No abstract

These results indicate that programming aimed at increasing mental health care use in the military might best focus on reducing self-stigma associated with seeking mental health services.

Study findings revealed significant personality differences between male and female medical students on 11 of 16 personality factors as well as substantial differences in personality functioning between medical students and the general population. Findings are described and future directions for analyses are presented.

Tinnitus is a distressing symptom affecting the health-related quality of life of many individuals. Yet most audiologists feel ill equipped in providing clinical services to these patients. This article presents an overview of a clinical pathway for patients seen in the multidisciplinary Tinnitus Management Clinic at the Cleveland Clinic. The model illustrates an efficient approach for managing patients with varying levels of perceived tinnitus severity and annoyance by sequencing patient care and intervention strategies. After providing a general overview of the clinical pathway, three unique components of the model are highlighted: (1) benefits of a Group Education Session; (2) usefulness of the Sound Therapy Option Profile, a new tool designed to guide the clinician in selecting the most appropriate sound therapy device for a given patient; and (3) participation of a psychologist and neurologist on the multidisciplinary management team.

BackgroundIntegrating mental health providers into primary care clinics improves access to and outcomes of mental health care. In the Veterans Health Administration (VA) Primary Care Mental Health Integration (PCMHI) program, mental health providers are co-located in primary care clinics, but the implementation of this model is challenging outside large VA medical centers, especially for rural clinics without full mental health staffing. Long wait times for mental health care, little collaboration between mental health and primary care providers, and sub-optimal outcomes for rural veterans could result. Telehealth could be used to provide PCMHI to rural clinics; however, the clinical effectiveness of the tele-PCMHI model has not been tested. Based on evidence that implementation facilitation is an effective implementation strategy to increase uptake of PCMHI when delivered on-site at larger VA clinics, it is hypothesized that this strategy may also be effective with regard to ensuring adequate uptake of the tele-PCMHI model at rural VA clinics.MethodsThis study is a hybrid type 2 pragmatic effectiveness-implementation trial of tele-PCMHI in six sites over 24 months. Tele-PCMHI, which will be delivered by clinical staff available in routine care settings, will be compared to usual care. Fidelity to the care model will be monitored but not controlled. We will use the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework to evaluate the patient-level clinical effectiveness of tele-PCMHI in rural VA clinics and also to evaluate the fidelity to and outcomes of the implementation strategy, implementation facilitation. The proposed study will employ a stepped-wedge design in which study sites sequentially begin implementation in three steps at 6-month intervals. Each step will include (1) a 6-month period of implementation planning, followed by (2) a 6-month period of active implementation, and (3) a final period of stepped-down implementation facilitation.DiscussionThis study will evaluate the effectiveness of PCMHI in a novel setting and via a novel method (clinical video telehealth). We will test the feasibility of using implementation facilitation as an implementation strategy to deploy tele-PCMHI in rural VA clinics.Trial registrationClinicalTrials.gov registration number NCT02713217. Registered on 18 March 2016Electronic supplementary materialThe online version of this article (10.1186/s13012-019-0875-5) contains supplementary material, which is available to authorized users.