Kovess‐Masfety V, Lee S, Makanjuola V, McGrath J, Medina‐Mora ME, Moskalewicz J, Navarro‐Mateu F, Nierenberg AA, Nishi D, Ojagbemi A, Oladeji BD, O'Neill S, Posada‐Villa J, Puac‐Polanco V, Rapsey C, Ruscio AM, Sampson NA, Scott KM, Slade T, Stagnaro JC, Stein DJ, Tachimori H, ten Have M, Torres Y, Viana MC, Vigo DV, Williams DR, Wojtyniak B, Xavier M, Zarkov Z, Ziobrowski HN, WHO World Mental Health Survey collaborators. Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys. World Psychiatry 2022; 21:272-286. [PMID: 35524618 PMCID: PMC9077614 DOI: 10.1002/wps.20971] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Patient-reported helpfulness of treatment is an important indicator of quality in patient-centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post-traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys - 17 in high-income countries (HICs) and 13 in low- and middle-income countries (LMICs) - carried out as part of the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help-seeking if earlier treatments are not helpful.
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Affiliation(s)
| | | | | | - Ali Al‐Hamzawi
- College of MedicineAl‐Qadisiya University, Diwaniya GovernorateIraq
| | - Jordi Alonso
- Health Services Research UnitIMIM‐Hospital del Mar Medical Research InstituteBarcelonaSpain
| | - Yasmin A. Altwaijri
- Epidemiology SectionKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Laura H. Andrade
- Núcleo de Epidemiologia Psiquiátrica ‐ LIM 23Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial ResearchNational Institute of Psychiatry Ramón de la Fuente MuñizMexico CityMexico
| | - Chrianna Bharat
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyNSWAustralia
| | - Guilherme Borges
- Department of Epidemiologic and Psychosocial ResearchNational Institute of Psychiatry Ramón de la Fuente MuñizMexico CityMexico
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum ‐ Katholieke Universiteit LeuvenLeuvenBelgium
| | | | - José Miguel Caldas de Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research CenterNOVA University of LisbonLisbonPortugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health and Chronic Diseases Research CenterNOVA University of LisbonLisbonPortugal
| | - Wai Tat Chiu
- Department of Health Care PolicyHarvard Medical SchoolBostonMAUSA
| | - Alfredo Cía
- Anxiety Disorders Research CenterBuenos AiresArgentina
| | - Marius Ciutan
- National School of Public HealthManagement and Professional DevelopmentBucharestRomania
| | - Louisa Degenhardt
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyNSWAustralia
| | | | - Peter de Jonge
- Department of Developmental PsychologyUniversity of GroningenGroningenThe Netherlands
| | - Ymkje Anna de Vries
- Department of Developmental PsychologyUniversity of GroningenGroningenThe Netherlands
| | - Silvia Florescu
- National School of Public HealthManagement and Professional DevelopmentBucharestRomania
| | - Oye Gureje
- Department of PsychiatryUniversity College HospitalIbadanNigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAMUniversitat de BarcelonaBarcelonaSpain
| | - Meredith G. Harris
- School of Public HealthUniversity of Queensland, Herston, and Queensland Centre for Mental Health ResearchWacolQLDAustralia
| | - Chiyi Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning HospitalShenzhenChina
| | - Aimee N. Karam
- Institute for Development, ResearchAdvocacy and Applied CareBeirutLebanon
| | - Elie G. Karam
- Institute for Development, ResearchAdvocacy and Applied CareBeirutLebanon,Department of Psychiatry and Clinical PsychologySt. George Hospital University Medical CenterBeirutLebanon
| | - Georges Karam
- Institute for Development, ResearchAdvocacy and Applied CareBeirutLebanon,Department of Psychiatry and Clinical PsychologySt. George Hospital University Medical CenterBeirutLebanon
| | - Norito Kawakami
- Department of Mental Health, Graduate School of MedicineUniversity of TokyoTokyoJapan
| | - Andrzej Kiejna
- Psychology Research Unit for Public HealthWSB UniversityTorunPoland
| | - Viviane Kovess‐Masfety
- Laboratoire de Psychopathologie et Processus de Santé EA 4057Université de ParisParisFrance
| | - Sing Lee
- Department of PsychiatryChinese University of Hong KongTai PoHong Kong
| | | | - John J. McGrath
- School of Public HealthUniversity of Queensland, Herston, and Queensland Centre for Mental Health ResearchWacolQLDAustralia,National Centre for Register‐based ResearchAarhus UniversityAarhusDenmark
| | - Maria Elena Medina‐Mora
- Department of Epidemiologic and Psychosocial ResearchNational Institute of Psychiatry Ramón de la Fuente MuñizMexico CityMexico
