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Improved patient-reported outcomes after interprofessional training in mental health: a nonrandomized intervention study.

ABSTRACT: BACKGROUND:Collaborative interprofessional practices are essential in caring for people with complex mental health problems. Despite the difficulties of demonstrating positive impacts of interprofessional education (IPE), it is believed to enhance interprofessional practices. We aimed to assess impacts on patient satisfaction, self-reported psychological distress and mental health status in a psychiatric ward. METHODS:We conducted a nonrandomized intervention study with patient satisfaction, psychological distress, and health status as outcomes. Mental health inpatients were referred to either an interprofessional training unit (intervention group) or to a conventionally organized ward (comparison group). Outcomes were assessed using the Short Form Health Survey (SF-36), the Kessler Psychological Distress Scale (K10), and the Client Satisfaction Questionnaire (CSQ-8). RESULTS:The intervention group included 129 patients, the comparison group 123. The former group reported better mental health status than the latter; the postintervention mean difference between them being 5.30 (95% CI 2.71-7.89; p?=?0.001; SF-36), with an effect size of 0.24. The intervention group patients also scored higher on satisfaction (mean difference 1.01; 95% CI 0.06-1.96; p?=?0.04), with an effect size of 0.31. The groups' mean scores of psychological distress were identical. CONCLUSION:Our results support the hypothesized value of interprofessional training: intervention group patients reported higher scores regarding mental health status and satisfaction than did comparison group patients. As IPE interventions have rarely involved patients and fewer have taken place in practice settings, further research into both the processes and the long-term effects of IPE in mental healthcare is needed. TRIAL REGISTRATION:The study was registered in ClinicalTrials.gov: NCT03070977 on March 6, 2017.

SUBMITTER: Marcussen M

PROVIDER: S-EPMC7227283 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Improved patient-reported outcomes after interprofessional training in mental health: a nonrandomized intervention study.

Marcussen Michael M Nørgaard Birgitte B Borgnakke Karen K Arnfred Sidse S

BMC psychiatry 20200514 1

<h4>Background</h4>Collaborative interprofessional practices are essential in caring for people with complex mental health problems. Despite the difficulties of demonstrating positive impacts of interprofessional education (IPE), it is believed to enhance interprofessional practices. We aimed to assess impacts on patient satisfaction, self-reported psychological distress and mental health status in a psychiatric ward.<h4>Methods</h4>We conducted a nonrandomized intervention study with patient sa ...[more]

PMID: 32410668

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Project description:BackgroundPatient-reported outcomes (PROs) can be used to monitor patients during treatment. Healthcare provider preferences for individualized vs. standardized PROs have been understudied.MethodsThis study surveyed oncology and mental health providers to compare attitudes towards individualized and standardized PROs. We have developed a method for individualizing PROs, called precision PROs, and the survey specifically assessed preferences for this method. We compared attitudes and preferences by provider type and by whether respondents were current or never users of PROs.ResultsOncology providers expressed more positive attitudes for standardized PROs in treatment planning compared to mental health providers (F(1,440) = 5.978, p = 0.015). The interaction between provider type (oncology vs. mental health) and type of PRO (individualized vs. standardized) was not significant for the attitudes about the clinical utility of PROs (p = 0.709). When directly asked about the precision PRO approach, oncologists were less likely to prefer standardized items (OR = 0.478, p = 0.001) or have no preference (OR = 0.445, p = 0.007) to the precision PRO approach when compared to mental health providers. Qualitative analyses suggested standardized PROs may be simpler or easier to understand whereas individualized PROs better capture patient variability and the unique aspects of each patient's condition. Some mental health providers expressed reticence about letting patients choose how to tailor PROs. Never users of PROs reported more positive attitudes towards individualized measures than standardized measures whereas current users of PROs did not have a difference in attitudes (p = 0.010). User status was mostly unrelated to preferences.ConclusionResults suggest that healthcare provider preference for individualized PROs may differ by medical specialty. How PROs are tailored may need to differ by discipline. This is particularly important given that previous research showing a preference for individualized PROs over standardized was conducted with psychotherapists. Further research on patient preferences for individualized and standardized PROs is warranted as is research on the clinical utility of individualized PROs such as the precision PRO approach.

Project description:BackgroundAlthough digital health tools are increasingly recognized as effective in improving clinical outcomes such as asthma control and medication adherence, few studies have assessed patient experiences and perception of value.ObjectiveThe aim of this study was to evaluate patient satisfaction, perception of usability and value, and desire to continue after 12 months of using a digital health intervention to support asthma management.MethodsParticipants were enrolled in a randomized controlled study evaluating the impact of a digital health platform for asthma management. Participants used electronic inhaler sensors to track medication use and accessed their information in a digital health platform. Electronic surveys were administered to intervention arm participants aged 12 years and older after 12 months of use. The survey assessed asthma control, patient satisfaction with the sensor device, and perception of the usability and value of the digital health platform through closed-ended and open-ended questions. Logistic regression models were used to assess the impact of participants' characteristics on survey completion, satisfaction, and perception of value.ResultsOf the 207 intervention arm participants aged 12 years and older, 89 submitted survey responses (42.9% response rate). Of these 89 participants, 70 reported being very satisfied (79%, 70/89) or somewhat satisfied (20%, 18/89) with the inhaler sensor device. Moreover, 93% (83/89) expressed satisfaction with the reports, and 90% (80/89) found the information from the reports useful for learning about their asthma. In addition, 72% (64/89) of the participants reported that they were interested in continuing to use the sensor and platform beyond the study. There were no significant differences in satisfaction with the device or the platform across participants' characteristics, including device type, age, sex, insurance type, asthma control, or syncing history; however, participants with smartphones and longer participation were more likely to take the survey.ConclusionsElectronic sensors and a digital health platform were well received by participants who reported satisfaction and perceived value. These results were consistent across multiple participants' characteristics. These findings can add to a limited literature to keep improving digital health interventions and ensure the meaningful and enduring impact on patient outcomes.

