scholarly journals Long-Term Clinical Outcomes of Care Management for Chronically Depressed Primary Care Patients: A Report From the Depression in Primary Care Project

2010 ◽  
Vol 8 (5) ◽  
pp. 387-396 ◽  
Author(s):  
M. S. Klinkman ◽  
S. Bauroth ◽  
S. Fedewa ◽  
K. Kerber ◽  
J. Kuebler ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Outcomes ◽  
Care Management ◽  
Outcomes Of Care ◽  
Care Project ◽  
Primary Care Patients

scholarly journals Depression Outcomes in Smokers and Nonsmokers: Comparison of Collaborative Care Management Versus Usual Care

2019 ◽  
Vol 10 ◽  
pp. 215013271986126 ◽  
Author(s):  
Joseph A. Akambase ◽  
Nathaniel E. Miller ◽  
Gregory M. Garrison ◽  
Paul Stadem ◽  
Heather Talley ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Outcomes ◽  
Collaborative Care ◽  
Clinical Remission ◽  
Care Management ◽  
Negative Impact ◽  
Reference Group ◽  
Care Practice ◽  
Treatment Type ◽  
Primary Care Patients

Background: Depression is common in the primary care setting and tobacco use is more prevalent among individuals with depression. Recent research has linked smoking to poorer outcomes of depression treatment. We hypothesized that in adult primary care patients with the diagnosis of depression, current smoking would have a negative impact on clinical outcomes, regardless of treatment type (usual primary care [UC] vs collaborative care management [CCM]). Methods: A retrospective chart review study of 5155 adult primary care patients with depression in a primary care practice in southeast Minnesota was completed. Variables obtained included age, gender, marital status, race, smoking status, initial Patient Health Questionnaire–9 (PHQ-9), and 6-month PHQ-9. Clinical remission (CR) was defined as 6-month PHQ-9 <5. Persistent depressive symptoms (PDS) were defined as PHQ-9 ≥10 at 6 months. Treatment in both CCM and UC were compared. Results: Using intention to treat analysis, depressed smokers treated with CCM were 4.60 times as likely (95% CI 3.24-6.52, P < .001) to reach CR and were significantly less likely to have PDS at 6 months (adjusted odds ratio [AOR] 0.19, 95% CI 0.14-0.25, P < .001) compared with smokers in UC. After a 6-month follow-up, depressed smokers treated with CCM were 1.75 times as likely (95% CI 1.18-2.59, P = .006) to reach CR and were significantly less likely to have PDS (AOR 0.45, 95% CI 0.31-0.64, P < .001) compared with smokers in UC. Conclusions: CCM significantly improved depression outcomes for smokers at 6 months compared with UC. However, in the UC group, smoking outcomes were not statistically different at 6 months for either remission or PDS. Also, nonsmokers in CCM had the best clinical outcomes at 6 months in both achieving clinical remission and reduction of PDS when compared with smokers in UC as the reference group.

scholarly journals Evaluation of the 13-item Hypomania Checklist and a brief 3-item manic features questionnaire in primary care

2017 ◽  
Vol 41 (4) ◽  
pp. 187-191 ◽  
Author(s):  
Sukhmeet Singh ◽  
Paul Scouller ◽  
Daniel J. Smith
Keyword(s):  
Primary Care ◽  
Bipolar Disorder ◽  
Clinical Implications ◽  
Predictive Values ◽  
Mean Delay ◽  
Item Questionnaire ◽  
Primary Care Patients ◽  
The Mean ◽  
Recorded Diagnosis

Aims and methodThe mean delay for bipolar disorder diagnosis is 10 years. Identification of patients with previous hypomania is challenging, sometimes resulting in misdiagnosis. The aims of this study were: (a) to estimate the proportion of primary care patients with depression currently taking antidepressants who have undiagnosed bipolar disorder and (b) to compare a brief 3-item manic features questionnaire with the Hypomania Checklist (HCL-13). The sample comprised patients with a recorded diagnosis of depression, either on long-term antidepressant therapy or with previous multiple courses of antidepressants.ResultsOf 149 participants assessed, 24 (16.1%) satisfied criteria for bipolar disorder. Areas under the curve (AUC) for the 3-item questionnaire and the HCL-13 were similar (0.79 and 0.72, respectively) but positive predictive values (PPV) were low.Clinical implicationsBipolar disorder may be underdiagnosed in primary care. A 3-item questionnaire could be used by general practitioners to screen for bipolar disorder in their patients with depression.

Obesity management by general practitioners: the unavoidable necessity

2015 ◽  
Vol 21 (4) ◽  
pp. 366 ◽  
Author(s):  
Sarah Jansen ◽  
Ben Desbrow ◽  
Lauren Ball
Keyword(s):  
Primary Care ◽  
Weight Management ◽  
National Health ◽  
Public Health Issue ◽  
Management Support ◽  
Obesity Management ◽  
Management Interventions ◽  
Primary Care Patients ◽  
Insufficient Time

Nearly 62% of primary care patients are overweight or obese, and obesity is now a National Health Priority Area. Weight management interventions in primary care currently generate little more than 1 kg of weight loss per patient over a 2-year period. Consequently, further strategies are required to improve the effectiveness of weight management in primary care. The National Health and Medical Research Council (NHMRC) have released updated guidelines for the management of overweight and obese patients in primary care. However, there is some disconnect between establishment of guidelines and their implementation in practice. Barriers to GPs using guidelines for the management of obesity include low self-efficacy, perceived insufficient time in consultations and the challenge of raising the topic of a patient’s weight. Nonetheless, patients prefer to receive weight management support from GPs rather than other health professionals, suggesting that the demand on GPs to support patients in weight management will continue. GPs cannot afford to side-line obesity management, as obesity is likely to be the most prevalent modifiable risk factor associated with patients’ long-term health. Without further strategies to support GPs in their management of patients’ weight, obesity will continue to be an expensive and long-term public health issue.

