This document summarizes research on strategies for integrating mental health care into primary care practices. It finds that screening patients for mental health issues alone is not effective and does not change outcomes. The most effective strategy found is collaborative care, which involves primary care providers, case managers with mental health backgrounds, and supervision from mental health professionals. However, more research is still needed to identify best practices and overcome financial barriers to fully integrating services.
Determinants of Fall Risk and Injury in Hispanic Elderly Living in El Paso Community
Guillermina Solis, PhD, RN, F/GNP
Vanessa Guerrero, RN
Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013
Patients' satisfaction towards doctors treatmentmustafa farooqi
The mood of the care recipient to see if the impression (expectations) of service are met by the patient may be defined as patient satisfaction. The current perspective on service efficiency tends to be that patient treatment meets public standards and requirements in terms of interpersonal support as well as professional assistance. (Hardy et al. 1996).
For various reasons, customer satisfactions in the healthcare industry have been investigated. First it was important to decide on the extent and the degree to which patient care seekers, the meeting of drugs criteria and the continuous use of these services have effect, satisfaction as a quality of service metric, as well as allowing doctors and health services to better appreciate and use the input of the patient. (Ong et al. 2000).
Consumer satisfaction with healthcare services is a multi-panel term that refers to the core facets of treatment and suppliers, while PS medical services with the quality enhancement systems from the patient context, full control of quality and the intended outcomes of services are considered to be of primary importance (Janicijevic et al. 2013).
The Pakistani health system is being changed somewhat and there are wonderful scope for applying standard of services to health care. Patients in Pakistan now have access to increased quality health care. Obviously, the staff and staff are the most important winners of a successful health care environment of every community sector framework (Bakari et al. 2019).
The medical clinic of today's study is the product of a long and complicated war of civilization to quantify produce and study and to give thought to the thoughtful (Fullman et al. 2017).
Validity and bias in epidemiological studyAbhijit Das
Validity and bias are essential aspects of any research—a brief description of internal and external validity and different types of bias related to the epidemiological study.
Determinants of Fall Risk and Injury in Hispanic Elderly Living in El Paso Community
Guillermina Solis, PhD, RN, F/GNP
Vanessa Guerrero, RN
Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013
Patients' satisfaction towards doctors treatmentmustafa farooqi
The mood of the care recipient to see if the impression (expectations) of service are met by the patient may be defined as patient satisfaction. The current perspective on service efficiency tends to be that patient treatment meets public standards and requirements in terms of interpersonal support as well as professional assistance. (Hardy et al. 1996).
For various reasons, customer satisfactions in the healthcare industry have been investigated. First it was important to decide on the extent and the degree to which patient care seekers, the meeting of drugs criteria and the continuous use of these services have effect, satisfaction as a quality of service metric, as well as allowing doctors and health services to better appreciate and use the input of the patient. (Ong et al. 2000).
Consumer satisfaction with healthcare services is a multi-panel term that refers to the core facets of treatment and suppliers, while PS medical services with the quality enhancement systems from the patient context, full control of quality and the intended outcomes of services are considered to be of primary importance (Janicijevic et al. 2013).
The Pakistani health system is being changed somewhat and there are wonderful scope for applying standard of services to health care. Patients in Pakistan now have access to increased quality health care. Obviously, the staff and staff are the most important winners of a successful health care environment of every community sector framework (Bakari et al. 2019).
The medical clinic of today's study is the product of a long and complicated war of civilization to quantify produce and study and to give thought to the thoughtful (Fullman et al. 2017).
Validity and bias in epidemiological studyAbhijit Das
Validity and bias are essential aspects of any research—a brief description of internal and external validity and different types of bias related to the epidemiological study.
Jim Warren
National Institute for Health Innovation (NIHI)
The University of Auckland
The presentation was accompanied by this video:
http://www.youtube.com/watch?v=jbvmGqmIxXY
The goal of this webinar was to help hospice and healthcare professionals understand the history, philosophy, and practice of hospice and palliative care.
