PBRN Findings: Integrated Care for Individuals With Serious Mental Illnesses.
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ABSTRACT:
SUBMITTER: Kelly EL
PROVIDER: S-EPMC8324043 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Individuals with serious mental illnesses and poorly managed medical conditions known as serious medical-psychiatric illnesses (SMPIs) are vulnerable to disruptions in care, resulting in poor outcomes. Intensive integrated care management approaches are indicated when these individuals are hospitalized on medical-surgical inpatient units in order to ensure continuity of medical and psychiatric services. This column describes a manualized intervention for hospitalized individuals with SMPIs that was developed in a National Institute of Mental Health ALACRITY research center. The approach uses a critical time intervention model incorporating motivational interviewing and shared decision making to maximize engagement and continuity of care for individuals with SMPIs.
| S-EPMC8249312 | biostudies-literature
Project description:ObjectiveThe authors assessed the 2-year outcomes, costs, and financial sustainability of a medical care management intervention for community mental health settings.MethodA total of 407 psychiatric outpatients with serious mental illnesses were randomly assigned to usual care or to a medical care manager who provided care coordination and education. Two-year follow-up chart reviews and interviews assessed quality and outcomes of care, as well as costs from both the health system and managerial perspectives.ResultsSustained improvements were observed in the intervention group in quality of primary care preventive services, quality of cardiometabolic care, and mental health-related quality of life. From a health system perspective, by year 2, the mean per-patient total costs for the intervention group were $932 (95% CI=-1,973 to 102) less than for the usual care group, with a 92.3% probability that the program was associated with lower costs than usual care. From the community mental health center perspective, the program would break even (i.e., revenues would cover setup costs) if 58% or more of clients had Medicaid or another form of insurance. Given that only 40.5% of clients in this study had Medicaid, the program was not sustainable after grant funding ended.ConclusionsThe positive long-term outcomes and favorable cost profile provide evidence of the potential value of this model. However, the discrepancy between health system and managerial cost perspectives limited the program's financial sustainability. With anticipated insurance expansions under health reform, there is likely to be a stronger business case for safety net organizations considering implementing evidence-based interventions such as the one examined in this study.
| S-EPMC3775649 | biostudies-literature
Project description:BACKGROUND:Medication used for acute aggression in psychiatry must have rapid onset of effect, low frequency of administration and low levels of adverse effects. Zuclopenthixol acetate is said to have these properties. OBJECTIVES:To estimate the clinical effects of zuclopenthixol acetate for the management of acute aggression or violence thought to be due to serious mental illnesses, in comparison to other drugs used to treat similar conditions. SEARCH METHODS:We searched the Cochrane Schizophrenia's Group Trials Register (July 2011). We supplemented this by citation searching and personal contact with authors and relevant pharmaceutical companies. SELECTION CRITERIA:All randomised clinical trials involving people thought to have serious mental illnesses comparing zuclopenthixol acetate with other drugs. DATA COLLECTION AND ANALYSIS:Two review authors extracted and cross-checked data independently. We calculated fixed-effect relative risks (RR) and 95% confidence intervals (CI) for dichotomous data. We analysed by intention-to-treat. We used mean differences (MD) for continuous variables. MAIN RESULTS:We found no data for the primary outcome, tranquillisation. Compared with haloperidol, zuclopenthixol acetate was no more sedating at two hours (n = 40, 1 RCT, RR 0.60, 95% CI 0.27 to 1.34). People given zuclopenthixol acetate were not at reduced risk of being given supplementary antipsychotics (n = 134, 3 RCTs, RR 1.49, 95% CI 0.97 to 2.30) although additional use of benzodiazepines was less (n = 50, 1 RCT, RR 0.03, 95% CI 0.00 to 0.47). People given zuclopenthixol acetate had fewer injections over seven days compared with those allocated to haloperidol IM (n = 70, 1 RCT, RR 0.39, 95% CI 0.18 to 0.84, NNT 4, CI 3 to 14). We found no data on more episodes of aggression or harm to self or others. One trial (n = 148) reported no significant difference in adverse effects for people receiving zuclopenthixol acetate compared with those allocated haloperidol at one, three and six days (RR 0.74, 95% CI 0.43 to 1.27). Compared with haloperidol or clotiapine, people allocated zuclopenthixol did not seem to be at more risk of a range of movement disorders (< 20%). Three studies found no difference in the proportion of people getting blurred vision/dry mouth (n = 192, 2 RCTs, RR at 24 hours 0.90, 95% CI 0.48 to 1.70). Similarly, dizziness was equally infrequent for those allocated zuclopenthixol acetate compared with haloperidol (n = 192, 2 RCTs, RR at 24 hours 1.15, 95% CI 0.46 to 2.88). There was no difference between treatments for leaving the study before completion (n = 522, RR 0.85, 95% CI 0.31 to 2.31). One study reported no difference in adverse effects and outcome scores, when high dose (50-100 mg/injection) zuclopenthixol acetate was compared with low dose (25-50 mg/injection) zuclopenthixol acetate. AUTHORS' CONCLUSIONS:Recommendations on the use of zuclopenthixol acetate for the management of psychiatric emergencies in preference to 'standard' treatment have to be viewed with caution. Most of the small trials present important methodological flaws and findings are poorly reported. This review did not find any suggestion that zuclopenthixol acetate is more or less effective in controlling aggressive acute psychosis, or in preventing adverse effects than intramuscular haloperidol, and neither seemed to have a rapid onset of action. Use of zuclopenthixol acetate may result in less numerous coercive injections and low doses of the drug may be as effective as higher doses. Well-conducted pragmatic randomised controlled trials are needed.
