Cognitive behavioral therapy for depressive disorders: Outcomes from a multi-state, multi-site primary care practice

Bogucki, Olivia E.; Craner, Julia R.; Berg, Summer L.; Miller, Stephanie; Wolsey, Megan K.; Smyth, Kileen T.; Sedivy, Sara J.; Mack, John D.; Johnson, Maren; Burke, Lisa; Williams, Mark W.; Katzelnick, David J.; Sawchuk, Craig N.

doi:10.1016/j.jad.2021.07.061

Cited by 7 publications

(5 citation statements)

References 37 publications

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“…Evaluations of data collected using previous iterations of the database have been promising as they have provided information about the effectiveness of primary care-based adapted cognitive behavioral interventions for anxiety, depression, and adjustment disorders. 49,50,57 For a psychotherapy program integrated within primary care, these data are especially useful given that these practices are accustomed to using MBC in the management of other chronic medical conditions such as asthma 58,59 and diabetes. 60 Having broad-scale data, such as those housed in Mayo Clinic's database, allows us to more effectively communicate with primary care administration about the role of IBH and our impact on their patient population, helps our service advocate for continued support and resources, and aids us in targeting resources toward areas of high potential impact.…”

Section: Discussionmentioning

confidence: 99%

“…Early publications from the practice have described Mayo Clinic's IBH psychotherapy program, outlined initial efforts in the development and implementation of a psychotherapy tracking database, and reported on previous clinical practice outcomes. [49][50][51][52] We provide an overview of the EHR process used to build an expansive and continuously populating psychotherapy tracking database, review the types of data available in the database, present descriptive statistics, and discuss specific ways in which the database functions to inform and improve the practice. We also offer examples of the practical utility of the database as applied across clinical, educational, research, and administrative domains.…”

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confidence: 99%

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Study What You Do: Developing a Psychotherapy Tracking Database in a Large-Scale Integrated Behavioral Health Service

Roche

Savitz²,

Kelpin³

et al. 2023

Ann Fam Med

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PURPOSE Many individuals with behavioral health challenges receive services in primary care, and integrated behavioral health (IBH) programs can help increase access to evidencebased interventions. IBH programs can benefit substantially from integrating standardized tracking databases that allow for the implementation of measurement-based care to evaluate patient-, clinician-, and practice-level outcomes. We describe the development and integration of Mayo Clinic's pediatric and adult primary care psychotherapy tracking database.METHODS IBH practice leaders directed the development of a large psychotherapy tracking database that continuously populates from Mayo Clinic's electronic health record system. The database captures numerous patient variables including demographics, behavioral health and substance use issues, psychotherapy principles used, and self-reported symptoms. We retrieved current data for patients empaneled in Mayo Clinic's pediatric and adult primary care psychotherapy programs from June 2014 to June 2022. RESULTSThe tracking database contained data for 16,923 adult patients and 6,298 pediatric patients. The mean age of adult patients was 43.2 years (SD 18.3), 88.1% were non-Latine White, and 66.7% identified as female. The mean age of pediatric patients was 11.6 years (SD 4.2), 82.5% were non-Latine White, and 56.9% identified as female. We provide examples of practical applications of the database across clinical, educational, research, and administrative domains. CONCLUSIONSThe development and integration of a psychotherapy tracking database supports clinician communication, examination of patient outcomes, practice quality improvement efforts, and clinically relevant research. Our description of Mayo Clinic's IBH database may serve as a model for other IBH practices.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Study What You Do: Developing a Psychotherapy Tracking Database in a Large-Scale Integrated Behavioral Health Service

Roche

Savitz²,

Kelpin³

et al. 2023

Ann Fam Med

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“…Recent studies reported that in 1589 participants recruited from a multi-site primary care practice, 491 participants with anxiety participated in cognitive behavioral therapy (CBT) had decreased level of anxiety ( P < 0.001, d = 0.57–0.95),[ 2 ] and in 1302 participants with a primary depressive disorder, 435 endorsed moderate to severe depression engaged on CBT had decreased levels of depression as well ( P ≤ 0.001, d = 0.52–0.78). [ 31 ]…”

Section: Discussionmentioning

confidence: 99%

Medical and nonmedical use of psychiatric medications among medical students in Riyadh, Saudi Arabia