| | | | - Fernando Navarro‐Mateu
- Unidad de Docencia, Investigación y Formación en Salud MentalUniversidad de MurciaMurciaSpain
| | - Andrew A. Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Department of PsychiatryMassachusetts General HospitalBostonMAUSA
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of MedicineUniversity of TokyoTokyoJapan
| | - Akin Ojagbemi
- Department of PsychiatryUniversity College HospitalIbadanNigeria
| | | | | | - José Posada‐Villa
- Colegio Mayor de Cundinamarca UniversityFaculty of Social SciencesBogotaColombia
| | | | - Charlene Rapsey
- Department of Psychological MedicineUniversity of OtagoDunedinNew Zealand
| | | | - Nancy A. Sampson
- Department of Health Care PolicyHarvard Medical SchoolBostonMAUSA
| | - Kate M. Scott
- Department of Psychological MedicineUniversity of OtagoDunedinNew Zealand
| | - Tim Slade
- Matilda Centre for Research in Mental Health and Substance UseUniversity of SydneySydneyAustralia
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud MentalUniversidad de Buenos AiresBuenos AiresArgentina
| | - Dan J. Stein
- Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental DisordersUniversity of Cape Town and Groote Schuur HospitalCape TownSouth Africa
| | - Hisateru Tachimori
- National Institute of Mental HealthNational Center for Neurology and PsychiatryKodairaTokyoJapan
| | - Margreet ten Have
- Trimbos‐InstituutNetherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental HealthCES UniversityMedellinColombia
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public HealthFederal University of Espírito SantoVitoriaBrazil
| | - Daniel V. Vigo
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada,Department of Global Health and Social MedicineHarvard Medical SchoolBostonMAUSA
| | - David R. Williams
- Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Bogdan Wojtyniak
- Centre of Monitoring and Analyses of Population HealthNational Institute of Public Health ‐ National Research InstituteWarsawPoland
| | - Miguel Xavier
- Lisbon Institute of Global Mental Health and Chronic Diseases Research CenterNOVA University of LisbonLisbonPortugal
| | - Zahari Zarkov
- Department of Mental HealthNational Center of Public Health and AnalysesSofiaBulgaria
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Dooley J, Barnes DR. Negotiating 'the problem' in GP home visits to people with dementia. Soc Sci Med 2022; 298:114862. [PMID: 35248896 DOI: 10.1016/j.socscimed.2022.114862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/16/2021] [Accepted: 02/22/2022] [Indexed: 11/18/2022]
Abstract
People with dementia are often marginalised in health care due to the effects of the condition on short term memory and communication. The problem presentation is a key area of primary care consultations where patients 'have the floor', and hence are able to direct the trajectory of the consultation to achieve certain ends. An exploration of how patients with advanced dementia participate in this stage of the consultation can thus demonstrate their participation and subsequent engagement. We used conversation analysis to describe how healthcare professionals (HCPs), people with dementia, and their carers establish the presenting problem in 17 out-of-hours primary care home visit consultations. In all cases, the carer had called the out of hours service on behalf of the patient. Rather than traditional "what can I help you with?" problem solicits, HCPs instead stated their reason-for-visit using information provided by the carer. All the patients showed some misalignment with this presented reason-for-visit, by denying the existence of current symptoms and/or their involvement in the decision to call the doctor. Carers appeared to show respect for the patient's ownership of their experience, only providing input on invitation from doctors or patients. Patient acknowledgement and willingness to engage in examination were needed for progressivity, but agreement with the reason-for-visit was not. In two consultations, the reason-for-visit was not explained to patients, and in both cases this resulted in the person with dementia showing frustration and resistance to examination. People with dementia may resist doctor home visits for many reasons, such as embarrassment for not remembering symptoms, or stoicism in the face of medical ailments. These findings show how the balance of progressivity and intersubjectivity tips towards progressivity in consultations with people with dementia, but this is reversed when the patient is not engaged in the reason-for-visit.