Improving service delivery to cancer survivors in primary care settings project.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 52-52
Author(s):  
Lewis E. Foxhall
Keyword(s):  
Primary Care ◽  
Colon Cancer ◽  
Cancer Survivors ◽  
Care Management ◽  
Survivorship Care ◽  
Behavioral Counseling ◽  
Colon Cancers ◽  
Screening And Prevention

52 Background: An estimated 14 million cancer survivors live in the U.S., with up to 18 million expected by 2020. Methods: We established a partnership with three Texas family medicine training programs to provide interactive educational sessions focused on survivors’ needs for primary prevention and lifestyle counseling, surveillance and screening, and prevention of psychosocial and long-term effects. Surveys assessing resident and PCP knowledge, self-efficacy, and practices regarding survivorship care management were administered through REDCap in July 2016 and 2017. Results: Baseline response rates were 64% (60/94) and 59% (55/93) at follow-up. Compared to baseline, providers at follow-up were significantly more likely to report being “very confident” in their knowledge about: appropriate surveillance to detect recurrent breast cancer (5% vs 24%; p = 0.01); long-term physical effects of colon cancer and its treatment (8% vs 18%; p = 0.04); potential adverse psychosocial outcomes of colon cancer treatment (24% vs 44%; p = 0.01); appropriate screening for new primary breast (29% vs 61%; p < 0.001) and colon cancers (27% vs 51%; p = 0.01); and preventive lifestyle/behavioral counseling for breast (39% vs 59%; p = 0.03) and colon cancers (37% vs 59%; p = 0.01). Participants were also more likely to “strongly agree” that they have the skills necessary to: provide follow-up care related to the colon cancer and its treatment (10% vs 28%; p = 0.02); initiate appropriate screening for other new primary cancers for breast (28% vs 56%; p < 0.01) and colon cancer survivors (28% vs 58%; p < 0.01); and conduct lifestyle/behavioral counseling to prevent cancer for breast (33% vs 53%; p = 0.03) and colon cancer survivors (34% vs 55%; p = 0.02). Conclusions: Preliminary results suggest our project has improved provider knowledge, self-efficacy, and practices regarding survivorship care management, with the highest levels in areas pertaining to screening and prevention. We aim to continue this trajectory of improvement in subsequent project years and disseminate the project to other primary care training sites in Texas and beyond.

scholarly journals Collaborative Care Management Associated With Improved Depression Outcomes in Patients With Personality Disorders, Compared to Usual Primary Care

2018 ◽  
Vol 9 ◽  
pp. 215013271877326 ◽  
Author(s):  
Jeremy J. Solberg ◽  
Mark E. Deyo-Svendsen ◽  
Kelsey R. Nylander ◽  
Elliot J. Bruhl ◽  
Dagoberto Heredia ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Clinical Outcomes ◽  
Collaborative Care ◽  
Care Management ◽  
Term Treatment ◽  
Study Cohort ◽  
Long Term Treatment ◽  
Patient Health ◽  
Short And Long Term

Background: The use of a collaborative care management (CCM) model can dramatically improve short- and long-term treatment outcomes for patients with major depressive disorder (MDD). Patients with comorbid personality disorder (PD) may experience poorer treatment outcomes for MDD. Our study seeks to examine the differences in MDD treatment outcomes for patients with comorbid PD when using a CCM approach rather than usual care (UC). Methods: In our retrospective cohort study, we reviewed the records of 9614 adult patients enrolled in our depression registry with the clinical diagnosis MDD and the diagnosis of PD (Yes/No). Clinical outcomes for depression were measured with Patient Health Questionnaire–9 (PHQ-9) scores at 6 months. Results: In our study cohort, 59.4% of patients (7.1% of which had comorbid PD) were treated with CCM, as compared with 40.6% (6.8% with PD) treated with UC. We found that the presence of a PD adversely affected clinical outcomes of remission within both groups, however, at 6 months patients with PD had significantly lower MDD remission rates when treated with UC as compared with those treated with CCM (11.5% vs 25.2%, P = .002). Patients with PD in the UC group were also noted to have an increased rate of persistent depressive symptoms (PHQ-9 score ≥10) at 6 months as compared with those in the CCM group (67.7% vs 51.7%, P = .004). Conclusions: In patients with comorbid MDD and PD, clinical outcomes at 6 months were significantly improved when treated with CCM compared with UC. This finding is encouraging and supports the idea that CCM is an effective model for caring for patients with behavioral concerns, and it may be of even greater benefit for those patients being treated for comorbid behavioral health conditions.

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