scholarly journals Applying the Principles for Digital Development: Case Study of a Smartphone App to Support Collaborative Care for Rural Patients With Posttraumatic Stress Disorder or Bipolar Disorder (Preprint)

2018 ◽  
Author(s):  
Amy M Bauer ◽  
Sarah Hodsdon ◽  
Jared M Bechtel ◽  
John C Fortney
Keyword(s):  
Collaborative Care ◽  
Stress Disorder ◽  
Smartphone App ◽  
Web Based ◽  
Health Technologies ◽  
Care Managers ◽  
System Usability ◽  
Digital Development ◽  
Psychiatric Conditions ◽  
Rural Patients

BACKGROUND Despite a proliferation of patient-facing mobile apps for mental disorders, there is little literature guiding efforts to incorporate mobile tools into clinical care delivery and integrate patient-generated data into care processes for patients with complex psychiatric disorders. OBJECTIVE The aim of this study was to seek to gain an understanding of how to incorporate a patient-provider mobile health (mHealth) platform to support the delivery of integrated primary care–based mental health services (Collaborative Care) to rural patients with posttraumatic stress disorder and/or bipolar disorder. METHODS Using the Principles for Digital Development as a framework, we describe our experience designing, developing, and deploying a mobile system to support Collaborative Care. The system consists of a patient-facing smartphone app that integrates with a Web-based clinical patient registry used by behavioral health care managers and consulting psychiatrists. Throughout development, we engaged representatives from the system’s two user types: (1) providers, who use the Web-based registry and (2) patients, who directly use the mobile app. We extracted mobile metadata to describe the early adoption and use of the system by care managers and patients and report preliminary results from an in-app patient feedback survey that includes a System Usability Scale (SUS). RESULTS Each of the nine Principles for Digital Development is illustrated with examples. The first 10 patients to use the smartphone app have completed symptom measures on average every 14 days over an average period of 20 weeks. The mean SUS score at week 8 among four patients who completed this measure was 91.9 (range 72.5-100). We present lessons learned about the technical and training requirements for integration into practice that can inform future efforts to incorporate health technologies to improve care for patients with psychiatric conditions. CONCLUSIONS Adhering to the Principles for Digital Development, we created and deployed an mHealth system to support Collaborative Care for patients with complex psychiatric conditions in rural health centers. Preliminary data among the initial users support high system usability and show promise for sustained use. On the basis of our experience, we propose five additional principles to extend this framework and inform future efforts to incorporate health technologies to improve care for patients with psychiatric conditions: design for public health impact, add value for all users, test the product and the process, acknowledge disruption, and anticipate variability.

Sex Differences in Anxiety Disorders

2019 ◽  
pp. 404-432
Author(s):  
Teresa A. Piggott ◽  
Alexandra N. Duran ◽  
Isha Jalnapurkar ◽  
Tyler Kimm ◽  
Stephanie Linscheid ◽  
...  
Keyword(s):  
Sex Differences ◽  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Stress Disorder ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Considerable Research ◽  
Psychosocial Influences ◽  
Psychiatric Conditions ◽  
The Impact

Women are more likely than men to meet lifetime criteria for an anxiety disorder. Moreover, anxiety is a risk factor for the development of other psychiatric conditions, including major depression. Numerous studies have identified evidence of sex differences in anxiety disorders, and there is considerable research concerning factors that may contribute to vulnerability for anxiety in females. In addition to psychosocial influences, biological components such as the female reproductive hormone cycle have also been implicated. Although psychotropic medication is more likely to be prescribed to women, there is little controlled data available concerning sex differences in the efficacy and/or tolerability of pharmacotherapy in anxiety disorders. This chapter provides an overview of the impact of gender in the epidemiology, phenomenology, course, and treatment response in generalized anxiety disorder (GAD), social anxiety disorder (SAD), posttraumatic stress disorder (PTSD), panic disorder (PD), and obsessive-compulsive disorder (OCD).

scholarly journals RESPECT-Mil: Feasibility of a Systems-Level Collaborative Care Approach to Depression and Post-Traumatic Stress Disorder in Military Primary Care

2008 ◽  
Vol 173 (10) ◽  
pp. 935-940 ◽  
Author(s):  
Charles C. Engel ◽  
Thomas Oxman ◽  
Christopher Yamamoto ◽  
Darin Gould ◽  
Sheila Barry ◽  
...  
Keyword(s):  
Primary Care ◽  
Post Traumatic Stress Disorder ◽  
Collaborative Care ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Post Traumatic Stress ◽  
Care Approach ◽  
Post Traumatic

Posttraumatic stress disorder collaborative care: A quality improvement study in veterans affairs primary care.