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Affiliation(s)
- Jemima Dooley
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol, BS82PL, UK.
| | - Dr Rebecca Barnes
- Nuffield Department of Primary Care, Medical Science Division, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
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Keenan A, Lin D, Shepherd J, Bailey H, Benson C, Meakin S. Patient-psychiatrist discordance and drivers of prescribing long-acting injectable antipsychotics for schizophrenia management in the real-world: a point-in-time survey. BMC Psychiatry 2022; 22:187. [PMID: 35300629 PMCID: PMC8932174 DOI: 10.1186/s12888-022-03846-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess discordance between psychiatrists and their patients with schizophrenia regarding disease management and understand drivers of prescribing long-acting injectable (LAI) antipsychotics. METHODS Data were collected via the Adelphi Schizophrenia Disease Specific Programme™, a point-in-time real-world international survey of psychiatrists and their consulting patients with schizophrenia, conducted in 2019. Psychiatrists completed an attitudinal survey on schizophrenia management and provided patient profiles for their next 10 adult consulting patients. The same patients voluntarily completed patient self-completion forms. Disease severity and improvement were assessed via physician-reported Clinical Global Impression scale; patients' adherence to treatment was rated through a 3-point scale (1=not at all adherent, 3=fully adherent). RESULTS Four hundred sixty-six psychiatrists provided data for 4345 patients (1132 receiving a LAI; 3105 on non-LAI treatment; 108 not on treatment). LAIs were more commonly prescribed to patients with severe schizophrenia, with varying reasons for prescribing. Globally, only slight agreement was observed between psychiatrists and patients for Clinical Global Impression severity of illness (κ=0.174) and level of improvement on treatment (κ=0.204). There was moderate agreement regarding level of adherence to treatment (κ=0.524). Reasons for non-adherence did not reach a level of agreement greater than fair. CONCLUSIONS Our real-world survey found that LAIs were more often reserved for severe schizophrenia patients and improving adherence was a key driver for prescribing. However, compared with the patients themselves, psychiatrists tended to underestimate patients' disease severity and overestimate their adherence.
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Affiliation(s)
| | - Dee Lin
- grid.497530.c0000 0004 0389 4927Janssen Scientific Affairs, LLC, Titusville, NJ USA
| | | | | | - Carmela Benson
- grid.497530.c0000 0004 0389 4927Janssen Scientific Affairs, LLC, Titusville, NJ USA
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Courtet P, Pecout C, Lainé-Pellet AF, Chekroun M, Avril C, Mourad JJ. Patients' Perspectives About the Treatment They Receive for Cardiovascular Diseases and Mental Disorders: Web-Based Survey Study. JMIR Form Res 2022; 6:e32725. [PMID: 35293869 PMCID: PMC8968624 DOI: 10.2196/32725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/06/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background Noncommunicable disease (NCD)–related deaths account for 71% of deaths worldwide. The World Health Organization recently developed a global action plan to address the impact of NCDs, with the goal of reducing the number of premature NCD-related deaths to 25% by the year 2025. Appropriate therapeutic adherence is critical for effective disease management; however, approximately 30%-50% of patients with an NCD do not comply with disease management activities as prescribed. Web-based patient communities can represent platforms from which specific information on patients’ perception of treatment adherence can be gathered outside of a clinical trial setting. Objective This study aims to better understand patients’ perspectives regarding therapeutic adherence and iatrogenic risk in 2 major groups of NCDs for which poor disease management can have fatal consequences: cardiovascular diseases and mental disorders. Therapeutic adherence, motivational factors, patients’ awareness and perception of iatrogenesis, and treatment tools used by patients were assessed. Methods A web-based survey was performed among patients with cardiovascular diseases or mental disorders or both conditions who were registered on the French Carenity platform, a web-based community in which patients with an NCD can share experiences and receive support and information. The study inclusion criteria were defined as follows: diagnosis of cardiovascular disease or mental disorder or both conditions (self-declared), age ≥18 years, residence in France, registration on the French Carenity platform, and ongoing pharmaceutical treatment for the condition. Patients who met the inclusion criteria were then invited to complete a self-administered web-based questionnaire that included questions addressing therapeutic adherence and iatrogenic risk. Results A total of 820 patients were enrolled in the study, including patients with cardiovascular diseases (403/820, 49.2%), patients with mental disorders (292/820, 35.6%), and patients with both cardiovascular diseases and mental disorders (125/820, 15.2%). The mean age of the participants was 55.2 (SD 12.7) years. We found that 82.8% (679/820) of patients experienced adverse effects of medication. Patients tended to perceive themselves to be more adherent than they actually were; a significant number of patients disregarded their prescription and stopped or interrupted medication without consulting with a doctor. Patients with cardiovascular diseases were nearly twice as adherent as patients with a mental disorder (P≤.001). Adherence was significantly associated with gender (P≤.001), age (P≤.001), and treatment complexity (P≤.001). Finally, for each disease type, 3 patient profiles were identified, which provide interesting insight for improving therapeutic adherence and adjustment strategies specifically according to patient behavior. Conclusions This study provides insight into the perspectives of patients receiving therapy for cardiovascular diseases or mental disorders or both conditions, which could help improve the management of NCDs and prevent premature death. Our study also shows that web-based patient platforms provide new opportunities to improve disease management by understanding patients’ experiences.
