scholarly journals Depression and Anxiety Screens as Simultaneous Predictors of 10-Year Incidence of Diabetes Mellitus in Older Adults in Primary Care

2016 ◽  
Vol 65 (2) ◽  
pp. 294-300 ◽  
Author(s):  
Tasneem Khambaty ◽  
Christopher M. Callahan ◽  
Anthony J. Perkins ◽  
Jesse C. Stewart
Keyword(s):  
Diabetes Mellitus ◽  
Older Adults ◽  
Primary Care ◽  
Depression And Anxiety

scholarly journals Engagement and Clinical Improvement Among Older Adult Primary Care Patients Using a Mobile Intervention for Depression and Anxiety: Case Studies (Preprint)

2019 ◽  
Author(s):  
L Casey Orr ◽  
Andrea K Graham ◽  
David C Mohr ◽  
Carolyn J Greene
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Health Interventions ◽  
Depression And Anxiety ◽  
Health Technologies ◽  
Mental Health Interventions ◽  
Mobile Intervention ◽  
Study Participants

BACKGROUND Technology-based mental health interventions are an increasingly attractive option for expanding access to mental health services within the primary care system. Older adults are among the groups that could potentially benefit from the growing ubiquity of technology-based mental health interventions; however, older adults are perceived to be averse to using technology and have reported barriers to use. OBJECTIVE The aim of this paper is to present a case study of 3 participants from a clinical trial evaluating IntelliCare, an evidence-based mobile intervention for depression and anxiety, among adults recruited from primary care clinics. Our report of these 3 participants, who were aged 60 years or older, focuses on their engagement with the IntelliCare service (ie, app use, coach communication) and clinical changes in depression or anxiety symptoms over the intervention period. METHODS The 3 case study participants were offered IntelliCare with coaching for 8 weeks. The intervention consisted of 5 treatment intervention apps that support a variety of psychological skills, a <i>Hub</i> app that contained psychoeducational content and administered weekly assessments, and coaching for encouragement, accountability, and technical assistance as needed. The 3 case study participants were selected to reflect the overall demographics of participants within the trial and because their interactions with IntelliCare provided a good illustration of varied experiences regarding engagement with the intervention. RESULTS The 3 participants’ unique experiences with the intervention are described. Despite potential barriers and experiencing some technical glitches, the participants showed proficient ability to use the apps, high levels of participation through frequent app use and coach interaction, and decreased depression and anxiety scores. At the end of the 8-week intervention, each of these 3 participants expressed great enthusiasm for the benefit of this program through feedback to their coach, and they each identified a number of ways they had seen improvements in themselves. CONCLUSIONS These 3 cases provide examples of older individuals who engaged with and benefitted from the IntelliCare service. Although the results from these 3 cases may not generalize to others, they provide an important, informed perspective of the experiences that can contribute to our understanding of how older adults use and overcome barriers to mental health technologies. The findings also contribute toward the ultimate goal of ensuring that the IntelliCare intervention is appropriate for individuals of all ages.

scholarly journals Engagement and Clinical Improvement Among Older Adult Primary Care Patients Using a Mobile Intervention for Depression and Anxiety: Case Studies

10.2196/16341 ◽  
2020 ◽  
Vol 7 (7) ◽  
pp. e16341
Author(s):  
L Casey Orr ◽  
Andrea K Graham ◽  
David C Mohr ◽  
Carolyn J Greene
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Health Interventions ◽  
Depression And Anxiety ◽  
Health Technologies ◽  
Mental Health Interventions ◽  
Mobile Intervention ◽  
Study Participants