Provider Based Patient Engagement - An Essential Strategy for Population HealthPhytel
As the healthcare industry starts to re-engineer care delivery to accommodate new reimbursement models, providers on the front lines of change recognize the need for population health management and for increasing patients’ engagement in their own care. These two approaches are inextricably bound together, because it is impossible to manage the health of a population without getting patients more involved in self-management and the modification of their own risk factors. This paper discusses the fundamentals of patient engagement and shows how automation tools and web-based care management can facilitate this key process.
Anna Ratzliff, MD, PhD, Associate Director for Education, Division of Integrated Care & Public Health Department of Psychiatry & Behavioral Sciences, University of Washington
Latino Health Forum 2014
Hospice care and palliative care: Is there a difference between the two, and if so, what?
Many people still think that palliative care means hospice care. But today, hospice is only a small part of palliative care.
The goal of palliative care is to prevent or treat the symptoms and side effects of a disease; and it should be part of the picture from the first day a serious illness is diagnosed.
Dr. Jim Meadows, Director of Hospice and Palliative Care at Tennessee Oncology, will discuss this important topic. How does a family and a health care team best work together to guide a patient through a terminal illness? How does everyone continue to support quality, patient-centered, end-of-life care?
Where’s the evidence that screening for distress benefits cancer patients?James Coyne
“The case against screening for distress.” A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
Patient Directed Care; Why it’s important and what does it really mean?Spectrum Health System
Understanding the importance of effective patient centered communication for patient engagement and improved health outcomes. Will discuss the importance of patient directed care and its relationship to the quadruple aim. Will discuss the barriers and a framework for conversations that are critical to patient directed care and cultural competency.
Presentation by Annette Gardner PhD, MPH
Assistant Professor, Department of Social and Behavioral Sciences,
and the Philip R. Lee Institute for Health Policy Studies, UCSF
Treating The Whole Person: Strategies for Integrating Care. Workshop for Physicians,
Mental Health Providers, ER nurses, Psychiatric Nurses, and Students
Jim Warren
National Institute for Health Innovation (NIHI)
The University of Auckland
The presentation was accompanied by this video:
http://www.youtube.com/watch?v=jbvmGqmIxXY
The goal of this webinar was to help hospice and healthcare professionals understand the history, philosophy, and practice of hospice and palliative care.
Provider Based Patient Engagement - An Essential Strategy for Population HealthPhytel
As the healthcare industry starts to re-engineer care delivery to accommodate new reimbursement models, providers on the front lines of change recognize the need for population health management and for increasing patients’ engagement in their own care. These two approaches are inextricably bound together, because it is impossible to manage the health of a population without getting patients more involved in self-management and the modification of their own risk factors. This paper discusses the fundamentals of patient engagement and shows how automation tools and web-based care management can facilitate this key process.
Anna Ratzliff, MD, PhD, Associate Director for Education, Division of Integrated Care & Public Health Department of Psychiatry & Behavioral Sciences, University of Washington
Latino Health Forum 2014
Hospice care and palliative care: Is there a difference between the two, and if so, what?
Many people still think that palliative care means hospice care. But today, hospice is only a small part of palliative care.
The goal of palliative care is to prevent or treat the symptoms and side effects of a disease; and it should be part of the picture from the first day a serious illness is diagnosed.
Dr. Jim Meadows, Director of Hospice and Palliative Care at Tennessee Oncology, will discuss this important topic. How does a family and a health care team best work together to guide a patient through a terminal illness? How does everyone continue to support quality, patient-centered, end-of-life care?
Where’s the evidence that screening for distress benefits cancer patients?James Coyne
“The case against screening for distress.” A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
Patient Directed Care; Why it’s important and what does it really mean?Spectrum Health System
Understanding the importance of effective patient centered communication for patient engagement and improved health outcomes. Will discuss the importance of patient directed care and its relationship to the quadruple aim. Will discuss the barriers and a framework for conversations that are critical to patient directed care and cultural competency.