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Affiliation(s)
- Philippe Courtet
- Service d'Urgence et Post-Urgence Psychiatrique, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | | | | | | | | | - Jean-Jacques Mourad
- Département de Médecine Interne et Centre d'Excellence, Société Européenne d'Hypertension, Groupe Hospitalier Paris Saint Joseph, Paris, France
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Loewenstein SN, Pittelkow E, Kukushliev VV, Hadad I, Adkinson J. The Effects of Postoperative Physician Phone Calls for Hand and Wrist Fractures: A Prospective, Randomized Controlled Trial. Cureus 2022; 14:e22202. [PMID: 35308675 PMCID: PMC8925981 DOI: 10.7759/cureus.22202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/05/2022] Open
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Cannon M, Crede M, Kimber JM, Brunkow A, Nelson R, McAndrew LM. The Common-Sense Model and Mental Illness Outcomes: A Meta-Analysis. Clin Psychol Psychother 2022; 29:1186-1202. [PMID: 35112427 DOI: 10.1002/cpp.2721] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 11/09/2022]
Abstract
Psychotherapists can improve their patients' outcomes during and after therapy by improving patients' self-management. Patients who do not effectively manage their mental illness generally have worse outcomes. Leventhal's Common-Sense Model of Self-Regulation theorizes that patients' perceptions of their illness (illness representations) guide their self-management, influencing health outcomes. The present study quantified the relations between illness representations, self-management, and outcomes for mental illnesses. We conducted a meta-analysis and included articles if they reported: 1) on adults with mental illnesses; and 2) the correlation between mental illness representations and mental illness outcomes. 25 articles were included which represented 28 independent samples. The pattern of correlations among illness representations (identity, consequences, timeline, control, coherence, and emotional representations), self-management strategies (attendance, engagement, and adherence to treatment) and mental illness outcomes (symptom severity and quality of life) was consistent with analyses from previous studies of mental and physical illnesses. The results found threat-related illness representations mostly had a large relationship with worse mental illness outcomes and self-management. Protective illness representations had a small-to-large relationship with better mental illness outcomes and self-management. The results suggest patients' perceptions of their mental illness may be a critical indicator of their mental illness outcomes, including symptom severity and quality of life. This theory-driven meta-analysis supports calls for the inclusion of illness representations in psychotherapy for mental illness.
