Depression in primary care

Alson, Amy R; Robinson, Dwight R.; Ivanova, Danielle; Azer, John; Moreno, Manuel Pando; Turk, Marie Lyse; Nitturkar, Abhishek; Blackman, Karen

doi:10.1177/0091217416636580

Cited by 7 publications

(3 citation statements)

References 33 publications

(48 reference statements)

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“…Taking advantage of longitudinal of PRO information is promising in this regard, and aligns with other evidence pointing at the potential of PROs for mental health assessment in settings with pressing demands [52,60]. It is no not likely that PROs provide reliable measures in other mental health disorders, especially when they course with low awareness, confusional states or impaired understanding, such as in psychosis or substance use.…”

supporting

confidence: 64%

Change in functioning outcomes as a predictor of the course of depression: a 12-month longitudinal study

Forero

Olariu²,

Álvarez

et al. 2018

Qual Life Res

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supporting

confidence: 64%

Change in functioning outcomes as a predictor of the course of depression: a 12-month longitudinal study

Forero

Olariu²,

Álvarez

et al. 2018

Qual Life Res

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“…Significant improvements in outcome measures were seen in depression, bipolar depression, and PTSD symptoms among patients seen by our core team. Alson et al (2016) recommended that primary care practices using the Collaborative Care model implement evidence-based treatments of depression as well as appropriate consultation with a psychiatrist by primary care providers. In our collaborative care model, we were able to demonstrate significant improvements in outcome measures with our core team that included a PMHNP as the psychiatric provider.…”

Section: Discussionmentioning

confidence: 99%

Behavioral health integration in a nurse-led federally qualified health center: Outcomes of care

Weber

Stalder

Techau

et al. 2020

J Am Assoc Nurse Pract

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Background: Over the past 20 years, significant evidence has emerged for collaborative care in the treatment of depression and anxiety disorders in primary care. Purpose: The purpose of this project was to integrate an interprofessional and collaborative care model of behavioral health services into routine nurse-led primary care delivered to vulnerable and underserved populations across the lifespan. Team members included psychiatric nurse practitioners (PMHNPs), a registered nurse, and a case manager. Methods: An Access database was developed to track clients seen by the PMHNPs. Three key outcome measures were tracked over time: Posttraumatic Stress Disorder (PTSD) Checklist Civilian Version, Hamilton Depression Rating Scale (HAM-D), and Bipolar Depression Rating Scale (BDRS). A retrospective analysis of client outcome data from January 2017 through December 2019 was conducted. Results: There were 118 patients included who were mostly female (63.6%), White (90.7%), and not Hispanic (69.5%), with Medicaid as their primary insurance (74.6%). For each outcome, models with linear and quadratic function forms for time were fit. The final model for PTSD Checklist Score had a linear functional form for time and the final models for BDRS and HAM-D had linear and quadratic terms for time. All predictors were significantly associated with the outcome. Implications for practice: This program demonstrated that a patient-centered, nurse-led team approach to the treatment of depression, bipolar depression, and PTSD can be successful in primary care.

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“…Many of these people have histories of adverse childhood experiences (ACEs) or interpersonal violence (IPV). Most patients with depression rely on treatment from their primary care provider, in part due to lack of psychiatric mental health (PMH) services and issues of stigma that prevent patients from seeking PMH care, especially among racial and ethnic minorities (Alson et al, 2016). However, primary care providers only identify half of their patients with depression (Felix et al, 2014).…”

mentioning

confidence: 99%

Integrating behavioral health in primary care: Time to shift paradigms

Kalmakis

2021

J Am Assoc Nurse Pract

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When talking with nurse practitioners (NPs) in casual conversation, they often share their objections to "dealing" with mental health concerns in primary care practices, believing that this is not their responsibility. I found this to be true of many NPs when I conducted a study in 2016 about NP practices, skills, attitudes, and perceived barriers to screening for previous child abuse in adult patients. Most of the primary care NPs surveyed did not regularly screen for childhood abuse and did not believe screening was their responsibility. The NPs reported they did not have enough time to screen, worried about retraumatizing patients, and lacked confidence in their ability to respond appropriately when patients revealed previous abuse (Kalmakis et al., 2017). This raises the question, if primary care NPs do not ask patients about experiences of child abuse, interpersonal violence, substance use, or symptoms of depression, who does? Furthermore, how can we provide effective treatment for chronic stress, depression, and substance misuse problems that stem from behavioral health challenges if we do not ask?It is time to shift paradigms in advanced nursing practice. After a cursory review, I noted only 12 papers on the integration of behavioral health and primary care published in JAANP over the past 10 years. Nursing researchers, and clinicians, need to shift current paradigms, and our scholarly publications should reflect this shift.Behavioral health (psychiatric mental health and unhealthy substance use) and physical health (biological/body) have been treated as distinct from each other in the United States with our current acute carefocused health delivery system. A system that NPs have embraced rather than challenged. Traditionally, individuals see one health care provider for behavioral health and another for physical health, and both dedicate a high degree of effort to acute care problems, whereas chronic conditions remain poorly managed. This acute carefocused medical model falls far short of the needs of individual patients whose mental health and physical

show abstract

Depression in primary care

Cited by 7 publications

References 33 publications

Change in functioning outcomes as a predictor of the course of depression: a 12-month longitudinal study

Change in functioning outcomes as a predictor of the course of depression: a 12-month longitudinal study

Behavioral health integration in a nurse-led federally qualified health center: Outcomes of care

Integrating behavioral health in primary care: Time to shift paradigms

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