Project description:BACKGROUND:Depressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (??70 years) using personal support services. METHODS:A prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients', nurses', and personal support workers' perceptions about the intervention's appropriateness, benefits, and barriers and facilitators to implementation. RESULTS:Of the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period. CONCLUSIONS:Our findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion intervention in improving client outcomes, reducing use of expensive health services, and improving clinical practice behaviours of home care providers. Future research should evaluate its efficacy using a randomized clinical trial design, in different settings, with an adequate sample of older home care recipients with depressive symptoms. TRIAL REGISTRATION:Clinicaltrials.gov identifier: NCT01407926.

Project description:Interprofessional education (IPE) is based on the concept that health professional students are best trained on the skills, knowledge, and attitudes that promote population health when they learn with and about others from diverse health science fields. Previously, IPE has focused almost exclusively on the clinical context. This study piloted and evaluated an IPE learning experience that emphasizes population health in a sample of public health undergraduate students. We hypothesized that students who completed the 2-hour online asynchronous module would better understand the value of public health's role in interprofessional teams, the benefit of interprofessional teamwork in improving health outcomes, and the value of collaborative learning with other interprofessional students. Students engaged in pre- and post-training assessments and individual reflections throughout the module. Sixty-seven undergraduate public health students completed the module and assessments. After completion, a greater proportion strongly agreed that students from different health science disciplines should be educated in the same setting to form collaborative relationships with one another (19 vs. 39% before and after completion, respectively). A greater proportion also strongly agreed that care delivered by an interprofessional team would benefit the health outcomes of a patient/client after the training (60 vs. 75% before and after, respectively). Mean scores describing how strongly students agreed with the above two statements significantly increased post-training. A greater proportion of students strongly agreed that incorporating the public health discipline as part of an interprofessional team is crucial to address the social determinants of health for individual health outcomes after taking the training (40 vs. 55% before and after, respectively). There was little change in attitudes about the importance of incorporating public health as part of an interprofessional team to address social determinants of health for population health outcomes, which were strongly positive before the training. Most students reported being satisfied with the module presentation and felt their understanding of interprofessional practice improved. This training may be useful for students from all health disciplines to recognize the benefits of engaging with and learning from public health students and to recognize the important role of public health in interprofessional practices.

Project description:TRIAL DESIGN: A pragmatic cluster randomised controlled trial. METHODS: PARTICIPANTS: Clusters were primary health care clinics on the Ministry of Health list. Clients were eligible if they were aged 18 and over. INTERVENTIONS: Two members of staff from each intervention clinic received the training programme. Clients in both intervention and control clinics subsequently received normal routine care from their health workers. OBJECTIVE: To examine the impact of a mental health inservice training on routine detection of mental disorder in the clinics and on client outcomes. OUTCOMES: The primary outcome was the rate of accurate routine clinic detection of mental disorder and the secondary outcome was client recovery over a twelve week follow up period. Randomisation: clinics were randomised to intervention and control groups using a table of random numbers. Blinding: researchers and clients were blind to group assignment. RESULTS: Numbers randomised: 49 and 50 clinics were assigned to intervention and control groups respectively. 12 GHQ positive clients per clinic were identified for follow up. Numbers analysed: 468 and 478 clients were followed up for three months in intervention and control groups respectively. OUTCOME: At twelve weeks after training of the intervention group, the rate of accurate routine clinic detection of mental disorder was greater than 0 in 5% versus 0% of the intervention and control groups respectively, in both the intention to treat analysis (p?=?0.50) and the per protocol analysis (p =0.50). Standardised effect sizes for client improvement were 0.34 (95% CI?=?(0.01,0.68)) for the General Health Questionnaire, 0.39 ((95% CI?=?(0.22, 0.61)) for the EQ and 0.49 (95% CI?=?(0.11,0.87)) for WHODAS (using ITT analysis); and 0.43 (95% CI?=?(0.09,0.76)) for the GHQ, 0.44 (95% CI?=?(0.22,0.65)) for the EQ and 0.58 (95% CI?=?(0.18,0.97)) for WHODAS (using per protocol analysis). HARMS: None identified. CONCLUSION: The training programme did not result in significantly improved recorded diagnostic rates of mental disorders in the routine clinic consultation register, but did have significant effects on patient outcomes in routine clinical practice. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number Register ISRCTN53515024.

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Improved patient-reported outcomes after interprofessional training in mental health: a nonrandomized intervention study.

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Improved patient-reported outcomes after interprofessional training in mental health: a nonrandomized intervention study.

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