Presentation by Annette Gardner PhD, MPH
Assistant Professor, Department of Social and Behavioral Sciences,
and the Philip R. Lee Institute for Health Policy Studies, UCSF
Treating The Whole Person: Strategies for Integrating Care. Workshop for Physicians,
Mental Health Providers, ER nurses, Psychiatric Nurses, and Students
We are Worth the Investment. NSW Council for Intellectual Disability Conference 16-17 July 2015. Healthier Lives and the NDIS, John Feneley, Memtal Health Commissioner NSW
80 mental health interview questions with answersharrisaimee4
In this file, you can ref interview materials for mental health such as, mental health situational interview, mental health behavioral interview, mental health phone interview, mental health interview thank you letter, mental health interview tips …
80 mental health interview questions with answers free pdf download
Running head VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEM.docxjenkinsmandie
Running head: VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 1
VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 3
Veterans PTSD Causes, Treatments, and Support systems
Veterans PTSD Causes, Treatments, and Support systems
Evaluations on Post Traumatic Stress Disorder (PTSD) among veterans is imperative for a positive health outcome. The evaluations and analysis of the results ensure that barriers to treatment are addressed and have access to the available support systems. Studies carried out have depicted the successes of the treatments and support programs in the health systems to veterans. Modifications on the systems have also been recommended to combat and control PTSD. Alternative approaches such as computerized systems, natural treatment methods, and home-based systems are also essential in providing a holistic approach in PTSD treatments. Treatment methods success ensures that veterans do not fall victim to depression, which can result in chronic diseases. This can be as a result of negative health behaviors and lifestyles. Understanding the consequences of PTSD among veterans will ensure that approaches utilized offer not only treatment methods but also offer support systems for general wellbeing.
The first source focuses on the treatment and success of three-week outpatient program by “evaluating patterns and predictors of symptom change during a three-week intensive outpatient treatment for veterans with PTSD.” The study is evidence-based on statistics drawn from the program and modifications for optimal success rates. 191 veterans were the participants in the research comprising of a daily group and individual Cognitive Processing Therapy (Zalta et al., 2018). The data was analyzed from the sample cohorts in accordance with military and demographic characteristics. Measures in the study involved treatment engagement as well as comparison of pre-treatment and post-treatment changes (Zalta et al., 2018). The results showed progress in the evaluation of predictors and patterns in treatment changes. Procedures utilized involved group sessions with daily activities for the development of the treatment program. Self-report metrics were also applied in the procedures as control groups were challenging in the study. Modified and intensive outpatient (IOP) treatment to veterans showed high success levels in the program (Zalta et al., 2018).
The second source examines a new treatment in exploring the feasibility of computerized, placebo-controlled, and home-based executive function training (EFT) on psychological and neuropsychological functions. The source titled “Computer-based executive function training for combat veterans with PTSD” shows trials in assessing feasibility and predictors output. The study shows how the functions can be useful in brain activation combating PTSD in veterans. Symptoms experienced after treatment on PTSD cases are stimulated through neural and cognition reactivity, which can be contr.
Background: Behavioral health conditions are prevalent among patients in inpatient medical settings and when not adequately treated contribute to diminished treatment outcomes and quality of life. Substantial evidence has demonstrated the effectiveness of psychological interventions in addressing behavioral health conditions in a range of settings but, to a lesser extent with psychologically-based interventions delivered in inpatient medical settings. Purpose: The purpose of this paper is to increase attention on psychological interventions being delivered to patients across a broad spectrum of medical specialties in inpatient medical settings to support the implementation of interventions to address increasing patient needs. Methods: This selected, brief review of the literature sought to describe published psychologically-based interventions delivered in inpatient medical settings. A search for studies catalogued on PubMed from 2007 to 2016 was examined and studies were included in the review if they were delivered within inpatient medical settings. Two reviewers independently assessed relevant studies for criteria. Results: A total of ten articles met the inclusion criteria with interventions targeting outcomes across four primary domains: 1) pain and fatigue; 2) cognition; 3) affective/emotional and; 4) self-harm. Several articles support interventions grounded in Cognitive-Behavioral Therapy and brief psychological interventions. Most studies reported favorable outcomes for the interventions relative to controls. Conclusions: Psychologically-based interventions, especially those that integrate components of cognitive-behavioral therapy and a multidisciplinary approach, can be implemented in inpatient medical settings and may promote improved patient outcomes. However, the quality of this evidence requires formal assessment, requiring more comprehensive reviews are needed to replicate findings and clarify effectiveness of interventions.