| S-EPMC4175533 | biostudies-other
Project description:Individuals with schizophrenia have higher mortality and shorter lifespans. There are a multitude of factors which create these conditions, but one aspect is worse physical health, particularly cardiovascular and metabolic health. Many interventions to improve the health of individuals with schizophrenia have been created, but on the whole, there has been limited effectiveness in improving quality of life or lifespan. One potential new avenue for inquiry involves a more patient-centric perspective; understanding aspects of physical health most important, and potentially most amenable to change, for individuals based on their life narratives. This study used topic modeling, a type of Natural Language Processing (NLP) on unstructured speech samples from individuals (n = 366) with serious mental illness, primarily schizophrenia, in order to extract topics. Speech samples were drawn from three studies collected over a decade in two geographically distinct regions of the United States. Several health-related topics emerged, primarily centered around food, living situation, and lifestyle (e.g., routine, hobbies). The implications of these findings for how individuals with serious mental illness and schizophrenia think about their health, and what may be most effective for future health promotion policies and interventions, are discussed.
| S-EPMC9405157 | biostudies-literature
Project description:BackgroundThe outbreak of coronavirus disease 2019 (COVID-19) has caused significant stress and mental health problems among the general public. However, persons at greatest risk for poor mental health outcomes, such as people with serious mental illness, have been largely overlooked.ObjectiveThis paper presents the protocol for a study that aims to examine the mental health impact of COVID-19 and social distancing behaviors in people with serious mental illness and the behaviors undertaken to prevent COVID-19 infection in this group.MethodsParticipants will include individuals with serious mental illness (eg, schizophrenia, bipolar disorder) and nonpsychiatric control participants who are currently participating in or have previously participated in several ongoing parent observational studies. Data will be collected from April 2020 through August 2020. Participants will complete phone interviews at 2 time points to assess their current emotional functioning and discuss the measures they have taken to prevent COVID-19 infection. Baseline (pre-COVID-19) mental health, sampled by ecological momentary assessment over an extended period, will be compared with current mental health, also sampled by ecological momentary assessment over an extended period. Demographic, cognitive, and psychosocial factors at baseline will be used to examine risk and resilience to current mental health and coping.ResultsThe inclusion of participants for the first round of telephone assessments started on April 3, 2020 and will be completed by May 31, 2020. As of April 30, 2020, 101 individuals had completed these first-round assessments. The second round of telephone assessments will likely occur between June 1, 2020, and August 31, 2020. Study results will be published in peer-reviewed scientific journals.ConclusionsOur findings will have broad implications for understanding the psychological consequences of COVID-19 among vulnerable persons with serious mental illness and will provide the opportunity to identify targets to reduce negative outcomes in the future. We also hope our efforts will provide a roadmap and resources for other researchers who would like to implement a similar approach.International registered report identifier (irrid)DERR1-10.2196/19203.
