Efficacy of Nurse Telehealth Care and Peer Support in Augmenting Treatment of Depression in Primary Care

Hunkeler, Enid M.; Meresman, Joel F.; Hargreaves, William A.; Fireman, Bruce; Berman, William; Kirsch, Arlene J.; Groebe, Jennifer; Hurt, Stephen W.; Braden, Patricia; Getzell, Michael; Feigenbaum, Paul; Peng, Tiffany; Salzer, Mark S.

doi:10.1001/archfami.9.8.700

Cited by 411 publications

(325 citation statements)

References 39 publications

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“…It is ideal to establish care connections in the community whereby primary care clinicians provide collaborative and continuous care to patients with mental disorders. 12,[23][24][25] Related research has documented the importance of linking patients to primary care. In one study, linkage following detoxifi cation produced better patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Primary Care After Psychiatric Crisis: A Qualitative Analysis

Griswold¹,

Zayas²,

Pastore³

et al. 2008

The Annals of Family Medicine

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PURPOSE Patients with serious psychiatric problems experience diffi culty accessing primary care. The goals of this study were to assess whether care managers improved access and to understand patients' experiences with health care after a psychiatric crisis.METHODS A total of 175 consecutive patients seeking care in a psychiatric emergency department were randomly assigned to an intervention group with care managers or a control group. Brief, semistructured interviews about health care encounters were conducted at baseline and 1 year later. Five raters, using the content-driven, immersion-crystallization approach, analyzed 112 baseline and year-end interviews from 28 participants in each group. The main outcomes were patients' responses about their care experiences, connections with primary care, and integration of medical and mental health care. Scores for physical function and mental function were compared by analysis of variance (ANOVA). RESULTSAt baseline, most participants described negative experiences in receiving care and emphasized the importance of listening, sensitivity, and respect. Fully 71% of patients in the intervention group said that having a care manager to assist them with primary care connections was benefi cial. Patients in the intervention group had signifi cantly better physical and mental function than their counterparts in the control group at 6 months (P = .03 for each) but not at 12 months. There was also a trend toward functional improvement over the course of the study in the intervention group.CONCLUSIONS This analysis suggests that care management is effective in helping patients access primary care after a psychiatric crisis. It provides evidence on and insight into how care may be delivered more effectively for this population. Future work should assess the sustainability of care connections and longer-term patient health outcomes. Ann Fam Med 2008;6:38-43. DOI: 10.1370/afm.760. INTRODUCTIONP atients with serious mental illness have medical comorbidity and may not receive adequate primary care; they have impaired physical and emotional health and use the emergency department rather than the primary care setting. [1][2][3] There is evidence that even if individuals with serious mental illness have a regular source of primary care, they may not access services because of a lack of coordination between mental and medical health care. 4,5 Primary care is of value to patients with behavioral disorders. In one study, patients with psychiatric disorders viewed primary care as the cornerstone for both their physical and mental health care; they emphasized continuity of care and listening skills as critical components. 6 Getting connected to the physician, however, may pose a problem for patients with serious mental illness who are emerging from psychiatric crisis. Responsiveness of the treatment system and collaboration between mental health and primary care systems can enhance communication between medical and mental health care professionals and positively affect PR IM A RY ...

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Section: Discussionmentioning

confidence: 99%

Primary Care After Psychiatric Crisis: A Qualitative Analysis

Griswold¹,

Zayas²,

Pastore³

et al. 2008

The Annals of Family Medicine

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“…chronic conditions including depression Hunkeler et al, 2000;Katzelnick et al, 2000;Rost, Nutting, Smith, Werner, & Duan, 2001;Simon, Von Korff, Rutter, & Wagner, 2000;Unutzer et al, 2002;Wells et al, 2000), anxiety (Roy-Byrne, Katon, Cowley, & Russo, 2001), alcohol use disorders (Oslin et al, 2003), and physical health conditions (Aubert et al, 1998;Delaronde, 2002;Rich et al, 1995), at a lower total cost of care (Rich et al, 1995), particularly among the more severely ill (Wasson et al, 1992).…”

mentioning

confidence: 99%

Implementation of Guideline-Based Care for Depression in Primary Care

Rollman

Korsen

Schulberg

2005

Adm Policy Ment Health

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Evidence-based clinical practice guidelines for treating depression in primary care settings were developed, in part, to ensure that health services are provided in a consistent, highquality, and cost-effective manner. Yet for a variety of reasons, guideline-based primary care for depression remains the exception rather than the rule. This work provides a brief review of effective strategies used to customize and then deliver evidence-based treatment for depression in primary care settings; describes two representative case studies that illustrate locally customized collaborative care strategies for treatment delivery; and concludes with principles and implications for policy and practice based on our practical experiences.

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“…However, this requires systemic organization, such as a practice network (12), which is usually not in place in the current health care environment. Care management could be organized at a health plan level, such as through a health maintenance organization or a managed behavioral health organization (13). Current arrangements for providing mental health care, in which a primary care practice may interact with multiple managed behavioral health organizations, may make it difficult for most practices to finance and coordinate care management (14).…”

Section: Star*d and Primary Carementioning

confidence: 99%

Wishing Upon a STAR*D: The Promise of Ideal Depression Care by Primary Care Providers

Ong

Rubenstein²

2009

Psychiatric Services

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The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial found that after initial treatment, depressed patients treated in primary care settings had the same or slightly better outcomes than those treated in specialty care settings. The authors describe challenges to using the STAR*D approach and protocols in usual primary care settings. These include inadequate availability of appointments, insufficient resources for care management and treatment monitoring, and lack of payment to primary care providers for providing mental health care. Substantial reengineering of payment and delivery systems is needed in order for the STAR*D approach to be viable in primary care clinics.

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Efficacy of Nurse Telehealth Care and Peer Support in Augmenting Treatment of Depression in Primary Care

Abstract: Nurse telehealth care improves clinical outcomes of antidepressant drug treatment and patient satisfaction and fits well within busy primary care settings.

Cited by 411 publications

References 39 publications

Primary Care After Psychiatric Crisis: A Qualitative Analysis

Primary Care After Psychiatric Crisis: A Qualitative Analysis

Implementation of Guideline-Based Care for Depression in Primary Care

Wishing Upon a STAR*D: The Promise of Ideal Depression Care by Primary Care Providers

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