PCOMS and an Acute Care Inpatient Unit: Quality Improvement and Reduced Readm...Barry Duncan
High psychiatric readmission rates continue while evidence suggests that care is not perceived by patients as “patient centered.” Research has focused on aftercare strategies with little attention to the inpatient treatment itself as an intervention to reduce readmission rates. Quality improvement strategies based on patient-centered care may offer an alternative. We evaluated outcomes and readmission rates using a benchmarking methodology with a naturalistic data set from an inpatient psychiatric facility (N 2,247) that used a quality-improvement strategy called systematic patient feedback. A systematic patient feedback system, the Partners for Change Outcome Management System (PCOMS), was used. Overall pre-post effect sizes were d 1.33 and d 1.38 for patients diagnosed with a mood
disorder. These effect sizes were statistically equivalent to RCT benchmarks for feedback and depression.
Readmission rates were 6.1% (30 days), 9.5% (60 days), and 16.4% (180 days), all lower than national benchmarks. We also found that patients who achieved clinically significant treatment outcomes were less likely to be readmitted. We tentatively suggest that a focus on real-time patient outcomes as well as care that is “patient centered” may provide lower readmission rates.
Running head VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEM.docxrtodd599
Running head: VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 1
VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 3
Veterans PTSD Causes, Treatments, and Support systems
Yoan Collado
Carlos Albizu University
Veterans PTSD Causes, Treatments, and Support systems
Evaluations on Post Traumatic Stress Disorder (PTSD) among veterans is imperative for a positive health outcome. The evaluations and analysis of the results ensure that barriers to treatment are addressed and have access to the available support systems. Studies carried out have depicted the successes of the treatments and support programs in the health systems to veterans. Modifications on the systems have also been recommended to combat and control PTSD. Alternative approaches such as computerized systems, natural treatment methods, and home-based systems are also essential in providing a holistic approach in PTSD treatments. Treatment methods success ensures that veterans do not fall victim to depression, which can result in chronic diseases. This can be as a result of negative health behaviors and lifestyles. Understanding the consequences of PTSD among veterans will ensure that approaches utilized offer not only treatment methods but also offer support systems for general wellbeing.
The first source focuses on the treatment and success of three-week outpatient program by “evaluating patterns and predictors of symptom change during a three-week intensive outpatient treatment for veterans with PTSD.” The study is evidence-based on statistics drawn from the program and modifications for optimal success rates. 191 veterans were the participants in the research comprising of a daily group and individual Cognitive Processing Therapy (Zalta et al., 2018). The data was analyzed from the sample cohorts in accordance with military and demographic characteristics. Measures in the study involved treatment engagement as well as comparison of pre-treatment and post-treatment changes (Zalta et al., 2018). The results showed progress in the evaluation of predictors and patterns in treatment changes. Procedures utilized involved group sessions with daily activities for the development of the treatment program. Self-report metrics were also applied in the procedures as control groups were challenging in the study. Modified and intensive outpatient (IOP) treatment to veterans showed high success levels in the program (Zalta et al., 2018).
The second source examines a new treatment in exploring the feasibility of computerized, placebo-controlled, and home-based executive function training (EFT) on psychological and neuropsychological functions. The source titled “Computer-based executive function training for combat veterans with PTSD” shows trials in assessing feasibility and predictors output. The study shows how the functions can be useful in brain activation combating PTSD in veterans. Symptoms experienced after treatment on PTSD cases are stimulated through neural and c.