2021 ◽  
Vol 39 (2) ◽  
pp. 198-211
Author(s):  
Jessica A. Chen ◽  
Matthew Jakupcak ◽  
Russell McCann ◽  
Jacqueline J. Fickel ◽  
Carol E. Simons ◽  
...  
Keyword(s):  
Primary Care ◽  
Posttraumatic Stress Disorder ◽  
Quality Improvement ◽  
Posttraumatic Stress ◽  
Collaborative Care ◽  
Stress Disorder ◽  
Veterans Affairs

Psychiatric Diseases in Pregnancy

2019 ◽  
Author(s):  
Jennifer Ludgin ◽  
Deanna Sverdlov ◽  
Errol R. Norwitz
Keyword(s):  
Substance Abuse ◽  
Pregnant Women ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Care Providers ◽  
Post Traumatic Stress ◽  
Post Traumatic ◽  
Psychiatric Conditions ◽  
In Pregnancy

The exacerbation of pre-existing psychiatric conditions and the development of a new-onset psychiatric disorder during pregnancy directly affects the care of pregnant women. Depression and anxiety are highly prevalent in reproductive age women and may be exacerbated in the perinatal and postpartum periods. Post-traumatic stress disorder is another common condition seen in this population and may worsen under the stress of pregnancy, delivery, and childrearing. Substance abuse is also pervasive in this population, requiring obstetricians to have a thorough understanding of how to manage and treat pregnant women with dependence disorders. Psychiatric conditions and substance abuse often co-exist. These and other disorders present significant risk to the mother and fetus. It is essential therefore for obstetric care providers to understand how to screen for, diagnose, and treat psychiatric disorders during pregnancy and in the postpartum period. This review contains 4 tables, and 58 references. Keywords: perinatal depression, postpartum depression, postpartum psychosis, anxiety in pregnancy, substance abuse in pregnancy, post-traumatic stress disorder in pregnancy, eating disorders in pregnancy, pregnancy screening

scholarly journals Implementation of care managers for patients with depression: a cross-sectional study in Swedish primary care

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e035629
Author(s):  
Pia Augustsson ◽  
Anna Holst ◽  
Irene Svenningsson ◽  
Eva-Lisa Petersson ◽  
Cecilia Björkelund ◽  
...  
Keyword(s):  
Primary Care ◽  
Collaborative Care ◽  
Qualitative Content Analysis ◽  
Controlled Trial ◽  
Cross Sectional Study ◽  
Healthcare Management ◽  
Sectional Study ◽  
Cross Sectional ◽  
Care Manager ◽  
Care Managers

ObjectivesTo perform an analysis of collaborative care with a care manager implementation in a primary healthcare setting. The study has a twofold aim: (1) to examine clinicians’ and directors’ perceptions of implementing collaborative care with a care manager for patients with depression at the primary care centre (PCC), and (2) to identify barriers and facilitators that influenced this implementation.DesignA cross-sectional study was performed in 2016–2017 in parallel with a cluster-randomised controlled trial.Setting36 PCCs in south-west Sweden.ParticipantsPCCs’ directors and clinicians.OutcomeData regarding the study’s aims were collected by two web-based questionnaires (directors, clinicians). Descriptive statistics and qualitative content analysis were used for analysis.ResultsAmong the 36 PCCs, 461 (59%) clinicians and 36 (100%) directors participated. Fifty-two per cent of clinicians could cooperate with the care manager without problems. Forty per cent regarded to their knowledge of the care manager assignment as insufficient. Around two-thirds perceived that collaborating with the care manager was part of their duty as PCC staff. Almost 90% of the PCCs’ directors considered that the assignment of the care manager was clearly designed, around 70% considered the priority of the implementation to be high and around 90% were positive to the implementation. Facilitators consisted of support from colleagues and directors, cooperative skills and positive attitudes. Barriers were high workload, shortage of staff and extensive requirements and demands from healthcare management.ConclusionsOur study confirms that the care manager puts collaborative care into practice. Facilitators and barriers of the implementation, such as time, information, soft values and attitudes, financial structure need to be considered when implementing care managers at PCCs.

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