Pilot Randomized Trial of a Cross-Diagnosis Collaborative Care Program for Patients With Mood Disorders

Kilbourne, M.P.H. Amy M.; Li, Decartes; Lai, Zongshan; Waxmonsky, Jeanette; Ketter, T A

doi:10.1002/da.22003

Cited by 13 publications

(12 citation statements)

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“…The improvement of psychosocial functioning was not associated to the amelioration of clinical symptoms, although we cannot exclude that an increase of patients' well-being may have positively influenced their general psychosocial functioning. Our findings are similar to those previously found with long lasting rehabilitative programs in subjects with MDD or BD,1237 suggesting that also short-term rehabilitative interventions may be considered valuable tools to improve psychosocial functioning in these populations.…”

Section: Discussionsupporting

confidence: 90%

Short-Term Psychiatric Rehabilitation in Major Depressive and Bipolar Disorders: Neuropsychological-Psychosocial Outcomes

Perna

Daccò²,

Sacco³

et al. 2017

Psychiatry Investig

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ObjectiveOur pilot study aims to investigate the efficacy of a Short-Term (4 weeks) Psychiatric Rehabilitation Program (S-T PsyRP), without specific cognitive remediation trainings, on the neuropsychological performance and psychosocial functioning of inpatients with Major Depressive Disorder (MDD) or Bipolar Disorder (BD). Published studies with similar aims are lacking.MethodsFifty-three inpatients with MDD and 27 with BD (type I/II) were included. The S-T PsyRP was usually performed as clinical practice at Villa San Benedetto Menni Hospital and included a variety of activities aimed at promoting personal autonomies, interpersonal/social skills, and self-care. At the beginning and the end of the hospitalization we evaluated: neuropsychological performance (cognitive tests on verbal/visual working memory, attention, visual-constructive ability, language fluency, and comprehension); psychosocial functioning by the Rehabilitation Areas Form (RAF, handbook VADO); illness severity by the Brief Psychiatric Rating Scale (BPRS). Repeated-measure ANOVA and Pearson's linear correlation were used.ResultsWe found significant improvement (p<0.01) in all the neuropsychological tests except for one, in 4 out of 6 RAF psychosocial areas (“involvement in ward activities”, “autonomies”, “self-care”, and “self-management of health”) and in clinical symptoms severity. No associations were found between the amelioration of clinical symptoms and neuropsychological or psychosocial improvement.ConclusionA S-T PsyRP without specific cognitive remediation trainings may improve several cognitive/functional domains in MDD or BD inpatients, probably by offering opportunities to engage in demanding problem-solving conditions and cognitively stimulating activities.

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Section: Discussionsupporting

confidence: 90%

Short-Term Psychiatric Rehabilitation in Major Depressive and Bipolar Disorders: Neuropsychological-Psychosocial Outcomes

Perna

Daccò²,

Sacco³

et al. 2017

Psychiatry Investig

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“…LG was found in previous trials 48,49 to improve physical or mental health outcomes for bipolar as well as depressive disorders. 4,37,[48][49][50][51] The study was approved by local institutional review boards and registered under clinicaltrials.gov.…”

Section: Methodsmentioning

confidence: 99%

“…Effective implementation of evidence-based practices (EBPs) into community-based settings is slow, 1 especially for mental disorders, resulting in poor outcomes and millions of research dollars wasted when EBPs fail to reach those most in need. 2 As a prime example, the Collaborative Chronic Care Model (CCM) is an EBP shown to improve physical and mental health outcomes for persons with mood disorders, 3 including depression and bipolar disorder, 4 but has not been widely implemented, a few strategies have proven effective for reducing provider and organizational barriers to CCM implementation, especially in lowerresourced community-based practices. [5][6][7][8][9][10][11][12][13][14] As a consequence, mood disorders result in significant functional impairment, high medical costs, and preventable mortality.…”