Rahma Morgan ElshazlyAssignment Evidence-based Project (P.docxaudeleypearl
Rahma Morgan Elshazly
Assignment: Evidence-based Project (Part 2)
9/14/19
Matrix Worksheet Template
Use this document to complete Part 2 of the Module 2 Assessment, Evidence-Based Project, and Part 1: An Introduction to Clinical Inquiry and Part 2: Research Methodologies
Full citation of selected article
Article #1
Article #2
Article #3
Article #4
Kim, E., Furlong, M., Dowdy, E., & Felix, E. (2014). Exploring the Relative Contributions of the Strength and Distress Components of Dual-Factor Complete Mental Health Screening. Canadian Journal Of School Psychology, 29(2), 127-140. DOI: 10.1177/0829573514529567
Rückert, H. (2015). Students׳ mental health and psychological counseling in Europe. Mental Health & Prevention, 3(1-2), 34-40. DOI: 10.1016/j.mhp.2015.04.006
Dieser, R., Christenson, J., & Davis-Gage, D. (2014). Integrating flow theory and the serious leisure perspective into mental health counseling. Counseling Psychology Quarterly, 28(1), 97-111. DOI: 10.1080/09515070.2014.944883
Laux, J., Calmes, S., Moe, J., Dupuy, P., Cox, J., & Ventura, L. et al. (2018). The Clinical Mental Health Counseling Needs of Mothers in the Criminal Justice System. The Family Journal, 19(3), 291-298. DOI: 10.1177/1066480711405823
Why you chose this article and/or how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical issue of interest)
The article was considered since it is related to mental health counseling which is the clinical area of interest. The article relates to the area of interest since it focuses on mental health screening and its relationship to the dual-factor approach. The research article enriches the area under consideration by providing information on the best avenues to improve mental health outcomes.
The article was chosen since it focused on mental health and the relationship to psychological counseling among students. The article seeks to offer information on how an understanding of mental health can be applied in counseling to improve on the health outcomes.
The article focuses on mental health counseling as it relates to the serious leisure perspective and flow theory. The article relates to the clinical area of interest since it seeks to improve mental health counseling. The article acknowledges that various models have been utilized in mental health counseling and adoption of new methods is critical to success of mental health counseling.
The research deals with the mental health needs of mothers within the prison system. The study was informed by the fact that the community does not seem to care about incarcerated mothers. The study seeks to ensure that the mothers received the needed help to ensure mental wellbeing. The research contributes to the clinical area of interest since it helps shape a discussion regarding mental health in rehabilitation centers.
Brief description of the aims of the research of each peer-reviewed article
The research was aime ...
AssignmentRead a selection of your colleagues responses..docxnormanibarber20063
Assignment:
Read
a selection of your colleagues' responses.
Respond
to at least
two
of your colleagues by comparing your assessment tool to theirs. APA Format with at least two references in each responses no more than five years old
Response Post #1
Main Post - Brief Psychiatric Rating Scale
Week 2 Discussion - Assessment and Diagnosis in Psychotherapy
Main Post
Assessment Tools
It is paramount as health care professionals to be skillful in assessing clients to be able to diagnose, plan, and produce optimal care yielding full or partial recovery of the clients. Various assessment and measuring tools are available for mental health providers to help measure illness, diagnose clients, and measure a client’s response to treatment that will help supplement data obtained from the clinical interview. Though assessments usually span the entire treatment cycle, a thoughtfully constructed initial intake meeting can be a great tool to establish and reinforce the required therapeutic alliances between client and therapist, provide reassurance, ease anxiety, and enhance information gathering process required for an accurate diagnosis and suitable treatment plan (Wheeler, 2014).
Brief Psychiatric Rating Scale
The Brief Psychiatric Rating Scale (BPRS) was developed in the sixties. It is still one of the most popular behavioral rating scales/instruments use today by clinicians to quickly gather information about the possible presence and severity of various psychiatric symptoms and to assess changes in symptoms in response to medications (Zanello et al., 2013). Originally, the BPRS was a 16-item scale, it was later extended to the standard 18-item version and currently expanded to a 24-item scale to measure additional aspects of schizophrenia symptoms thereby increasing its sensitivity to psychotic and affective disorders and to be used for patients living in the community (Shafer et al., 2017).
The 18-item BPRS assess the following symptoms: somatic concern, anxiety, emotional withdrawal, conceptual disorganization, guilt feelings, tension, mannerisms and posturing, grandiosity, depressive mood, hostility, suspiciousness, hallucinatory behavior, motor retardation, uncooperativeness, unusual thought content, blunted affect, excitement, and disorientation (Yee et al., 2017). The manual of administration of the 24-item BPRS offers a more detailed semi-structured interview with more probe questions for each symptom, and providing supplementary rules for the rating (e.g., delusions) including a well-defined anchor point (Zanello et al., 2013). The recent analysis of the 24-item BPRS produced a four-factor solution: Negative Symptoms, Positive Symptoms, Manic-hostility, and Anxiety–Depression (Zanello et al., 2013). The current BPRS is rated on a seven-point Likert-type scale. A rating of “1” indicates the absence of symptoms, ratings of “2–3” indicate “very mild” to “mild” symptoms that are considered to have nonpathological inte.