Background Technology-based mental health interventions are an increasingly attractive option for expanding access to mental health services within the primary care system. Older adults are among the groups that could potentially benefit from the growing ubiquity of technology-based mental health interventions; however, older adults are perceived to be averse to using technology and have reported barriers to use. Objective The aim of this paper is to present a case study of 3 participants from a clinical trial evaluating IntelliCare, an evidence-based mobile intervention for depression and anxiety, among adults recruited from primary care clinics. Our report of these 3 participants, who were aged 60 years or older, focuses on their engagement with the IntelliCare service (ie, app use, coach communication) and clinical changes in depression or anxiety symptoms over the intervention period. Methods The 3 case study participants were offered IntelliCare with coaching for 8 weeks. The intervention consisted of 5 treatment intervention apps that support a variety of psychological skills, a Hub app that contained psychoeducational content and administered weekly assessments, and coaching for encouragement, accountability, and technical assistance as needed. The 3 case study participants were selected to reflect the overall demographics of participants within the trial and because their interactions with IntelliCare provided a good illustration of varied experiences regarding engagement with the intervention. Results The 3 participants’ unique experiences with the intervention are described. Despite potential barriers and experiencing some technical glitches, the participants showed proficient ability to use the apps, high levels of participation through frequent app use and coach interaction, and decreased depression and anxiety scores. At the end of the 8-week intervention, each of these 3 participants expressed great enthusiasm for the benefit of this program through feedback to their coach, and they each identified a number of ways they had seen improvements in themselves. Conclusions These 3 cases provide examples of older individuals who engaged with and benefitted from the IntelliCare service. Although the results from these 3 cases may not generalize to others, they provide an important, informed perspective of the experiences that can contribute to our understanding of how older adults use and overcome barriers to mental health technologies. The findings also contribute toward the ultimate goal of ensuring that the IntelliCare intervention is appropriate for individuals of all ages.

scholarly journals Potentially Inappropriate Prescribing in Older Adults with Hypertension or Diabetes Mellitus and Hypertension in a Primary Care Setting in Bahrain

2018 ◽  
Vol 27 (3) ◽  
pp. 241-249 ◽  
Author(s):  
Khalid A.J. Al Khaja ◽  
Husain Ahmed Isa ◽  
Sindhan Veeramuthu ◽  
Reginald P. Sequeira
Keyword(s):  
Diabetes Mellitus ◽  
Older Adults ◽  
Primary Care ◽  
General Practitioners ◽  
Primary Care Physicians ◽  
Inappropriate Prescribing ◽  
Family Physicians ◽  
Continuous Variables ◽  
Potentially Inappropriate Prescribing ◽  
The Difference

Objectives: The aims of this study were to evaluate: (1) the prevalence and types of potentially inappropriate prescribing in older adults with hypertension or diabetes mellitus and hypertension, and (2) whether or not differences in the training of primary care physicians were associated with potentially inappropriate prescribing. Materials and Methods: Primary care prescriptions issued by family physicians and general practitioners were audited using Screening Tool of Older Persons’ Prescriptions criteria (version 1), with 18 out of 65 applicable criteria. Descriptive statistics were used to test the difference between proportions, and two-tailed t test was used for continuous variables. Results: A total of 2,090 outpatient prescriptions were written during the study period; of these, 712 (34.1%) were potentially inappropriate. The mean number of drugs per patient was 6.03 (±2.5). Of the 712 prescriptions, 543 (76.3%) were used for the treatment of acute medical illnesses. The most common examples of potentially inappropriate prescribing were: orphenadrine (n = 174; 8.33%), long-term nonsteroidal anti-inflammatory drugs for > 3 months (n = 150; 7.18%), proton pump inhibitors for > 8 weeks (n = 135; 6.46%), antihypertensive therapy duplication (n = 59; 2.82%), long-acting glyburide (n = 48; 2.29%), and chlordiazepoxide for > 1 month (n = 44; 2.11%). Family physicians showed a greater tendency toward potentially inappropriate prescribing compared to general practitioners, but the difference was nonsignificant (n = 514 [34.75%] vs. n = 162 [31.3%]; p = 0.16). Conclusions: The prevalence of potentially inappropriate prescribing (i.e., 34.1%) was within the spectrum reported worldwide and unrelated to the training backgrounds of physicians. Most of the identified potentially inappropriate prescribing (76.3%) in older adults was associated with medications for acute medical illnesses and hence inappropriate polypharmacy should be discouraged.

scholarly journals Diagnosing and treating depression and anxiety in patients with cardiovascular disorders and diabetes mellitus in primary healthcare: is training of physicians enough for improvement?

