Depression Care Management for Chinese Americans in Primary Care: A Feasibility Pilot Study

Abstract

Objective: Addiction or Substance Use Disorder (SUD) is a growing public health problem which affects the person, the whole family and society. The primary care physician is often the first point of contact in health care and can play a significant role in early detection and intervention. It is well established that early intervention is associated with better outcome, however in their formal medical training; primary care physicians receive no formal training on drug addiction management. In this pilot study we developed an innovative tele-mentoring model for drug addiction management and looked at feasibility as well acceptability among remote primary care physicians (PCPs). Methods: The tele-mentoring model consists of both synchronous and asynchronous components. The synchronous component (which includes the National Institute of Mental Health And Neuro Sciences (NIMHANS) academic centre Hub and remote district level primary care Spoke), is implemented by use of low-cost multipoint videoconference based tele-ECHO clinics. During the tele-ECHO clinics, held fortnightly, the remote PCPs used internet enabled smartphones to connect as well as present the patient case summaries to the multidisciplinary expert team of NIMHANS HUB. The asynchronous component consists of mobile based ubiquitous e-learning integrated to a course completion certificate. We evaluated this innovative tele-mentoring Programme on participant engagement, learning, competence and satisfaction. A pre-post design and e-learning assignments were used to measure the outcomes. Results: Of the proposed 21 tele-ECHO clinics, 11 were held till the end of August 2017. All the primary care physicians were able to virtually join at least one drug tele-ECHO clinic. Out of 38 participants, two participated in all the tele-ECHO clinics and 47.36% (n=18) attended more than six (>60% of total) tele-ECHO clinics. 76.31% (n=29) of the PCPs presented 41 patient case summaries. Among 38 PCPs, a cumulative of 89.47% has completed three E-Learning assignments. Majority of participants (80%) used smartphone with 4G connections to join the tele-ECHO clinics. There was a significant increase in the score on knowledge gained over the time duration of 1 month (3.00±0.86, p < 0.001) and 3 months (3.16±0.90, p < 0.001) assessments compared to the baseline (1.77±1.02). 32.25% (n=10) reported improved confidence level in managing a case of SUD on 10 point scale. Discussion: It has been feasible to connect an academic hub i.e. NIMHANS to the PCPs of 36 remote districts of Bihar and conduct multipoint videoconference based tele-ECHO clinics. The results indicate high-participant retention. The learners are comfortable in adapting new technology based learning as evidenced by higher rate of e-learning assignment completion. These findings suggest this new innovative learning model using technology can be an important way for effective training to address addiction management.

Efficacy of depression treatments for immigrant patients: results from a systematic review

“…While most agree collaborative care is important and effective in patient management, the evidence is divided on the effectiveness of care management components for depression. This is highlighted in the study by Kwong et al [33] that showed no advantage of adding a care management component relative to enhanced physician care in depressive symptomology.…”

Integrated Primary Care and Social Work: A Systematic Review

“…Nine studies were located in traditional primary care practice settings (Angeles et al, 2013;Boult, Rassen, Rassen, Moore, & Robison, 2000;Farmer, Clark, Drewel, Swenson, & Ge, 2011;Fortinsky, Kulldorff, Kleppinger, & Kenyon-Pesce, 2009;Katon et al, 2001;Richardson et al, 2014;Roy-Byrne et al, 2010;Saitz et al, 2013;Sommers, Marton, Barbaccia, & Randolph, 2000). Six studies were located in public-health community clinics (Béland et al, 2006;Counsell et al, 2007;Ell et al, 2010;Kwong, Chung, Cheal, Chou, & Chen, 2013;Roy-Byrne et al, 2014;Safren, O'Cleirigh, Skeer, Elsesser, & Mayer, 2013), and four studies were located in academic health care systems (Counsell et al, 2007;Huffman et al, 2014;Ross, Roberts, Campbell, Solomon, & Brouhard, 2004). The remaining studies were conducted in assisted-living settings (Bellantonio et al, 2008;Boult et al, 2001), a detoxification unit (Samet et al, 2003), Veterans Administration medical centers (Engelhardt, Toseland, Gao, & Banks, 2006), a community hospital (Leung et al, 2004), and OB/GYN clinics (Grote et al, 2015;.…”

“…Across all 26 studies, most participants were White; however, five studies did not report the race/ethnicity of participants (Angeles et al, 2013;Béland et al, 2006;Bellantonio et al, 2008;Leung et al, 2004;. Two studies focused exclusively on Hispanic patients (Ell et al, , 2010, and one focused exclusively on Chinese American patients (Kwong et al, 2013).…”

Fallmanagement als innovativer Ansatz in der medizinisch-psychosomatischen Rehabilitation

“…[ 40 ] . Gleichzeitig erscheint es immer notwendiger, besondere Versichertengruppen wie Patienten mit Migrationshintergrund, die entweder einen eingeschränkten Zugang zu medizinischen Dienstleistungen haben oder nicht ausreichend über das medizinische Versorgungs-und soziale Sicherungssystem informiert sind, individuell zu betreuen [ 41 ] . Aufgrund des neuen Ansatzes der Einzelfallbetreuung wäre hierbei jedoch zunächst zu überprüfen, welche Versichertengruppen besonders vom Fallmanagement profi tieren könnten bzw.…”