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Affiliation(s)
- Margeaux Cannon
- University at Albany, State University of New York 1400, Washington, NY, USA
| | - Marcus Crede
- Iowa State University 901 Stange Rd. Ames, IA, USA
| | - Justin M Kimber
- University at Albany, State University of New York 1400, Washington, NY, USA
| | - Alexandria Brunkow
- University at Albany, State University of New York 1400, Washington, NY, USA
| | - Rebecca Nelson
- University at Albany, State University of New York 1400, Washington, NY, USA
| | - Lisa M McAndrew
- University at Albany, State University of New York 1400, Washington, NY, USA
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Yan XJ, Qiu HY, Luo QQ, Wang B, Xu P, Ji CF, Chen SL. Improving Clinician-Patient Communication Alleviates Stigma in Patients With Functional Dyspepsia Receiving Antidepressant Treatment. J Neurogastroenterol Motil 2022; 28:95-103. [PMID: 34980692 PMCID: PMC8748843 DOI: 10.5056/jnm20239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/25/2021] [Accepted: 03/21/2021] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Antidepressants are effective in patients with functional dyspepsia (FD). However, stigma associated with FD and antidepressants may affect treatment adherence. This study aims to explore possible communication strategies to alleviate stigma and improve adherence in patients with FD. Methods In this randomized, single-center, and single-blind trial, 160 patients with FD initiating antidepressant treatment were recruited. Different communication strategies were performed when prescribing antidepressants. Participants in Group 1 were told that brain is the “headquarters” of gut, and that antidepressants could act as neuromodulators to relieve symptoms of FD through regulating the functions of gut and brain. Participants in Group 2 were told that antidepressants were empirically effective for FD. Stigma scores, medication-related stigma, treatment compliance, and efficacy were analyzed. Results After 8-week antidepressant treatment, the proportion of patients with FD with decreased stigma scores in Group 1 was significantly higher than in Group 2 (internalized stigma 64.10% vs 12.00%; perceived stigma 55.13% vs 13.33%; P < 0.01). Medication-related stigma was lower in Group 1 than in Group 2 (P < 0.05 for 3 of 4 questions). Concurrently, patients in Group 1 had better treatment compliance (0.71 ± 0.25 vs 0.60 ± 0.25, P < 0.01) and efficacy. In Group 1, participants with decreased post-treatment stigma scores showed better treatment compliance and efficacy than those with non-decreased scores. Decrease in stigma scores positively correlated with treatment compliance. Conclusion Improving knowledge of patients with FD of the disease and antidepressants via proper communication may be an effective way to alleviate stigma and promote adherence.
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Affiliation(s)
- Xiu-Juan Yan
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Hong-Yi Qiu
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Qing-Qing Luo
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Bo Wang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Ping Xu
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Chen-Feng Ji
- Department of Psychological Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sheng-Liang Chen
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
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Zhou Y, Ma Y, Yang WFZ, Wu Q, Wang Q, Wang D, Ren H, Luo Y, Yang D, Liu T, Wu X. Doctor-patient relationship improved during COVID-19 pandemic, but weakness remains. BMC FAMILY PRACTICE 2021; 22:255. [PMID: 34937550 PMCID: PMC8694760 DOI: 10.1186/s12875-021-01600-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/02/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the quality of the doctor-patient relationship (DPR) in China and possible influencing factors during the COVID-19 period from the patient's perspective. METHODS An online survey was carried out nationwide from March 12, 2020 to March 30, 2020 in China via a convenience sampling strategy. Patients who met the inclusion criteria were invited to complete a questionnaire regarding the quality of DPR, including sociodemographic information, the Patient-Doctor Relationship Questionnaire (PDRQ-9), and influencing factors for DPR during the pandemic. RESULTS A total of 1903 patients were included. Our result showed that participants had a higher PDRQ-9 score during the COVID-19 pandemic (4.18 ± 0.51) than that before the COVID-19 pandemic (3.86 ± 0.67). Importance-performance analysis (IPA) revealed that doctor-patient communication, patient satisfaction, consultation time, doctor's attitude, and medical knowledge were specific aspects that needed to be prioritized to improve the DPR. Multiple linear regression analysis suggested that positive media reports, telemedicine, and national policies had a significantly positive effect on the DPR during the pandemic (P < 0.05). CONCLUSION In general, the DPR had been improved during the COVID-19 pandemic. Our research found the key points that needed to be prioritized to improve the DPR during the pandemic, which may provide effective suggestions for building a harmonious DPR in the future.
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Affiliation(s)
- Yanan Zhou
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China.,Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuejiao Ma
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Winson Fu Zun Yang
- Department of Psychological Sciences, College of Arts & Sciences, Texas Tech University, Lubbock, TX, USA
| | - Qiuxia Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qianjin Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Dongfang Wang
- Department of Psychiatry and Psychotherapy, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Honghong Ren
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yinli Luo
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Dong Yang
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Tieqiao Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoming Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
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Sator M, Holler P, Rosenbaum M. National train-the-trainer certificate programme for improving healthcare communication in Austria. PATIENT EDUCATION AND COUNSELING 2021; 104:2857-2866. [PMID: 34454798 DOI: 10.1016/j.pec.2021.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/20/2021] [Accepted: 07/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES In Austria a national train-the-trainer programme (TTT) has been developed, implemented and evaluated with the aim of training and certifying participants for developing, implementing and delivering communication skills training (CST) for health professionals. METHODS The programme included 5 in-person courses, application homework with feedback, peer work, and regular trainer network meetings. Global satisfaction with training and changes in self-efficacy among TTT-participants and their learners in the CST delivered as practice projects were evaluated. RESULTS 18 participants have graduated from the TTT-pilot. 98 people took part in the 9 CST delivered by TTT-participants. Participants' satisfaction has been rated very positively both for TTT and CST. At post-programme/post-training, statistically significant improvement was observed in self-efficacy for the TTT-participants and for the CST-participants. Additionally, valuable suggestions for programme/training improvement were identified. CONCLUSIONS This programme is an important step to sustainably improving CST in Austria. To guarantee high quality and consistency, a set of standards for certification have been developed for TTT and CST. PRACTICE IMPLICATIONS Implementation of best practices in training trainers and communication skills teaching can be guided by a structured approach. Those wanting to implement similar programmes can benefit from strengths and suggestions for improvement identified in this national project.
