Integrated Care: A Disruptive Innovation for Extending Psychiatric Expertise to Primary Care Practices

Adaji, Akuh

doi:10.1016/j.mayocpiqo.2018.03.004

Cited by 5 publications

(7 citation statements)

References 27 publications

(35 reference statements)

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“…In 2018, Penn Medicine’s Department of Psychiatry and Primary Care Service Line initiated a staged and adapted implementation of the evidence-based Collaborative Care Model—referred to as the Penn Integrated Care program (PIC) [ 40 ]—an approach for managing psychiatric disorders in primary care that combines mental and physical health services into a single setting [ 41 , 42 ]. Healthcare professionals from multiple disciplines work together to coordinate care and treat patients.…”

Section: General Methodsmentioning

confidence: 99%

A pilot study of participatory and rapid implementation approaches to increase depression screening in primary care

et al. 2021

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Background Most individuals with depression go unidentified and untreated. In 2016 the US Preventive Services Task Force released guidelines recommending universal screening in primary care to identify patients with depression and to link them to treatment. Feasible, acceptable, and effective strategies to implement these guidelines are needed. Methods This three-phased study employed rapid participatory methods to design and test strategies to increase depression screening at Penn Medicine, a large health system with 90 primary care practices. First, researchers solicited ideas and barriers from stakeholders to increase screening using an innovation tournament—a crowdsourcing method that invites stakeholders to submit ideas to address a workplace challenge. Second, a panel of stakeholders and scientists deliberated over and ranked the tournament ideas. An instant runoff election was held to select the winning idea. Third, the research team piloted the winning idea in a primary care practice using rapid prototyping, an approach that quickly refines and iterates strategy designs. Results The innovation tournament yielded 31 ideas and 32 barriers from diverse stakeholders (12 primary care physicians, 10 medical assistants, 4 nurse practitioners, 2 practice managers, and 4 patient support assistants). A panel of 6 stakeholders and scientists deliberated on the ideas and voted for patient self-report (i.e., through tablet computers, text message, or an online patient portal) as the winning idea. The research team rapid prototyped tablets in one primary care practice with one physician over 5 five-hour shifts to examine the feasibility, acceptability, and effectiveness of the strategy. Most patients, the physician, and medical assistants found the tablets acceptable and feasible. However, patient support assistants struggled to incorporate them in their workflow and expressed concerns about scaling up the process. Depression screening rates were higher using tablets compared to usual care; follow-up was comparable between tablets and usual care. Conclusions Rapid participatory methods engaged and amplified the voices of diverse stakeholders in primary care. These methods helped design an acceptable and feasible implementation strategy that showed promise for increasing depression screening in a primary care setting. The next step is to evaluate the strategy in a randomized controlled trial across primary care practices.

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Section: General Methodsmentioning

confidence: 99%

A pilot study of participatory and rapid implementation approaches to increase depression screening in primary care

et al. 2021

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“…Context Penn Medicine's Department of Psychiatry and Primary Care Service Line initiated a staged and adapted implementation of the evidence-based Collaborative Care Model-referred to as the Penn Integrated Care program (PIC; 39)-an approach for managing psychiatric disorders in primary care that combines mental and physical health services into a single setting (40,41). Healthcare professionals from multiple disciplines work together to coordinate and treat patients.…”

Section: General Methodsmentioning

confidence: 99%

A Pilot Study of Participatory and Rapid Implementation Approaches to Increase Depression Screening in Primary Care

