Bipolar disorder and PTSD screening and telepsychiatry diagnoses in primary care

Cerimele, Joseph M.; LePoire, Erin; Fortney, John C.; Hawrilenko, Matt; Unützer, Jürgen; Bauer, Amy M.

doi:10.1016/j.genhosppsych.2020.05.006

Cited by 10 publications

(6 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Physical and mental health comorbidities were common. Of the 767 participants with a TCC or TER telepsychiatry encounter during the 12-month treatment period, 357 (46.5%) were diagnosed with PTSD only, 135 (17.6%) were diagnosed with BD and PTSD, and 57 (7.4%) were diagnosed with BD only . Other telepsychiatrist-assigned diagnoses included unipolar depression (457 [59.6%]), anxiety (287 [37.4%]), alcohol use disorder (103 [13.4%]), other substance use disorder (109 [14.2%]), personality disorder (75 [9.8%]), and schizophrenia (29 [3.8%]).…”

Section: Resultsmentioning

confidence: 99%

Comparison of Teleintegrated Care and Telereferral Care for Treating Complex Psychiatric Disorders in Primary Care

et al. 2021

Self Cite

View full text Add to dashboard Cite

IMPORTANCEOnly one-third of patients with complex psychiatric disorders engage in specialty mental health care, and only one-tenth receive adequate treatment in primary care. Scalable approaches are critically needed to improve access to effective mental health treatments in underserved primary care settings.OBJECTIVE To compare 2 clinic-to-clinic interactive video approaches to delivering evidence-based mental health treatments to patients in primary care clinics. DESIGN, SETTING, AND PARTICIPANTSThis pragmatic comparative effectiveness trial used a sequential, multiple-assignment, randomized trial (SMART) design with patient-level randomization. Adult patients treated at 24 primary care clinics without on-site psychiatrists or psychologists from 12 federally qualified health centers in 3 states who screened positive for posttraumatic stress disorder and/or bipolar disorder and who were not already receiving pharmacotherapy from a mental health specialist were recruited from November 16, 2016, to June 30, 2019, and observed for 12 months.INTERVENTIONS Two approaches were compared: (1) telepsychiatry/telepsychologyenhanced referral (TER), where telepsychiatrists and telepsychologists assumed responsibility for treatment, and (2) telepsychiatry collaborative care (TCC), where telepsychiatrists provided consultation to the primary care team. TER included an adaptive intervention (phone-enhanced referral [PER]) for patients not engaging in treatment, which involved telephone outreach and motivational interviewing.MAIN OUTCOMES AND MEASURES Survey questions assessed patient-reported outcomes. The Veterans RAND 12-item Health Survey Mental Component Summary (MCS) score was the primary outcome (range, 0-100). Secondary outcomes included posttraumatic stress disorder symptoms, manic symptoms, depressive symptoms, anxiety symptoms, recovery, and adverse effects. RESULTSOf 1004 included participants, 701 of 1000 (70.1%) were female, 660 of 994 (66.4%) were White, and the mean (SD) age was 39.4 (12.9) years. Baseline MCS scores were 2 SDs below the US mean; the mean (SD) MCS scores were 39.7 (14.1) and 41.2 (14.2) in the TCC and TER groups, respectively. There was no significant difference in 12-month MCS score between those receiving TCC and TER (β = 1.0; 95% CI, −0.8 to 2.8; P = .28). Patients in both groups experienced large and clinically meaningful improvements from baseline to 12 months (TCC: Cohen d = 0.81; 95% CI, 0.67 to 0.95; TER: Cohen d = 0.90; 95% CI, 0.76 to 1.04). For patients not engaging in TER at 6 months, there was no significant difference in 12-month MCS score between those receiving PER and TER (β = 2.0; 95% CI, −1.7 to 5.7; P = .29). CONCLUSIONS AND RELEVANCEIn this comparative effectiveness trial of patients with complex psychiatric disorders randomized to receive TCC or TER, significantly and substantially improved outcomes were observed in both groups. From a health care system perspective, clinical leadership should implement whichever approach is most sustainable.

show abstract

Section: Resultsmentioning

confidence: 99%

Comparison of Teleintegrated Care and Telereferral Care for Treating Complex Psychiatric Disorders in Primary Care

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Care managers delivered core components of an evidence-based psychotherapy to hundreds of complex patients in underserved rural settings (nearly 90% of eligible patients), the majority of whom had no prior access to evidence-based psychotherapies. Reports generated from the checklist (see in the online supplemental materials) allowed us to identify areas for more support for the entire provider group as they learned to deliver BA to patients with complex conditions such as PTSD, bipolar disorder, and a host of other comorbidities (Cerimele & Bauer, 2019; Cerimele et al, 2020). Nevertheless, even after receiving ostensibly the same training, providers had starkly varying levels of skill delivery (see Figure 4) that are not attributable to differences in the patient populations served or completion of role-playing or the number learning calls attended.…”

Section: Discussionmentioning

confidence: 99%

“…SPIRIT focuses on patients who screen positive for bipolar disorder and/or posttraumatic stress disorder (PTSD) because both are prevalent yet undertreated conditions in primary care. Details of the rationale, study design, protocol, and patient participants has been reported elsewhere (Fortney et al, 2020). The Institutional Review Boards at the University of Arkansas for Medical Sciences, University of Michigan, and University of Washington reviewed and approved the study protocol.…”

Section: Settingmentioning

confidence: 99%

Outcomes of a health informatics technology-supported behavioral activation training for care managers in a collaborative care program.

