Psychiatric services最新文献

Objective: The authors sought to understand patient experiences with group teletherapy to inform improvements in service delivery.

Methods: From December 2022 to October 2023, semistructured interviews were conducted with 20 adults with depression or bipolar disorder who had received outpatient group teletherapy in the past 2 years. A rapid thematic analysis was conducted by using a matrix to identify patterns and synthesize data. A logic model from the patients' perspective was developed by extracting common themes related to elements of effective group teletherapy.

Results: Telehealth allowed for more empowered engagement in group teletherapy and enabled better access and longitudinal attendance for many patients, compared with in-person group therapy. However, many patients reported a reduced sense of emotional intimacy and connectedness with telehealth, and some reported that technology challenges and distractions contributed to feelings of disconnection. Patients were divided in their modality preferences, but many expressed an interest in receiving at least some of their group therapy sessions by telehealth.

Conclusions: Although group teletherapy has the potential to meet patients' needs and preferences, more work is needed to improve the quality of the experience for patients.

Objective: The authors aimed to increase measurement-based care in an outpatient academic psychiatry service.

Methods: The Measurement-Assisted Care program (MAC) was implemented as a clinical quality-improvement effort that included 4,665 unique patients and 176 clinicians over 12 months. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder scale (GAD-7), PTSD Checklist for DSM-5, and Brief Inventory of Thriving were automatically included in the patient electronic check-in process for new visits; the PHQ-9 and GAD-7 were included for return visits. Patient responses were automatically routed to clinicians' electronic health record inboxes and documentation templates. MAC was rolled out in two phases, and clinicians were surveyed about their use of MAC data 3-6 months after the start of the program.

Results: After implementation of MAC, PHQ-9 completion rates increased from 5% to 66% of visits for phase 1 and from 5% to 60% for phase 2. Post-MAC completion rates were higher for telehealth (70%) than for in-person (40%) visits. More than 90% of clinicians reported that MAC was useful with at least one of their three most recent patients, and 51% reported that it was useful with all three of their three most recent patients. Clinician adoption was high, with 78% reporting that they use MAC data to guide care.

Conclusions: MAC increased the completion rate of patient-reported outcome measures, especially for telehealth visits. Clinicians reported that they frequently use and discuss MAC data with patients, implying that technology-supported workflows can help systems with high telehealth utilization capture and use patient-reported outcomes.

Objective: The authors evaluated the feasibility of automated depression screening and a follow-up postscreening protocol.

Methods: Patient Health Questionnaire-2 (PHQ-2) and PHQ-9 screeners were sent to 20 specialty clinics and administered to patients who were ages ≥18 years, had not completed a PHQ-2 or PHQ-9 within the past 9 months, had no psychiatric diagnosis within the past 2 years, and had no behavioral health appointment within the previous year or an upcoming behavioral health appointment. In a two-pronged approach, patients with scores indicating moderate or moderately severe depression but with no indication of possible suicidal ideation were offered behavioral health resources (first prong), or patients with scores indicating severe depression or with possible suicidal ideation were contacted via telephone and requested to schedule a behavioral health appointment (second prong).

Results: The PHQ-2 was offered to 21,674 patients, with 38.1% (N=8,247) completing the screening; 13.1% (N=1,084) of those with completed screens had a positive depression score. Of patients who completed the PHQ-9, 44.5% (N=650) were eligible for the first prong of the intervention and 31.1% (N=455) for the second prong. Depression screening completion rates differed significantly by multiple sociodemographic factors. Mean±SD lag times from screening completion to successful contact and from contact to appointment completion were 7±6 and 5±4 days, respectively.

Conclusions: Automated depression screening with outreach based on depression severity is feasible and provides potentially efficient use of scarce resources. More research is needed on the mechanisms for automated screening and follow-up to examine factors such as patient engagement after a positive screening.

Objective: The purpose of this study was to examine how often clients report discussing cultural identities during counseling sessions; the extent to which discussion of cultural identities during treatment varies across therapists; whether identifying as BIPOC (Black, Indigenous, and people of color) predicts clients' discussion of cultural identities in sessions; and whether differences in the frequency of cultural conversations (i.e., dialogue that focuses on client cultural identities) across client groups depend on the therapist.

Methods: This study examined variation in reports of engagement in cultural conversations during sessions (N=10,731) with 1,997 clients and 72 therapists from a university counseling center. Data were analyzed by using Bayesian multilevel models.

