Building Bridges to Integrate Care (BRIDGES): Incubating Health Service Innovation across the Continuum of Care for Patients with Multiple Chronic Conditions

Bhattacharyya, Onil; Schull, Michael J.; Shojania, Kaveh G; Stergiopoulos, Vicky; Naglie, Gary; Webster, Fiona; Brandao, Ricardo; Mohammed, Tamara; Christian, Jennifer; Hawker, Gillian; Wilson, Lynn; Levinson, Wendy

doi:10.12927/hcq.2016.24701

Cited by 13 publications

(7 citation statements)

References 13 publications

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“…The DCC study used a Building Bridges to Integrate Care (BRIDGES) model, which used the Toronto-based BRIDGES model as a reference (Bhattacharyya et al ., 2016), and linked primary care centres, specialist hospitals and community care in accordance to the health system in Shenzhen. In this healthcare model, psychiatrists from specialist hospitals trained general practitioners (GPs) in primary care centres to identify, and provided treatment and education programmes for participants with subthreshold depressive symptoms.…”

Section: Methodsmentioning

confidence: 99%

The impact of COVID-19 on subthreshold depressive symptoms: a longitudinal study

Liao

Fan

Zhang

et al. 2021

Epidemiol Psychiatr Sci

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Aims The coronavirus disease 2019 (COVID-19) pandemic represents an unprecedented threat to mental health. Herein, we assessed the impact of COVID-19 on subthreshold depressive symptoms and identified potential mitigating factors. Methods Participants were from Depression Cohort in China (ChiCTR registry number 1900022145). Adults (n = 1722) with subthreshold depressive symptoms were enrolled between March and October 2019 in a 6-month, community-based interventional study that aimed to prevent clinical depression using psychoeducation. A total of 1506 participants completed the study in Shenzhen, China: 726 participants, who completed the study between March 2019 and January 2020 (i.e. before COVID-19), comprised the ‘wave 1’ group; 780 participants, who were enrolled before COVID-19 and completed the 6-month endpoint assessment during COVID-19, comprised ‘wave 2’. Symptoms of depression, anxiety and insomnia were assessed at baseline and endpoint (i.e. 6-month follow-up) using the Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder-7 (GAD-7) and Insomnia Severity Index (ISI), respectively. Measures of resilience and regular exercise were assessed at baseline. We compared the mental health outcomes between wave 1 and wave 2 groups. We additionally investigated how mental health outcomes changed across disparate stages of the COVID-19 pandemic in China, i.e. peak (7–13 February), post-peak (14–27 February), remission plateau (28 February−present). Results COVID-19 increased the risk for three mental outcomes: (1) depression (odds ratio [OR] = 1.30, 95% confidence interval [CI]: 1.04–1.62); (2) anxiety (OR = 1.47, 95% CI: 1.16–1.88) and (3) insomnia (OR = 1.37, 95% CI: 1.07–1.77). The highest proportion of probable depression and anxiety was observed post-peak, with 52.9% and 41.4%, respectively. Greater baseline resilience scores had a protective effect on the three main outcomes (depression: OR = 0.26, 95% CI: 0.19–0.37; anxiety: OR = 1.22, 95% CI: 0.14–0.33 and insomnia: OR = 0.18, 95% CI: 0.11–0.28). Furthermore, regular physical activity mitigated the risk for depression (OR = 0.79, 95% CI: 0.79–0.99). Conclusions The COVID-19 pandemic exerted a highly significant and negative impact on symptoms of depression, anxiety and insomnia. Mental health outcomes fluctuated as a function of the duration of the pandemic and were alleviated to some extent with the observed decline in community-based transmission. Augmenting resiliency and regular exercise provide an opportunity to mitigate the risk for mental health symptoms during this severe public health crisis.

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Section: Methodsmentioning

confidence: 99%

The impact of COVID-19 on subthreshold depressive symptoms: a longitudinal study

Liao

Fan

Zhang

et al. 2021

Epidemiol Psychiatr Sci

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“…Patients with complex care needs are major consumers in health care systems and account for a high percentage of the costs in the health systems. Integration of care pathways for those clients has become a priority for many health care systems [ 38 ]. A shared guide for standards of practice will be useful in the treatment of geriatric patients when “traditional” guidelines fail to address their complex needs.…”

Section: Discussionmentioning

confidence: 99%

Optimizing medical care for geriatric patients in Austria: defining a top five list of “Choosing Wisely” recommendations using the Delphi technique

et al. 2018

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PurposeInappropriate use of diagnostic and therapeutic medical procedures is common and potentially harmful for older patients. The Austrian Society of Geriatrics and Gerontology defined a consensus of five recommendations to avoid overuse of medical interventions and to improve care of geriatric patients.MethodsFrom an initial pool of 147 reliable recommendations, 20 were chosen by a structured selection process for inclusion in a Delphi process to define a list of five top recommendations for geriatric medicine. 12 experts in the field of geriatric medicine scored the recommendations in two Delphi rounds.ResultsThe final five recommendations are concerning urinary catheters in elderly patients, percutaneous feeding tubes in patients with advanced dementia, antipsychotics as the first choice to treat behavioral and psychological symptoms of dementia, and screening for breast, colorectal, prostate, or lung cancer, and the use of antimicrobials to treat asymptomatic bacteriuria.ConclusionsThe selected recommendations have the potential to improve medical care for older patients, to reduce side effects caused by unnecessary medical procedures, and to save costs in the health care system.