Bauer

Jakupcak

Hawrilenko

et al. 2021

Families, Systems, & Health

Self Cite

View full text Add to dashboard Cite

Introduction: Health informatics-supported strategies for training and ongoing support may aid the delivery of evidence-based psychotherapies. The objective of this study was to describe the development, implementation, and practice outcomes of a scalable health informatics-supported training program for behavioral activation for patients who screened positive for posttraumatic stress disorder and/or bipolar disorder. Method: We trained 34 care managers in 12 rural health centers. They used a registry checklist to document the delivery of 10 behavioral activation skills for 4,632 sessions with 455 patients. Care managers received performance feedback based on registry data. Using encounter-level data reported by care managers, we described the implementation outcomes of patient reach and care manager skill adoption. We used cross-classified multilevel modeling to explore variation in skill delivery accounting for patient characteristics, provider characteristics, and change over time. Results: Care managers engaged 88% of patients in behavioral activation and completed a minimum course for 57%. The average patient received 5.9 skills during treatment, with substantial variation driven more by providers (63%) than patients (29%). Care managers significantly increased the range of skills offered to patients over time. Discussion: The registry-based checklist was a feasible training and support tool for community-based providers to deliver behavioral activation. Providers received data-driven performance feedback and demonstrated skill improvement over time, promoting sustainment. Future research will examine patient-level outcomes. Results underscore the potential public health impact of a simple registry-based skills checklist coupled with a scalable remote training program for evidence-based psychotherapy.

show abstract

“…To arrive at a diagnosis, telepsychiatrists provided clinical care to patients via interactive video during the 12-month active treatment period and did not use structured interviews in this pragmatic effectiveness trial. Of the 192 patients diagnosed with bipolar disorder 23 , 179 completed the PMQ-9 at two or more clinic encounters and were included in the psychometric analyses as sample B.…”

Section: Setting and Participantsmentioning

confidence: 99%

The Patient Mania Questionnaire (PMQ-9): a Brief Scale for Assessing and Monitoring Manic Symptoms

et al. 2021

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Measurement-based care is an effective clinical strategy underutilized for bipolar disorder partly due to lacking a widely adopted patient-reported manic symptom measure. OBJECTIVE: To report development and psychometric properties of a brief patient-reported manic symptom measure. DESIGN: Secondary analysis of data collected in a randomized effectiveness trial comparing two treatments for 1004 primary care patients screening positive for bipolar disorder and/or PTSD. PARTICIPANTS: Two analytic samples included 114 participants with varied diagnoses and test-retest data, and 179 participants with psychiatrist-diagnosed bipolar disorder who had two or more assessments with the nineitem Patient Mania Questionnaire-9 [PMQ-9]). MAIN MEASURES: Internal and test-retest reliability, concurrent validity, and sensitivity to change were assessed. Minimally important difference (MID) was estimated by standard error of measurement (SEM) and by standard deviation (SD) effect sizes. KEY RESULTS: The PMQ-9 had high internal reliability (Cronbach's alpha = 0.88) and test-retest reliability (0.85). Concurrent validity correlation with manic symptom measures was high for the Internal State Scale-Activation Subscale (0.70; p<0.0001), and lower for the Altman Mania Rating Scale (0.26; p=0.007). Longitudinally, PMQ-9 was completed at 1511 clinical encounters in 179 patients with bipolar disorder. Mean PMQ-9 score at first and last encounters was 14.5 (SD 6.5) and 10.1 (SD 7.0), a 27% decrease in mean score during treatment, suggesting sensitivity to change. A point estimate of the MID was approximately 3 points (range of 2-4). CONCLUSIONS: The PMQ-9 demonstrated excellent testretest reliability, concurrent validity, internal consistency, and sensitivity to change and was widely used and acceptable to patients and clinicians in a pragmatic clini c a l tr i a l . C o m bi n e d w i th t h e P a ti e n t H e a l t h Questionnaire-9 (PHQ-9) measure of depressive symptoms this brief measure could inform measurementbased care for individuals with bipolar disorder in primary care and mental health care settings given its ease of administration and familiar self-report response format.

show abstract

Bipolar disorder and PTSD screening and telepsychiatry diagnoses in primary care

Cited by 10 publications

References 23 publications

Comparison of Teleintegrated Care and Telereferral Care for Treating Complex Psychiatric Disorders in Primary Care

Comparison of Teleintegrated Care and Telereferral Care for Treating Complex Psychiatric Disorders in Primary Care

Outcomes of a health informatics technology-supported behavioral activation training for care managers in a collaborative care program.

The Patient Mania Questionnaire (PMQ-9): a Brief Scale for Assessing and Monitoring Manic Symptoms

Contact Info

Product

Resources

About