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Tag: integrated care
06/06/2023

Implementation and workflow strategies for integrating digital therapeutics for alcohol use disorders into primary care: a qualitative study

Mogk JM, Matson TE, Caldeiro RM, Garza Mcwethy AM, Beatty T, Sevey BC, Hsu CW, Glass JE. Implementation and workflow strategies for integrating digital therapeutics for alcohol use disorders into primary care: a qualitative study. Addict Sci Clin Pract. 2023 May 8;18(1):27. doi: 10.1186/s13722-023-00387-w.

This study aimed to identify implementation needs and strategy design considerations for integrating digital therapeutics for alcohol use disorders (AUD) into primary care. Qualitative interviews were conducted with clinicians, care delivery leaders, and implementation staff (N=16). All participants had experience implementing digital therapeutics for depression or substance use disorders in primary care in the United States. Participants were asked to share successes and challenges from implementation efforts and how these experiences could inform the implementation of digital therapeutics for AUD. Common themes were identified across health system staff roles. Participants were committed to digital therapeutics for AUD and anticipated high patient demand for such treatments. Reported facilitators of successful implementation included: 1) use implementation strategies that align with the needs of patients with varying AUD severity, 2) use strategies that minimize burden on clinicians, and 3) offer digital therapeutics as an adjunct to other treatments for AUD. Other helpful implementation strategies included clinician training and electronic health record support. Findings inform future efforts to implement digital interventions for AUD in primary care.

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06/06/2022

Implementation of collaborative care for depressive disorder treatment among accountable care organizations

Newton H, Busch SH, Brunette M, Maust DT, O’Malley J, Meara ER. Implementation of collaborative care for depressive disorder treatment among accountable care organizations. Medicine 2021;100:27(e26539).

Collaborative care is a cost-effective model of primary care that combines care management, consulting behavioral health clinicians and registries to target mental health treatment. A study was conducted to determine the prevalence of collaborative care implementation in accountable care organizations (ACOs) and identify characteristics in ACOs associated with implementation. Researchers examined the association between implementation of collaborative care components and ACO characteristics. Four hundred five total respondents completed questions on collaborative care implementation in the 2017-2018 National Survey of ACOs. Only seventeen percent of ACOs implemented all collaborative care components. The most common components were care managers (71% of ACOs) and consulting mental health clinicians (58%). The least frequently implemented component was using patient registries to track and target mental health treatment (only 26%). The findings also showed ACOs responsible for mental healthcare quality measures were significantly more likely to implement collaborative care. This study demonstrates most ACOs do not have full implementation of behavioral health collaborative care. Payers interested in incentivizing integrated mental health care should address barriers to collaborative care implementation.

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10/11/2021

A qualitative exploration of the feasibility of incorporating depression apps into integrated primary care clinics

Dinkel D, Caspari JH, Fok L, et al. (2021). A qualitative exploration of the feasibility of incorporating depression apps into integrated primary care clinics. Translational Behavioral Medicine, Volume 11, Issue 9, September 2021, Pages 1708–1716, https://doi.org/10.1093/tbm/ibab075

The study explored how to integrate mobile apps for treating depression into primary care settings from the viewpoints of patients and clinic personnel. Participants were 17 patients with depression and 15 healthcare providers and staff. Data was collected through focus groups or semi-structured interviews (either in-person or via Zoom) from January to July 2020. Participants were asked about barriers and facilitators to app use, how best to integrate the app into primary care, and feedback on mental health apps more generally. Results showed that most patients have previously used health-related apps, but few have used mental health related apps. Patients found app features such as notifications, information, easy navigation, a support chat function, and ability to share data with their doctor as very helpful. Providers and staff identified facilitators such as integration of app data into electronic health records and clear evidence of effectiveness. All participants who reviewed the depression apps identified at least one that they would be interested in continuing to use. Overall, findings demonstrated that both patients and providers perceive depression apps to be beneficial.