Section: Introductionmentioning

confidence: 99%

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Change in Patient Outcomes After Augmenting a Low-level Implementation Strategy in Community Practices That Are Slow to Adopt a Collaborative Chronic Care Model

et al. 2019

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Background-Implementation strategies are essential for promoting uptake of evidence-based practices and for patients to receive optimal care. Yet strategies differ substantially in their intensity and feasibility. Lower-intensity strategies (e.g., training, technical support) are commonly used, but may be insufficient for all clinics. Limited research has examined the comparative effectiveness of augmentations to low-level implementation strategies for non-responding clinics. Objectives-To compare two augmentation strategies for improving uptake of an evidencebased collaborative care model (CCM) on 18-month outcomes for patients with depression at community-based clinics non-responsive to lower-level implementation support. Research Design-Providers initially received support using a low-level implementation strategy, Replicating Effective Programs (REP). After 6 months, non-responsive clinics were randomized to add either External Facilitation (REP+EF) or External and Internal Facilitation (REP+EF/IF).

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“…LG has been shown to be equally effective in patients with co-occurring substance use and medical comorbidities [ 46 ],[ 47 ],[ 49 ],[ 52 ],[ 61 ]. Community-based providers helped to adapt LG [ 46 ]-[ 48 ], but as with many psychosocial EBPs, have not been widely implemented in smaller practices [ 62 ].…”

Section: Methodsmentioning

confidence: 99%

Protocol: Adaptive Implementation of Effective Programs Trial (ADEPT): cluster randomized SMART trial comparing a standard versus enhanced implementation strategy to improve outcomes of a mood disorders program

et al. 2014

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BackgroundDespite the availability of psychosocial evidence-based practices (EBPs), treatment and outcomes for persons with mental disorders remain suboptimal. Replicating Effective Programs (REP), an effective implementation strategy, still resulted in less than half of sites using an EBP. The primary aim of this cluster randomized trial is to determine, among sites not initially responding to REP, the effect of adaptive implementation strategies that begin with an External Facilitator (EF) or with an External Facilitator plus an Internal Facilitator (IF) on improved EBP use and patient outcomes in 12 months.Methods/DesignThis study employs a sequential multiple assignment randomized trial (SMART) design to build an adaptive implementation strategy. The EBP to be implemented is life goals (LG) for patients with mood disorders across 80 community-based outpatient clinics (N N = 1,600 patients) from different U.S. regions. Sites not initially responding to REP (defined as <50% patients receiving ≥3 EBP sessions) will be randomized to receive additional support from an EF or both EF/IF. Additionally, sites randomized to EF and still not responsive will be randomized to continue with EF alone or to receive EF/IF. The EF provides technical expertise in adapting LG in routine practice, whereas the on-site IF has direct reporting relationships to site leadership to support LG use in routine practice. The primary outcome is mental health-related quality of life; secondary outcomes include receipt of LG sessions, mood symptoms, implementation costs, and organizational change.DiscussionThis study design will determine whether an off-site EF alone versus the addition of an on-site IF improves EBP uptake and patient outcomes among sites that do not respond initially to REP. It will also examine the value of delaying the provision of EF/IF for sites that continue to not respond despite EF.Trial registrationClinicalTrials.gov identifier: NCT02151331Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0132-x) contains supplementary material, which is available to authorized users.

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Pilot Randomized Trial of a Cross-Diagnosis Collaborative Care Program for Patients With Mood Disorders

Abstract: LGCC may improve outcomes for patients regardless of mood diagnosis, potentially providing a feasible and generalizable chronic care model for routine practice settings.

Cited by 13 publications

References 32 publications

Short-Term Psychiatric Rehabilitation in Major Depressive and Bipolar Disorders: Neuropsychological-Psychosocial Outcomes

Short-Term Psychiatric Rehabilitation in Major Depressive and Bipolar Disorders: Neuropsychological-Psychosocial Outcomes

Change in Patient Outcomes After Augmenting a Low-level Implementation Strategy in Community Practices That Are Slow to Adopt a Collaborative Chronic Care Model

Protocol: Adaptive Implementation of Effective Programs Trial (ADEPT): cluster randomized SMART trial comparing a standard versus enhanced implementation strategy to improve outcomes of a mood disorders program

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