Perceived Stress, Ways of Coping and Care Giving Burden among Family Caregive...iosrjce
Addressing perceived stress, ways of coping and care giving burden among family caregivers are
highly relevant in the current scenario in terms of prevention of mental illness and promotion of mental health of
people engaged in the care of their family member with schizophrenia. A community prevalence study
conducted by the IMHANS, Kerala estimated that 3.2 lakh people in the State suffer from schizophrenia (THE
HINDU, May 25, 2006).
Organizational Contex and Patient Safety: Is there a Role for Mindfulness?Heather Gilmartin
Presentation to review and define the concept of organizational context, present research on context and the relationship to healthcare associated infections, review the practice of mindfulness, discuss a role of mindfulness in patient safety.
Similar to Mental Health Disparities - Research (20)
Recovery from Addictions in Healthcare workers - by Ann Sparks (research synt...Ann Hinnen Sparks
Research Proposal of Experiential responses for various levels of health care workers who are in active recovery from addictions to mood altering substances.
Smoking cessation education intended for health care providers and the general population, alike.
Historical information, photos, glamorization of the addiction, current aids to quit, statistical data.
A case study of a woman in a hispanic community who sought healthcare for a Urinary Tract Infection, but it was discovered that she was being seriously sexually abused. How it was handled and difficulties encountered.
1. printed by
www.postersession.com
Mental Health Disparities in Primary Care Practices
Lindsey Hunt, BSN, RN ~ Jesika Moore, BSN, RN
Jennifer Peifer, BSN, RN ~ Jennifer Raines, BSN, RN ~ Ann Sparks, BSN, RN
Faculty Mentor: Elizabeth Carlson, PhD, MPH, GNP-BC, PHCNS-BC
In 2001, the Surgeon General
issued a report on the cultural,
racial, and ethical issues that
contribute to mental health
disparities in the U.S. In that
report, the recommendations
identified the necessity of
integrating mental health
careintoprimary health care; this
process would callfor research and
demonstration programs that would
strengthen the capacity of primary
care providers in the delivery of
integrated services. The purpose of
this research project is to find the
best strategies and evidence for
shifting the cultural norms of
primary care practice.
Researching mental health issues
in primary care has
demonstratedthereis still not
cohesive integration of services.
Nursing cannot tackle the PICO
question without collaborative
efforts and it will be difficult to
change cultural norms for patient
screening and treatment by nurse-
driven commitment alone.
Multidisciplinary perspective for a
collaborative approach is required
in order to yield a cohesive
integration of mental health into
primary care. Individualized case-
by-case nursing treatment plans
that include multidisciplinary
resources are required. Ultimately,
further nursing research integrating
other disciplines is still needed to
clearly identify best practices.
(P) In primary care practices,
(I) What strategies are effective at shifting cultural norms of service delivery,
(C) Versus the current compartmentalization of mental health and primary care,
(O) So that mental health care is cohesively integrated with primary care services?
In primary care practices, what strategies are effective
at shifting cultural norms of service delivery,
versus the current compartmentalization of mental health and primary care,
so that mental health care is cohesively integrated with primary care services?
Consistent findings from two
systematic reviews of primary
literature, three quasi-experimental
studies and one observational study
identify that screening for mental
health problems is an inadequate
response for cohesive integration of
mental health with primary care
practice. Varied screening
techniques were utilized in the
studies and screening did not
change the rate of antidepressants
prescribed, referrals to mental
health providers or patient
outcomes. Therefore, the answer of
what strategies are most effective in
shifting cultural norms and causing
integration between providers
remains unknown.
CHART or
PICTURE
Two librarians specializing in
nursing research were consulted
and a search was conducted of
CINAHL, PubMed, Cochrane,
Medline, PsychInfo and TRIP
databases; using the MeSh
terminology as database
appropriate. We limited our search
to English written articles published
between the years 1999-2009 and
used the keywords: Health Care
Delivery, Mental Health, Integrated,
Primary Care, strategies, Medical
Home Model. Exclusion criteria
were of articles focusing on
dementia and Alzheimer’s disease.