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01/29/2021

The COVID-19 pandemic: The ‘black swan’ for mental health care and a turning point for e-health

Wind T, Rijkeboer M, Andersson G, Riper H. (2020). The COVID-19 pandemic: The ‘black swan’ for mental health care and a turning point for e-health. 20: 100317. doi: 10.1016/j.invent.2020.100317

In this editorial, researchers define the effect of the COVID-19 pandemic on global mental health care as a “black swan” moment: an improbable event with significant consequences. Read More

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11/06/2020

Implementing technology-supported care for depression and alcohol use disorder in primary care in Colombia: Preliminary findings

Torrey W, Cepeda M, Castro S, et al. (2020). Implementing technology-supported care for depression and alcohol use disorder in primary care in Colombia: Preliminary findings. Psychiatric Services. 71(7): 678-683. doi: 10.1176/appi.ps.201900457

A multi-national and multi-disciplinary team of researchers implemented and evaluated implementation outcomes of kiosk-based depression and alcohol screening and tablet-based provider decision support for adult primary care patients in two Colombian clinics (one urban, one rural). Read More

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07/05/2019

Using social media to enhance provider network for HIV and harm reduction service integration in Vietnam

Li L, Lin C, Feng N, et al. (2019). Using social media to enhance provider network for HIV and harm reduction service integration in Vietnam. AIDS and Behavior. doi: 10.1007/s10461-019-02542-4

Researchers recruited 72 methadone maintenance therapy (MMT; n=28) and antiretroviral therapy (ART; n=44) providers from 4 provinces in Vietnam to participate in private interdisciplinary Facebook groups. Researchers were interested in exploring how Facebook could facilitate integration of HIV and substance use care for people with HIV who inject drugs. Read More

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03/15/2019

Beliefs and attitudes about the dissemination and implementation of internet-based self-care programs in a large integrated healthcare system

Hermes EDA, Burrone L, Heapy A, et al. (2019). Beliefs and attitudes about the dissemination and implementation of internet-based self-care programs in a large integrated healthcare system. Administration and Policy in Mental Health and Mental Health Services Research. 10.1007/s10488-018-0913-7

Researchers interviewed providers (n=12) and administrators or policy makers (n=8) from 10 Veterans Health Administration (VHA) programs to explore determinants of dissemination and implementation of digital health. Interviews were guided by the Unified Theory of Acceptance and Use of Technology. Researchers thematically coded interview transcripts and identified 8 distinct themes. All participants noted that current healthcare systems, including clinical norms and workflows do not facilitate use of digital health. Nineteen participants (95%) mentioned gaps in provider understanding of digital health and when or how to use digital health in practice, inadequate digital infrastructures (e.g., VHA internet systems, patient technology access), and the influence of support from leadership. Eighteen (90%) participants mentioned a need for organizational dissemination and implementation strategies (e.g., provider training, consumer advertising), specifically highlighting the need for a learning management system that allows providers and patients to access digital health programs. Fourteen participants (70%) mentioned that health system strategic priorities need to promote dissemination and implementation of digital health and that current strategies that may complement digital health implementation (e.g., measurement-based care, electronic health record development) also compete for funding. Twelve participants (60%) discussed how organizational structures and an emphasis on specialty care rather than integrated care can result in siloed information between central administration, specialty care facilities, and primary care facilities. Finally, 11 (55%) participants discussed regulations and policies relating to privacy and security (e.g. against the transmission of patient-reported information to health records) reducing the utility of digital health.

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04/27/2018

A novel approach to treating adolescents with substance use disorder in pediatric primary care.

Levy S, Mountain-Ray S, Reynolds J, Mendes SJ, Bromberg J. (2018). A novel approach to treating adolescents with substance use disorder in pediatric primary care. Substance Abuse. doi: 10.1080/08897077.2018.1455165

The authors describe and present initial results for a quality improvement project involving implementation of integrated treatment for adolescents with substance use disorder (SUD) in primary care. Read More

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11/17/2017

Consumer mobile health apps: Current state, barriers, and future directions.

Kao C-K, Liebovitz DM. (2017). Consumer mobile health apps: Current state, barriers, and future directions. Physical Medicine and Rehabilitation. 9(5): s106-s115. doi: 10.1016/j.pmrj.2017.02.018

In this discussion paper, the authors describe the current state of commercially available mobile health (mHealth) applications (apps), including barriers to, and future directions for, use of mHealth apps in clinical practice. Read More

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