Alswayed¹,

Alshuaibi²,

Alsayegh³

et al. 2022

Journal of Family Medicine and Primary Care

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Introduction: Psychiatric medication use has increased recently among college students. This includes antidepressants, opioids, stimulants, analgesics, sedatives, and anxiolytics, which could be self-administered without medical supervision. Objectives: To determine the prevalence of medical and nonmedical use of psychiatric prescription medications and its correlation with academic performance, demographic data as well as the motives for the nonmedical use. Methods: A cross-sectional study aims to assess the psychiatric medication use with or without prescription with the motives behind it, and demographic data of the students at medical colleges in Riyadh, Saudi Arabia. Results: A total of 1268 responded to the questionnaire. 251 (20%) of the participants reported using some psychiatric medications in their lifetime, while 191 (15%) participants used some psychiatric medications in the last 12 months. Antidepressants were most used in the surveyed population 144 (57%), followed by opioids/pain relief medications 62 (24%) and anxiolytics 39 (15%). Only 44 surveyed students (3.5%) reported nonmedical use of these psychiatric medications. As for the motives of nonmedical use, the greatest portion reported to use it for “relax or relieve tension” 12 (29%), followed by “relieve pain caused by other health problems” 8 (20%), and “medication to get through the day” 6 (15%). Conclusion: Nonmedical use of psychiatric medications among medical students in Riyadh is several times lower than reports by other researchers. Future research should focus on collecting more participants who are using medications without prescription and conduct cross-cultural studies to examine factors contributing to such low rates of illicit psychiatric medication use.

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“…PCBH has gained popularity, likely due to its promise of a much-needed increase in the availability of psychological interventions. Previous research indicates that brief psychotherapeutic interventions within integrated care lead to broad improvements in symptom reduction, functioning and well-being across a multitude of problem areas (23,25,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). Studies have also indicated that PCBH is cost-effective (41)(42)(43)(44)(45)(46)(47), appreciated by care providers (45,(48)(49)(50)(51) as well as patients (48, 50,52), and that the model can improve access to and reduce wait time for mental health services (53,54).…”

Section: Introductionmentioning

confidence: 99%

Primary Care Behavioral Health in Sweden – A Cluster Randomized Trial Evaluating Outcomes Related to Implementation, Organization, and Patients (KAIROS) – Study Protocol

von Cederwald,

Lilja,

Isacsson

et al. 2023

Preprint

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Background Providing comprehensive and continuous care for patients whose conditions have mental or behavioral components is a central challenge in primary care and an important part of improving universal health coverage. There is a great need for high and routine availability of psychological interventions, but traditional methods for delivering psychotherapy often result in low reach and long wait times. Primary Care Behavior Health (PCBH) is a method for organizing primary care in which behavioral health staff provide brief, flexible interventions to a large part of the population in active collaboration with other providers. While PCBH holds promise in addressing important challenges, it has not yet been thoroughly evaluated. Methods This cluster randomized trial will assess 17 primary care centers (PCCs) that are starting a PCBH implementation process. The PCCs will be divided into two groups, with one starting immediate implementation and the other acting as a control, implementing six months later. The purpose of the study is to strengthen the evidence base for PCBH regarding implementation-, organization-, and patient-level outcomes, taking into consideration that there is a partially dependent relationship between the three levels. Patient outcomes (such as increased daily functioning and reduction of symptoms) may be dependent on organizational changes (such as availability of treatment, waiting times and interprofessional teamwork), which in turn requires change in implementation outcomes (most notably, model fidelity). In addition to the main analysis, five secondary analyses will compare groups based on different combinations of randomization and time periods, specifically before and after each center achieves sufficient PCBH fidelity. Discussion A randomized comparison of PCBH and traditional primary care has, to our knowledge, not been made before. While the naturalistic setting and the intricacies of implementation pose certain challenges, we have designed this study in an effort to evaluate the causal effects of PCBH despite these complex aspects. The results of this project will be helpful in guiding decisions on how to organize the delivery of behavioral interventions and psychological treatment within the context of primary care in Sweden and elsewhere. Trial registration ClinicalTrials.gov: NCT05335382. Retrospectively registered on March 13th, 2022.

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Cognitive behavioral therapy for depressive disorders: Outcomes from a multi-state, multi-site primary care practice

Cited by 7 publications

References 37 publications

Study What You Do: Developing a Psychotherapy Tracking Database in a Large-Scale Integrated Behavioral Health Service

Study What You Do: Developing a Psychotherapy Tracking Database in a Large-Scale Integrated Behavioral Health Service

Medical and nonmedical use of psychiatric medications among medical students in Riyadh, Saudi Arabia

Primary Care Behavioral Health in Sweden – A Cluster Randomized Trial Evaluating Outcomes Related to Implementation, Organization, and Patients (KAIROS) – Study Protocol

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