Medical/Psychiatric Comanagement by Nurse Practitioners in Chronic Hepatitis C Treatment: A Case Study

Gardenier, Donald; Neushotz, Lori A.; O'Connor-Moore, Nicola

doi:10.1016/j.apnu.2006.11.003

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…For those who were already receiving some kind of behavioral health care, a relationship with the participant's behavioral health provider was established and care coordination was undertaken. For others, referrals were made and care was established before initiating treatment for their chronic hepatitis C. In all cases, comanagement plans were formulated that were appropriate to the participants' individual needs (Gardenier, Neushotz, & O'Connor, 2007).…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C Treatment Completion in Individuals With Psychiatric Comorbidity and Depression

Gardenier

Wisnivesky

McGinn

et al. 2011

Gastroenterology Nursing

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Hepatitis C virus is a common bloodborne pathogen. Patient, provider, and health care system factors combine to constrain access to treatment and have led to low rates of treatment initiation and continuation among medically eligible individuals. Behavioral health comorbidity, which is common in the patient population, has historically been an exclusion criterion and is one such barrier to care. We implemented an interdisciplinary nurse-managed primary care-based hepatitis C evaluation and treatment program to address behavioral health needs concurrently in an effort to increase treatment initiation and continuation rates among comorbid individuals. We found no association between having a psychiatric or substance use history and treatment discontinuation in our patient cohort. Likewise, there was no association in our cohort between becoming depressed or anxious while undergoing treatment and treatment discontinuation. The results of our study concur with others that have shown that addressing behavioral health comorbidities concurrently with hepatitis C evaluation and treatment may improve treatment continuation rates among comorbid patients, thereby helping to remove barriers to treatment of chronic hepatitis C.

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Section: Discussionmentioning

confidence: 99%

Hepatitis C Treatment Completion in Individuals With Psychiatric Comorbidity and Depression

Gardenier

Wisnivesky

McGinn

et al. 2011

Gastroenterology Nursing

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“…13 Inpatient comanagement services offer a unique model for studying teamwork. While the label is used to describe a variety of arrangements, [14][15][16] comanagement broadly describes a practice model wherein providers of various specialties deliver direct care to patients, in contrast to the traditional generalist-consultant model in which specialists lend expertise. 17 Many recent comanagement practices involve hospitalists in partnership with surgeons in the care of patients with concurrent medical and surgical needs, 18 but similar arrangements between hospitalists and medical subspecialists are being adopted in some medical centers for the care of complex patients with conditions such as heart failure, cancer, stroke, and solid organ transplantations.…”

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confidence: 99%

Effects of provider characteristics on care coordination under comanagement

Hinami

Whelan

Konetzka

et al. 2010

Journal of Hospital Medicine

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BACKGROUND:Care coordination is critical in settings characterized by high levels of uncertainty, time constraints, and interdependent work processes. The effects of provider characteristics on coordination in comanaged teams has never been examined.OBJECTIVE:To characterize individual providers based on their contribution to team coordination.PARTICIPANTS:Hospitalists, nonphysician providers, hepatologists, and fellows on a comanaged liver service of an academic hospital.DESIGN:Between April 2008 and October 2008, participants were surveyed at baseline and repeatedly at the completion of physician rotations to assess their preferred and actual comanagement structures. In addition, they repeatedly rated their comanagers' contributions to overall coordination using an instrument that assessed relational coordination (RC). Providers were categorized into tertiles of RC. Their management preferences and the frequency of a “composite bad outcome” (intensive care unit [ICU] transfer or inpatient death) in each tertile were evaluated.RESULTS:All (100%) Baseline Surveys and 177/224 (79%) Repeated Surveys were completed by 32 providers. RC was shown to be a stable attribute of providers and not of adverse patient outcomes. Higher coordinators were characterized by their “ownership of patients” (higher 86% vs. lowest 20%, P < 0.01). High compared to low coordinator hepatologists demonstrated leadership through a broader delegation of tasks as well as self‐assignment of responsibilities. A trend toward more frequent “composite bad outcomes” was seen for low tertile physicians: hospitalists (low 8.6% vs. high 1.1%, P < 0.01), hepatologists (low 5.2% vs. high 2.0%, P = 0.22), fellows (low 5.8% vs. high 1.8%, P = 0.08).CONCLUSION:Individual provider's teamwork‐related disposition affects perceived coordination on comanaged team and may influence patient outcomes. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

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“…Collaborating with the patient improves coordination of physical and mental health care and helps formulate a response to address changing health care needs in an organized and comprehensive manner (Gardenier et al, 2007). NPs can collaborate to improve therapeutic relationships by moving away from a prescriptive approach and invites patients with SMI to take ownership and control of their health care (Storfjell et al, 2008).…”

Section: Collaborative Practicementioning

confidence: 99%

“…An American case study examining the role ofNPs in treating and co-managing psychiatric and medical health issues identified interpersonal collaboration as a means to reducing complex service delivery barriers (Gardenier et al , 2007). Gardenier et al reported that the NP in the study worked in concert with the patient to advocate for the coordination of the many appointments required to treat the patient' s complex physical and mental health needs associated with Hepatitis C. NPs collaborated with the patient to overcome side effects of hepatitis treatment, such as rashes, made medication adjustments to treat mood alterations, and provided education for family members to help them support the patient.…”

Section: Navigating Complex Service Deliverymentioning

confidence: 99%

Reducing barriers to accessing primary care for individuals with severe mental illness: examining characteristics of Canadian nurse practitioner practice

DeLeenheer¹

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Individuals with severe mental illness experience reduced access to appropriate and timely primary care. This reduced access has been linked to various barriers and may negatively affect health outcomes. The purpose of this project is to identify the characteristics of nurse practitioner (NP) practice that may reduce the most common barriers to accessing primary care encountered by individuals with severe mental illness.(SMI). The most common barriers to access can be broadly described by three themes and include suboptimal therapeutic relationships, complex service delivery, and stigma. A systematic review of the literature indicated that NPs possess a number of practice characteristics that help overcome barriers to accessing primary care. These characteristics can be described as collaborative practice, a holistic approach, and flexible practice formats. NP practice characteristics have the potential to reduce barriers to care for individuals with SMI and improve access to primary care.

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Medical/Psychiatric Comanagement by Nurse Practitioners in Chronic Hepatitis C Treatment: A Case Study

Cited by 6 publications

References 13 publications

Hepatitis C Treatment Completion in Individuals With Psychiatric Comorbidity and Depression

Hepatitis C Treatment Completion in Individuals With Psychiatric Comorbidity and Depression

Effects of provider characteristics on care coordination under comanagement

Reducing barriers to accessing primary care for individuals with severe mental illness: examining characteristics of Canadian nurse practitioner practice

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