Of thearticles meeting the known
criteria for the PICO question, five
were selected successfully.
Background
Methods and Search
Strategy
Nursing Implications
& Recommendations
ConclusionObjectives/PICO Statement
Article1 Article2 Article 3 Article4 Article 5
Article Citation Gilbody, S., Sheldon, T., & House, A. (2008).
Screening and case-findinginstruments for
depression: a meta-
analysis.CanadianMedicalAssociation Journal,
178(8), 997-1003.
Bower, P., Gilbody, S., Richards, D., Fletcher, J., &
Sutton, A. (2006).Collaborative care for depression
in primary care: Making sense ofa
complexintervention: systematic review and meta-
regression. British Journal of Psychiatry, 189, 484-
493.
Sousa, K. H., & Zunkel, G. M. (2003). Optimizing
mental health in an academic nurse-managed clinic.
Journal of the American Academyof Nurse
Practitioners, 15(7), 313-318.
Horwitz, S. M., Hoagwood, K. E., Garner, A., Macknin,
M., Phelps, T., Wexberg, S., Foley, C., Lock, J. C.,
Hazen, J. E., Sturner, R.,Howard, B., & Kelleher, K. J.
(2008). No technological innovation is a panacea: A
case series in qualityimprovement for primary care
mental health services. Clinical Pediatrics, 47(7),
685-692.
Rost, K., Nutting, P., Smith, J., Werner, J., & Duan, N.
(2001). Improving depression outcomes in community
primary care practice: A randomized trial of the QuEST
intervention. Journal of GeneralInternal Medicine, 16,
143-149.
Type of Article Systematic Meta-Analysis Systematic review Experimental Case Study Experimental Randomized Trial
Level of Evidence Level I Level I Level IV Level III Level III
Background In many health care systems, the use of
screening questionnaires in primary care
without additional enhancement of care has
become the most commonly used quality-
improvement strategy for care of depression.
Nonetheless, the potential of these screening
instruments to improve the ability of
nonspecialists to recognize and manage
depression is substantial but cannot be
assumed under mandates of evidence-based
practice implementation.
Current management of depression is
suboptimal.Collaborative care interventions are
effective, but little is known about which aspects of
these complex interventions are essential.
When a patient presents at a primary care practice,
evaluation and treatment of mental health disorders
is not being tracked.
It is unclear weather increased awareness and
adequate recognition would improve health outcomes
if more closely tracked.
The available data for primary pediatric practices
does not demonstrate a consistent ability to
recognize, treat and follow through on patient mental
health care.
There remains a gray area between preparation of
physicians, identification of mental health issues, and
application of the tools that are most appropriate for
improving the problem.
Patients with major depression are likely to receive
substandard care and management leading to poor
outcomes.
Would an intervention program in a primary care
setting improve outcomes for patients beginning a new
treatment episode for major depression?
Purpose The purpose of this review was to determine
the specific clinical effectiveness of screening
and case-finding instruments without
additional enhancement of care in improving
the recognition, management and outcome
of depression.
The purpose of this article is to examine the
relationship between the content of collaborative
care interventions and outcomes to assist in the
design of collaborative care needed for the care of
depression.
The purpose of the article is to evaluate the initial
results of tracking and health outcomes, specifically
in mental health, for clients at an academic nursing
clinic and to describe an approach to mental health
treatment in this setting.
The purpose of this article was to evaluate the
findings of three different methods of identification of
pediatric mental health issues, in hopes to improve
healthcare outcomes as reported by clinicians.
The purpose of this article was to provide suggestions
for primary care clinics who did not employ onsite
mental health specialists.