| S-EPMC7247464 | biostudies-literature
Project description:BackgroundPsychosocial distress among patients with limited life expectancy influences treatment decisions, treatment adherence, and physical health. Veterans may be at elevated risk of psychosocial distress at the end of life, and understanding their mental healthcare needs may help identify hospitalized patients to whom psychiatric services should be targeted.ObjectiveTo examine mental illness prevalence and mental health treatment rates among a national sample of hospitalized veterans with serious physical illnesses. Design, Subjects, and Measurements: This was a retrospective study of 11,286 veterans hospitalized in a Veterans Health Administration acute care facility in fiscal year 2011 with diagnoses of advanced cancer, congestive heart failure, chronic obstructive pulmonary disease, and/or advanced HIV/AIDS. Prevalent and incident mental illness diagnoses during and before hospitalization and rates of psychotherapy and psychotropic use among patients with incident depression and anxiety were measured.ResultsAt least one-quarter of the patients in our sample had a mental illness or substance use disorder. The most common diagnoses at hospitalization were depression (11.4%), followed by alcohol abuse or dependence (5.5%), and post-traumatic stress disorder (4.9%). Of the 831 patients with incident past-year depression and 258 with incident past-year anxiety, nearly two-thirds received at least some psychotherapy or guideline-concordant medication within 90 days of diagnosis. Of 191 patients with incident depression and 47 with incident anxiety at time of hospitalization, fewer than half received mental healthcare before discharge.ConclusionsMany veterans hospitalized with serious physical illnesses have comorbid mental illnesses and may benefit from depression and anxiety treatment.
| S-EPMC5333567 | biostudies-literature
Project description:Spain healthcare system is decentralized, with seventeen autonomous regions overseeing healthcare. However, penitentiary healthcare is managed nationally, except in Catalonia, the Basque Country, and Navarra. These variations impact mental health care provision for inmates with serious mental illness (SMI). To delineate differences between regions in terms of mental health care provision for individuals with SMI, available resources, and the perspectives of healthcare professionals operating in the Spanish prison environment. Employing an explanatory sequential mixed-method approach, the study conducted an extensive literature review, quantitative data collection through structured questionnaires, and qualitative data collection via focus groups and four in-depth interviews. Analysis involved calculating percentages and ratios for quantitative data and thematic analysis for qualitative data interpretation to comprehensively understand mental healthcare provision. In December 2021, about 4% of inmates in Spain had SMI. There are three distinct models of mental healthcare within the Spanish prison system. The traditional penitentiary model, representing 83% of the incarcerated population, operates independently under the General Secretariat of Penitentiary Institutions at a national level. This model relies on an average of 5.2 penitentiary General Practitioners (pGP) per 1,000 inmates for psychiatric and general healthcare. External psychiatrists are engaged for part-time psychiatric assessment. Acute psychiatric hospitalization occurs in general nursing modules within penitentiary centers or in Restricted Access Units (RAUs) in reference hospitals. Two penitentiary psychiatric hospitals provide care to unimputable SMI inmates from all over Spain. Innovative penitentiary models, constituting 17% of the prison population, integrate penitentiary healthcare within regional public health systems. The Basque Country features a Mental Health Unit with full-time care teams within the penitentiary center. Catalonia emphasizes community care, providing full-time dedicated psychiatric services within and outside prisons, ensuring continued care in the community. Both models prioritize personnel with specialized mental health training and compensation akin to non-prison healthcare settings. Regional disparities in penitentiary mental healthcare models in Spain result in resource inequalities, impacting specialized care for inmates with SMI and opportunities for healthcare professionals. The models in the Basque Country and Catalonia offer valuable experiences for penitentiary healthcare.
| S-EPMC11372278 | biostudies-literature
Project description:IntroductionPeople with serious mental illnesses experience excess morbidity and premature mortality resulting from preventable conditions. The goal was to examine disparities in preventive care that might account for poor health outcomes.MethodsIn this retrospective cohort study, adults (N=803,276) served by Kaiser Permanente Northwest and federally qualified health centers/safety-net community health clinics were categorized into five groups: schizophrenia spectrum disorders, bipolar disorders/affective psychoses, anxiety disorders, nonpsychotic unipolar depression, and reference groups with no evidence of these specific mental illnesses. The primary outcome was overall preventive care-gap rate, the proportion of incomplete preventive services for which each patient was eligible in 2012-2013. Secondary analyses examined Kaiser Permanente Northwest data from 2002 to 2013. Data were analyzed in 2015.ResultsControlling for patient characteristics and health services use, Kaiser Permanente Northwest mean care-gap rates were significantly lower for bipolar disorders/affective psychoses (mean=18.6, p<0.001) and depression groups (mean=18.6, p<0.001) compared with the reference group. Schizophrenia (mean=19.4, p=0.236) and anxiety groups (mean=19.9, p=0.060) did not differ from the reference group (mean=20.3). In community health clinics, schizophrenia (mean=34.1, p<0.001), bipolar/affective psychosis (mean=35.7, p<0.001), anxiety (mean=38.5, p<0.001), and depression groups (mean=36.3, p<0.001) had significantly lower care-gap rates than those in the reference group (mean=40.0). Secondary analyses of diabetes and dyslipidemia screening trends in Kaiser Permanente Northwest showed diagnostic groups consistently had fewer care gaps than patients in the reference group.ConclusionsIn vastly different settings, individuals with serious mental illnesses received preventive services at equal or better rates than the general population.