2021 ◽  
Author(s):  
Olga Anatolevna Karpenko ◽  
Oleg Gennadyevich Melikhov ◽  
Andrej Alexandrovich Tyazhelnikov ◽  
Georgiy Petrovich Kostyuk
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Primary Healthcare ◽  
Pharmacological Treatment ◽  
Anxiety And Depression ◽  
Depression And Anxiety ◽  
Screening Criteria ◽  
Psychopharmacological Treatment ◽  
Independent Expert ◽  
Care Facilities

INTRODUCTION. Common mental disorders - anxiety and depression - are prevalent among patients with cardiovascular disease (CVD) and diabetes mellitus type 2 (DM) and can negatively influence treatment outcomes and healthcare expenses. Despite the importance of management of depression and anxiety in primary care facilities, the diagnostics and treatment of these disorders remain insufficient in the Russian Federation. OBJECTIVE. To explore whether the rates of referrals to psychiatrist and indicated pharmacological treatment received due to depression or anxiety among patients with CVD and DM will significantly change in the primary healthcare facility after the training of primary care physicians (PCPhs) to deal with comorbid depression and anxiety (including the algorithm for referral to a psychiatrist). METHODS. Patients in primary care outpatient settings with diagnoses of CVD and DM passed screening on anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), and information about the indicated treatment for anxiety or depression was collected when present (Sample 1: n = 400). The educational programme for PCPhs on diagnostics of anxiety and depression was then performed, and PCPhs were instructed to refer patients with HADS 7 to a psychiatrist. After the training, the second sample was collected (Sample 2: n = 178) using the same assessments as for Sample 1. The independent expert (psychiatrist) evaluated whether the patients had received the indicated pharmacological treatment, according to the screening criteria used in the study for anxiety and depression for both samples. RESULTS. The proportions of patients with borderline abnormal and abnormal HADS scores ( 7) were 365 (91.2%) and 164 (92.1%) in Sample 1 and Sample 2, respectively. In Sample 1, among patients with HADS 7, 119 (29.8%) received psychopharmacological treatment, but in only 46 (38.7%) cases it was indicated in compliance with the screening criteria. In Sample 2, among patients with HADS 7, 59 (33.1%) received psychopharmacological treatment, and in only 14 (23.7%) cases was it indicated in compliance with the screening criteria. The differences in the indicated pharmacological treatment were not statistically significant, and no one from Sample 2 with HADS 7 met a psychiatrist through PCPh referral. CONCLUSIONS. Anxiety and depression are prevalent in patients with CVD and DM treated in primary care facilities, but these patients may not be receiving the indicated pharmacological treatment. Barriers to referral and the use of psychiatric consultation exist despite the focused training of PCPhs and the straightforward referral protocol provided.

908-P: Predictive Model for Glycemic Level of People with Diabetes Mellitus Using Data Extracted from Electronic Medical Records in Primary Care

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 908-P
Author(s):  
SOSTENES MISTRO ◽  
THALITA V.O. AGUIAR ◽  
VANESSA V. CERQUEIRA ◽  
KELLE O. SILVA ◽  
JOSÉ A. LOUZADO ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Predictive Model ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Glycemic Level ◽  
Using Data

Addressing COVID-19 Worry and Social Isolation in Home-Based Primary Care

2020 ◽  
Author(s):  
Rachel Elizabeth Weiskittle ◽  
Michelle Mlinac ◽  
LICSW Nicole Downing
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Social Workers ◽  
Social Isolation ◽  
Mental Health Providers ◽  
Health Providers ◽  
Home Based Primary Care ◽  
Home Based ◽  
Socially Isolated

Social distancing measures following the outbreak of COVID-19 have led to a rapid shift to virtual and telephone care. Social workers and mental health providers in VA home-based primary care (HBPC) teams face challenges providing psychosocial support to their homebound, medically complex, socially isolated patient population who are high risk for poor health outcomes related to COVID-19. We developed and disseminated an 8-week telephone or virtual group intervention for front-line HBPC social workers and mental health providers to use with socially isolated, medically complex older adults. The intervention draws on skills from evidence-based psychotherapies for older adults including Acceptance and Commitment Therapy, Cognitive-Behavioral Therapy, and Problem-Solving Therapy. The manual was disseminated to VA HBPC clinicians and geriatrics providers across the United States in March 2020 for expeditious implementation. Eighteen HBPC teams and three VA Primary Care teams reported immediate delivery of a local virtual or telephone group using the manual. In this paper we describe the manual’s development and clinical recommendations for its application across geriatric care settings. Future evaluation will identify ways to meet longer-term social isolation and evolving mental health needs for this patient population as the pandemic continues.

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