Methodology Research Design:
Cochrane Systematic Review
Setting:
Not applicable
Population:
N=11,389 research studies
Sample:
N=16 randomized controlled studies
Variables:
•In-patient and out-patient settings
•Unselected versus high-risk patients
•U.S. studies versus other
Tools:
•Data extraction
•Two Independent Data Reviewers
•Mediation for bias
Outcomes:
•Rates of detection
•Rates of intervention/referral
•Outcomes
• < 6 months
• 6-12 months
• > 6 months
Research Design:
Systematic review
Setting:
Not applicable
Population:
N=12,398 research studies
Sample:
N=62 collaborative care studies
Variables:
•Collaborative care
•Primary care provider
•Mental health specialist
•Case management
Tools:
•Data extraction
•Two Independent Data Reviewers
•Discussion for bias
Outcomes:
•Antidepressant usage
•Reduction in depressive symptoms
Research Design:
Descriptive-survey
Setting:
Nurse-managed clinic
Population:
Audited charts at a Primary Care Clinic
Sample:
N=151 patient charts
Variables:
•Monitoring of health perceptions and quality of life
Tools:
•Mental Component Scale (MCS- comprised of:
Vitality Scale; SF-36 Social Functioning Scale; Role-
Emotional Scale; Mental Health Scale)
Outcomes:
•Rates of detection
•Adequacy of treatment
•Availability of detection facility
Research Design:
Quasi-experimental
Setting:
Ohio
Population:
Physicians and clients of pediatric clinics
Sample:
N=3 pediatric practices
N= 11 pediatricians
N= 376 parents
Variables:
•MD knowledge
•Parent participation
Tools:
•Pretest/Posttest
•Child Health And Development Interactive System
(CHADIS)
•Edinburgh Postnatal Depression Scale
Outcomes:
•Change in practice
•Physician perceptions
•Parent perceptions
Research Design:
Randomized effectiveness trial
Setting:
Community primary care practices
Population:
Primary care patients with major depression
Sample:
N=12 primary care clinics
N=479 patients
Variables:
•Antidepressants
•Prescription therapy
•Psychotherapy
•Satisfaction of care
Tools:
•Modified 23 Item Center for Epidemiologic Studies-
Depression Scale (mCES-D)
•SF-36
•Patient recall
•Satisfaction
Outcomes:
•Depressive symptoms
Statistics •Random effects pooling •Random effects meta-regression •Multi-variant analysis
•Linear T-score transformation
•Descriptive statistics •SAS 8.0
•Multivariate analysis
•T tests w/p values
Key Findings •Use of screening, questionnaires, or case-
finding instruments had a modest increase in
recognition/management of depression by
clinicians.
•Once identified with depression through a
screening tool, there was no documented
increase of antidepressant initiation.
•Positive effect of collaborative care on decreased
depressive symptoms
•Case managers with specific mental health
backgrounds and regular supervision has a
positive effect decreased symptoms
•Mental health scores for these clinic patients were
lower than the national norms, likely reflecting
unmet needs.
•This confirmed the problem but did not address the
solution.
•Comprehensive electronic systems appear to have
the potential to overcome several obstacles to
primary mental health care.
•A reasoned, organized approach to screening and
clear clinical guidelines for management of problems
need to be developed.
•Redefining staff roles significantly improved outcomes
in patients with newly identified depressive symptoms.
•Redefined roles were beneficial but impractical due to
financial constraints, more research on sustaining
these roles would improve longevity of patient
outcomes.
Clinical
Meaningfulness
The findings of this study suggest that, in
patients presenting to their primary care
practice, the utilization of a screening
tool/questionnaire/case-finding instrument
was not beneficial in the cohesive integration
and management of those with depression.
The findings of this study suggest that, in shifting
cultural norms in primary care practice
collaborative care (which includes primarycare,
case manager with a mental health background,
and regular supervision by a mental health care
professional) shows efficacy in terms of decreases
in depressive symptoms.
The findings of this study suggest that, in patients
presenting to their primary care practice, the
utilization of a screening tool was not beneficial in
cohesively integrating mental health care.
The findings of this study suggest that strategies to
effectively shift the cultural norms of current primary
care will require a great deal of education and
technical support to integrate mental health and
primary care service-delivery-systems.
The findings of this study suggest that redefining staff
roles to effectively shift cultural norms of current
primary care will require further evaluation of financial
re-distribution for maintenance of these roles and
improved health outcomes for mental health patients.
CHART or
PICTURE
Level I
40%
Level III
40%
Level IV
20%
Levels of Article Evidence
CHART or
PICTURE
CHARTor
PICTURE
CHARTor
PICTURE