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Affiliation(s)
- Marlene Sator
- Austrian Public Health Institute, Department Health Literacy and Health Promotion, Vienna, Austria; Austrian Health Literacy Alliance, c/o Austrian Health Promotion Fund, Vienna, Austria.
| | - Peter Holler
- Institute of Health Promotion and Disease Prevention, Graz, Austria; FH Joanneum University of Applied Sciences, Health and Tourism Management, Bad Gleichenberg, Austria
| | - Marcy Rosenbaum
- University of Iowa, Carver College of Medicine, Iowa City, USA
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Leclerc MÈ, Paradis A, Dewar M, Fortin C. The involvement of a significant other in the treatment of posttraumatic disorder: A systematic review. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2021. [DOI: 10.1016/j.ejtd.2020.100188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Forma F, Koep E, White J, Belland A, Waters H, Martin C. Impact of treatment-related discussions on healthcare resource use and costs among patients with severe mental illness. Curr Med Res Opin 2021; 37:1799-1809. [PMID: 34139902 DOI: 10.1080/03007995.2021.1943341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Serious mental illnesses (SMIs), including schizophrenia, bipolar disorder, and major depressive disorder (MDD), are often treated with antipsychotic medications. Unfortunately, medication non-adherence is widespread and is associated with serious adverse outcomes. However, little real-world data are available describing adherence, compliance, or other medication-taking-related discussions between providers and patients. This study described these communications in ambulatory care. METHODS Commercially insured patients having acute (emergency or inpatient) behavioral health (BH) events were included by specific criteria: age 18-65 years; diagnoses of schizophrenia, bipolar disorder, or MDD; continuous health insurance coverage 6 months before to 12 months after the first claim (index) date during 01/01/2014‒12/31/2015; and prescribed antipsychotic medication. Medical charts were abstracted for ambulatory visits with a BH diagnosis through 12 months after the acute event, describing any treatment compliance discussions that occurred. BH-related healthcare utilization and costs were measured via insurance claims. Results were analyzed by observation of an antipsychotic medication taking-related (i.e. compliance or adherence) discussion at the initial abstracted visit. RESULTS Ninety patients were included: 62% female, mean age 41 years. Only 58% had antipsychotic compliance discussions during the first abstracted ambulatory visit. A total of 680 BH-related visits were abstracted for the 90 patients. Providers frequently discussed any psychotropic medication use (97% of all visits abstracted); however, discussion of compliance with BH talk therapies was less common (49% of visits among patients with a first visit antipsychotic discussion and 23% without, p < .001). Follow-up BH-related healthcare utilization and costs were not significantly different by cohort. Patients with ≥2 compliance discussions had a significantly lower risk of follow-up acute events, which are the costliest components of healthcare for SMI (p = .023). CONCLUSION Increasing the frequency of antipsychotic treatment-related adherence/compliance discussions may represent an opportunity to improve the quality of care for these vulnerable patients and reduce the overall economic burden associated with the treatment of SMI diagnosis.
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Affiliation(s)
- Felicia Forma
- Health Economics and Outcomes Management, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Eleena Koep
- Health Economics and Outcomes Research, OPTUM, Eden Prairie, MN, USA
| | - John White
- Health Economics and Outcomes Research, OPTUM, Eden Prairie, MN, USA
| | - Angela Belland
- Health Economics and Outcomes Research, OPTUM, Eden Prairie, MN, USA
| | - Heidi Waters
- Health Economics and Outcomes Management, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Carolyn Martin
- Health Economics and Outcomes Research, OPTUM, Eden Prairie, MN, USA
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