| S-EPMC5736432 | biostudies-literature
Project description:BackgroundDigital mental health interventions offer unique advantages, and research indicates that these interventions are effective for a range of mental health concerns. Although these interventions are less established for individuals with serious mental illnesses, they demonstrate significant promise. A central consideration in traditional face-to-face therapies is the therapeutic alliance, whereas the nature of a digital therapeutic alliance and its relationship with outcomes requires further attention, particularly for individuals with serious mental illnesses.ObjectiveThis narrative review aims to encourage further consideration and critical evaluation of the therapeutic alliance in digital mental health, specifically for individuals with serious mental illnesses.MethodsA narrative review was conducted by combining 3 main areas of the literature: the first examining the evidence for digital mental health interventions for serious mental illnesses, the second illuminating the nature and role of the therapeutic alliance in digital interventions, and the third surrounding practical considerations to enhance a digital therapeutic alliance.ResultsResults indicated that a therapeutic alliance can be cultivated in digital interventions for those with serious mental illnesses, but that it may have unique, yet-to-be-confirmed characteristics in digital contexts. In addition, a therapeutic alliance appears to be less directly associated with outcomes in digital interventions than with those in face-to-face therapies. One possibility is that the digital therapeutic alliance is associated with increased engagement and adherence to digital interventions, through which it appears to influence outcomes. A number of design and implementation considerations may enhance the digital therapeutic alliance, including human support and technological features.ConclusionsMore research is required to further understand the nature and specific role of a therapeutic alliance in digital interventions for serious mental illnesses, particularly in informing their design. This review revealed several key research priorities to advance the therapeutic alliance in digital interventions.
| S-EPMC7442952 | biostudies-literature
Project description:IntroductionPatients with mental and physical health conditions are complex to treat and often use multiple medications. It is unclear how adherence to one medication predicts adherence to others. A predictive relationship could permit less expensive adherence monitoring if overall adherence could be predicted through tracking a single medication.MethodsTo test this hypothesis, we examined whether patients with multiple mental and physical illnesses have similar adherence trajectories across medications. Specifically, we conducted a retrospective cohort analysis using health insurance claims data for enrollees who were diagnosed with a serious mental illness, initiated an atypical antipsychotic, as well as an SSRI (to treat serious mental illness), biguanides (to treat type 2 diabetes), or an ACE inhibitor (to treat hypertension). Using group-based trajectory modeling, we estimated adherence patterns based on monthly estimates of the proportion of days covered with each medication. We measured the predictive value of the atypical antipsychotic trajectories to adherence predictions based on patient characteristics and assessed their relative strength with the R-squared goodness of fit metric.ResultsWithin our sample of 431,591 patients, four trajectory groups were observed: non-adherent, gradual discontinuation, stop-start, and adherent. The accuracy of atypical antipsychotic adherence for predicting adherence to ACE inhibitors, biguanides, and SSRIs was 44.5, 44.5, and 49.6%, respectively (all p < 0.001 vs. random). We also found that information on patient adherence patterns to atypical antipsychotics was a better predictor of patient adherence to these three medications than would be the case using patient demographic and clinical characteristics alone.ConclusionAmong patients with multiple chronic mental and physical illnesses, patterns of atypical antipsychotic adherence were useful predictors of adherence patterns to a patient's adherence to ACE inhibitors, biguanides, and SSRIs.FundingOtsuka Pharmaceutical Development & Commercialization, Inc.
| S-EPMC5960492 | biostudies-literature