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“…Data were derived from the Depression Cohort in China (DCC) study (Chinese Clinical Trial Registry ChiCTR 1900022145), which is an ongoing longitudinal, population-based study for early identification, treatment, prevention, and management of subthreshold depressive symptoms and MDD [ 24 ]. We developed a Toronto-based Building Bridges to Integrate Care (BRIDGES) health care model to standardize the screening, detection, and treatment of individuals with subthreshold depressive symptoms or MDD in Nanshan district, Shenzhen, to meet the mental health needs of residents and their families [ 25 ]. With a population of approximately 2 million in an area of 185 km 2 , Nanshan is one of the most densely populated districts of Shenzhen.…”

Section: Methodsmentioning

confidence: 99%

“…The DCC study used a BRIDGES health care model, which used the BRIDGES model, a project of the University of Toronto’s departments of medicine and family and community medicine, as a reference [ 25 ], to link mental health care delivery among primary health care centers, a general hospital, and a specialized mental health hospital in accordance with the health system in Nanshan. In the integrated health care model, individuals are screened at primary health care centers by general practitioners (GPs) at baseline and there is a referral gateway between primary health care centers and general and specialized mental health hospitals in the DCC study.…”

Section: Methodsmentioning

confidence: 99%

Screening Depressive Symptoms and Incident Major Depressive Disorder Among Chinese Community Residents Using a Mobile App–Based Integrated Mental Health Care Model: Cohort Study

Zhang¹,

Liao²,

Han³

et al. 2022

J Med Internet Res

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Background Depression is associated with significant morbidity and human capital costs globally. Early screening for depressive symptoms and timely depressive disorder case identification and intervention may improve health outcomes and cost-effectiveness among affected individuals. China’s public and academic communities have reached a consensus on the need to improve access to early screening, diagnosis, and treatment of depression. Objective This study aims to estimate the screening prevalence and associated factors of subthreshold depressive symptoms among Chinese residents enrolled in the cohort study using a mobile app–based integrated mental health care model and investigate the 12-month incidence rate and related factors of major depressive disorder (MDD) among those with subthreshold depressive symptoms. Methods Data were drawn from the Depression Cohort in China (DCC) study. A total of 4243 community residents aged 18 to 64 years living in Nanshan district, Shenzhen city, in Guangdong province, China, were encouraged to participate in the DCC study when visiting the participating primary health care centers, and 4066 (95.83%) residents who met the DCC study criteria were screened for subthreshold depressive symptoms using the Patient Health Questionnaire-9 at baseline. Of the 4066 screened residents, 3168 (77.91%) with subthreshold depressive symptoms were referred to hospitals to receive a psychiatric diagnosis of MDD within 12 months. Sleep duration, anxiety symptoms, well-being, insomnia symptoms, and resilience were also investigated. The diagnosis of MDD was provided by trained psychiatrists using the Mini-International Neuropsychiatric Interview. Univariate and multivariate logistic regression models were performed to explore the potential factors related to subthreshold depressive symptoms at baseline, and Cox proportional hazards models were performed to explore the potential factors related to incident MDD. Results Anxiety symptoms (adjusted odds ratio [AOR] 1.63, 95% CI 1.42-1.87) and insomnia symptoms (AOR 1.13, 95% CI 1.05-1.22) were associated with an increased risk of subthreshold depressive symptoms, whereas well-being (AOR 0.93, 95% CI 0.87-0.99) was negatively associated with depressive symptoms. During the follow-up period, the 12-month incidence rate of MDD among participants with subthreshold depressive symptoms was 5.97% (189/3168). After incorporating all significant variables from the univariate analyses, the multivariate Cox proportional hazards model reported that a history of comorbidities (adjusted hazard ratio [AHR] 1.49, 95% CI 1.04-2.14) and anxiety symptoms (AHR 1.13, 95% CI 1.09-1.17) were independently associated with an increased risk of incident MDD. The 5-item World Health Organization Well-Being Index was associated with a decreased risk of incident MDD (AHR 0.90, 95% CI 0.86-0.94). Conclusions Elevated anxiety symptoms and unfavorable general well-being were significantly associated with subthreshold depressive symptoms and incident MDD among Chinese residents in Shenzhen. Early screening for subthreshold depressive symptoms and related factors may be helpful for identifying populations at high risk of incident MDD.

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Building Bridges to Integrate Care (BRIDGES): Incubating Health Service Innovation across the Continuum of Care for Patients with Multiple Chronic Conditions

Cited by 13 publications

References 13 publications

The impact of COVID-19 on subthreshold depressive symptoms: a longitudinal study

The impact of COVID-19 on subthreshold depressive symptoms: a longitudinal study

Optimizing medical care for geriatric patients in Austria: defining a top five list of “Choosing Wisely” recommendations using the Delphi technique

Screening Depressive Symptoms and Incident Major Depressive Disorder Among Chinese Community Residents Using a Mobile App–Based Integrated Mental Health Care Model: Cohort Study

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