Implementation of evidence-based practices for complex mood disorders in primary care safety net clinics.
Implementation of evidence-based practices for complex mood disorders in primary care safety net clinics.
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DOI：
10.1037/fsh0000357
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发表时间：
2018-09
期刊：
影响因子：
--
通讯作者：
Curran GM
中科院分区：
文献类型：
--
作者：
Fortney JC;Pyne JM;Ward-Jones S;Bennett IM;Diehl J;Farris K;Cerimele JM;Curran GM
使用质量改进方法在六个联邦合格的健康中心实施双相抑郁症和难治性抑郁症的循证实践。在进行定性需求评估后，由一线提供者、患者和内容专家组成的实施团队确定、调整和采用了基于证据的实践。在外部协助下，现场临床冠军领导循证实践的部署。通过图表审查和交互式语音应答电话系统，从 104 名可能患有双相情感障碍或难治性抑郁症的患者中收集了评估数据。实施了五种做法：1) 双相情感障碍筛查，2) 远程精神科咨询，3) 处方指南，4) 在线认知行为治疗，以及 5) 在线同伴支持。实施结果：1) 15% 的符合条件的患者接受了双相情感障碍筛查（诊所间范围：3%–70%），2) 少数患者参与在线心理治疗或同伴支持，3) 38% 接受了远程精神科咨询（诊所间范围：0%–83%），4) 64% 的咨询患者接受了推荐的药物治疗。临床结果：在高风险或极高风险的筛查中，分别有 67% 和 69% 被诊断为双相情感障碍。三分之一 (32%) 的患者服用了新的情绪稳定剂，28% 的患者服用了新的抗抑郁药。在三个月的随访中，21% 的患者观察到临床反应（抑郁症状减少 50%）。质量改进流程导致了五个检测和处理流程的实施和评估。尽管因地点而异，但筛查改善了检测，并且大量患者接受了咨询和药物调整，但症状改善有限。
Use quality improvement methods to implement evidence-based practices for Bipolar Depression and Treatment Resistant Depression in six Federally Qualified Health Centers. Following qualitative needs assessments, implementation teams comprised of front-line providers, patients, and content experts identified, adapted, and adopted evidence-based practices. With external facilitation, onsite clinical champions lead the deployment of the evidence-based practices. Evaluation data were collected from 104 patients with probable Bipolar Disorder or Treatment Resistant Depression via chart review and an Interactive Voice Response telephone system. Five practices were implemented: 1) screening for Bipolar Disorder, 2) telepsychiatric consultation, 3) prescribing guidelines, 4) on-line Cognitive Behavioral Therapy, and 5) on-line peer support. Implementation Outcomes: 1) 15% of eligible patients were screened for Bipolar Disorder (inter-clinic range: 3%–70%), 2) few engaged in on-line psychotherapy or peer support, 3) 38% received telepsychiatric consultation (inter-clinic range: 0%–83%), and 4) 64% of patients with a consult were prescribed the recommended medication. Clinical Outcomes: Of those screening at high risk or very high risk, 67% and 69% respectively were diagnosed with Bipolar Disorder. A third (32%) of patients were prescribed a new mood stabilizer and 28% were prescribed a new antidepressant. Clinical response (50% reduction in depression symptoms), was observed in 21% of patients at three-month follow-up. Quality improvement processes resulted in the implementation and evaluation of five detection and treatment processes. Though varying by site, screening improved detection and a substantial number of patients received consultations and medication adjustments, however symptom improvement was modest.
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影响因子：
12.7
作者：
Glasgow, RE;Vogt, TM;Boles, SM
通讯作者：
Boles, SM
影响因子：
3.8
作者：
Ghaemi, S. Nassir;Hsu, Douglas J.;Sachs, Gary
通讯作者：
Sachs, Gary
影响因子：
2.8
作者：
Burke, Bridget Teevan;Miller, Benjamin F.;Phillips, Robert L.
通讯作者：
Phillips, Robert L.
影响因子：
17.7
作者：
Fortney, John C.;Pyne, Jeffrey M.;Rost, Kathryn M.
通讯作者：
Rost, Kathryn M.
DOI：
10.1353/cpr.2012.0039
发表时间：
2012-09-01
影响因子：
1.1
作者：
Hunt, Justin B.;Curran, Geoffrey;Fortney, John
通讯作者：
Fortney, John