Last

Buttenheim

Futterer

et al. 2021

Preprint

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Background: Most individuals with depression go unidentified and untreated. In 2016 the US Preventive Services Task Force released guidelines recommending universal screening in primary care to identify patients with depression and to link them to treatment. Feasible, acceptable, and effective strategies to implement these guidelines are needed. Methods: This three-phased study employed rapid participatory methods to design and test strategies to increase depression screening at Penn Medicine, a large health system with 90 primary care practices. First, researchers solicited ideas and barriers from stakeholders to increase screening using an innovation tournament—a crowdsourcing method that invites stakeholders to submit ideas to address a workplace challenge. Second, a panel of stakeholders and scientists deliberated over and ranked the tournament ideas. An instant runoff election was held to select the winning idea. Third, the research team piloted the winning idea in a primary care practice using rapid prototyping, an approach that quickly refines and iterates strategy designs. Results: The innovation tournament yielded 31 ideas and 32 barriers from diverse stakeholders (12 primary care physicians, 10 medical assistants, 4 nurse practitioners, 2 practice managers, and 4 patient support assistants). A panel of 6 stakeholders and scientists deliberated on the ideas and voted for patient self-report (i.e., through tablet computers, text message, or an online patient portal) as the winning idea. The research team rapid prototyped tablets in one primary care practice with one physician over 5 five-hour shifts to examine the feasibility, acceptability, and effectiveness of the strategy. Most patients, the physician, and medical assistants found the tablets acceptable and feasible. However, patient support assistants struggled to incorporate them in their workflow and expressed concerns about scaling up the process. Depression screening rates were higher using tablets compared to usual care; follow-up was comparable between tablets and usual care. Conclusions: Rapid participatory methods engaged and amplified the voices of diverse stakeholders in primary care. These methods helped design an acceptable and feasible implementation strategy that showed promise for increasing depression screening in a primary care setting. The next step is to evaluate the strategy in a randomized controlled trial across primary care practices.

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“…Disruptive innovation is a cornerstone of various disciplines, particularly in the business world, where paradigm‐altering approaches are often lauded 1 . Disruptive psychiatry , as a construct, can be considered to embody such an approach by the pursuit of innovations within the field which test boundaries and shake up the status quo.…”

Section: Disrupting the Current Paradigm With Innovationmentioning

confidence: 99%

“…To successfully innovate in the field of psychiatry for sustained patient benefit, the above approaches are advised to occur within an integrative biopsychosocial treatment model, which still emphasizes human and biophilic connection 24 . This is critical to address the interface between interrelated biological systems, and address complex psychosocial elements 1 . If we act boldly now with an open‐minded pursuit of disruptive innovation, the field of psychiatry can foundationally transform over the next decade.…”

Section: Final Commentmentioning

confidence: 99%

“…Disruptive innovation is a cornerstone of various disciplines, particularly in the business world, where paradigm-altering approaches are often lauded. 1 Disruptive psychiatry, as a construct, can be considered to embody such an approach by the pursuit of innovations within the field which test boundaries and shake up the status quo. Given the importance of addressing the current mental health pandemic, and the deficit of highly effective pharmacological treatments for various conditions, innovative disruptive thinking is required to provide more effective treatment options.…”

Section: Disrupting the Current Paradigm With Innovationmentioning

confidence: 99%

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Disruptive innovation in psychiatry

Sarris

2022

Annals of the New York Academy of Sciences

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Disruptive innovation is a cornerstone of various disciplines, particularly in the business world, where paradigmaltering approaches are often lauded. As a construct, disruptive psychiatry can be considered to embody such an approach by the pursuit of innovations within the field which test boundaries and shake up the status quo. Given the importance of addressing the current mental health pandemic, and the deficit of highly effective pharmacological treatments for various conditions, innovative disruptive thinking is required. Significant promise exists via the provision of potentially more effective innovative therapeutic options, including digital interventions, psychedelic medicines, microbiome-altering treatments, brain stimulation technology, and nanotechnology-based delivery systems. These approaches may be further advanced by individualization of the treatments using computational technology (including quantum computing, machine learning, and artificial intelligence) and genomics.

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Integrated Care: A Disruptive Innovation for Extending Psychiatric Expertise to Primary Care Practices

Cited by 5 publications

References 27 publications

A pilot study of participatory and rapid implementation approaches to increase depression screening in primary care

A pilot study of participatory and rapid implementation approaches to increase depression screening in primary care

A Pilot Study of Participatory and Rapid Implementation Approaches to Increase Depression Screening in Primary Care

Disruptive innovation in psychiatry

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