Results: Overall, clients reported having cultural conversations in 48.4% of sessions. Cultural conversations were much more likely to occur in sessions with BIPOC clients than with White clients: 66.2% of sessions with BIPOC clients involved conversations about cultural identities, compared with only 39.8% of sessions with White clients. Of note, the magnitude of this difference varied by therapist.

Conclusion: Cultural conversations were more likely to occur in treatment with BIPOC clients than with White clients, and the presence of cultural conversations in treatment varied by therapist.

Measurement-informed care (MIC), also known as measurement-based care or patient-reported outcomes, for behavioral health conditions has had low uptake in the United States. To advance MIC in the near term, the authors reviewed nationally endorsed behavioral health measures and worked with national experts to recommend a core set of outpatient measures to prioritize for use. The resulting set of measures is for common behavioral and comorbid conditions and is outcomes based, low burden, and suitable for value-based payment. The panel of national experts also recommended developing a consensus on quality-of-life measures and functional measures for use across diagnostic categories of the core set.

Objective: This study evaluated psychotropic polypharmacy frequency and patterns of use among Medicaid-enrolled youths.

Methods: A cross-sectional study of a state Medicaid claims database (2015-2020) focused on youths (≤17 years old) with at least one psychotropic medication claim and ≥90 continuous days of Medicaid enrollment. Psychotropic polypharmacy (claims for three or more therapeutic classes of psychotropics for ≥90 consecutive days) was analyzed as average annual days and annual prevalence of class combinations. Multivariable negative binomial regression models assessed changes in annual psychotropic polypharmacy days.

Results: A total of 126,972 unique youths were identified. Almost all youths with psychotropic polypharmacy had three-class combinations, the most common of which included attention-deficit hyperactivity disorder medications, antipsychotics, and antidepressants. The number of polypharmacy days increased from a mean±SD of 227.8±90.3 in 2015 to 235.7±97.5 in 2020. Polypharmacy days significantly increased year over year (rate ratio=1.01, 95% CI=1.00-1.01).

Conclusions: Psychotropic polypharmacy regimens reflect chronic use that is increasing over time.

Objective: Recent trends in U.S. suicide rates underscore a need for research on the risk for suicidality. The authors aimed to estimate national trends in suicidal ideation, suicide attempts, and health care utilization by using data from the 2015-2019 National Survey on Drug Use and Health.

Methods: Logistic regression was used to estimate the adjusted odds of past-year suicidal ideation and, among individuals with ideation, past-year suicide attempts, with separate interaction models estimating time trends by sex, age, and race-ethnicity. Time trends were further examined with logistic regression to estimate annual prevalence, overall and by sociodemographic, behavioral, and clinical characteristics. Logistic regression was used to estimate past-year general and mental health care utilization among adults with suicidal ideation. Analyses were survey weighted.

Results: Overall, 4.3% (N=13,195) of adults (N=214,505) reported suicidal ideation, and 13.0% (N=2,009) of those with ideation reported suicide attempts. Increases in prevalence of suicidal ideation, from 4.0% in 2015 to 4.9% in 2019, were significantly higher for young adults ages 18-25 years (p=0.001) than for older adults. Decreases in prevalence of suicide attempts among White adults (by 32.9%) were offset by increases among adults reporting Black (by 48.0%) and multiracial or other (by 82.3%) race-ethnicity. Less than half of adults with suicidal ideation (47.8%) received past-year mental health care, with significantly lower receipt for nearly all minoritized racial-ethnic groups, compared with White adults.

Conclusions: Widening racial-ethnic disparities in suicide attempts and lower mental health care utilization for minoritized groups underscore the importance of developing and implementing equity-focused, evidence-based suicide prevention strategies across health care settings.

Industry payments to psychiatrists remain poorly characterized. Using data from the Centers for Medicare and Medicaid Services, the authors of this repeated cross-sectional study detail the extent and concentration of nonresearch industry payments to psychiatrists from 2015 to 2021. The proportion of psychiatrists receiving industry payments, payment distribution, and payment concentration among psychiatrists was assessed. Among 56,955 psychiatrists, 75.0% received any industry payments from 2015 to 2021. These payments, totaling $357,971,774, were highly concentrated: 1% of psychiatrists received 74.7% of industry payments, with notable state-level variations in concentration of top industry-paid psychiatrists. The median psychiatrist received $0 from industry each year.