Implementation of an EHR-integrated web-based depression assessment in primary care: PORTAL-Depression.

Objectives: To integrate a computerized adaptive test for depression into the electronic health record (EHR) and establish systems for administering assessments in-clinic and via a patient portal to improve depression care.

Materials And Methods: This article reports the adoption, implementation, and maintenance of a health information technology (IT) quality improvement (QI) project, Patient Outcomes Reporting for Timely Assessment of Life with Depression (PORTAL-Depression). The project was conducted in a hospital-based primary care clinic that serves a medically underserved metropolitan community.

A novel Project ECHO curriculum on older adult pain management and opioid use disorder for outpatient clinicians.

Chronic pain, opioid use, and opioid use disorder (OUD) are increasingly common in older adults. Outpatient clinician education may improve outcomes. Our aim was to create and evaluate a novel curriculum for outpatient clinicians on older adult pain management, opioid prescribing, and OUD leveraging Project ECHO®, a model for delivering subspecialized medical knowledge to community outpatient clinicians via videoconferencing.

Population Health Management Approach to Depression Symptom Monitoring in Primary Care via Patient Portal: A Randomized Controlled Trial.

Depression is undertreated in primary care. Using patient portals to administer regular symptom assessments could facilitate more timely care. At an urban academic medical center outpatient clinic, patients with active portal accounts and depression on their problem list or a positive screen in the past year were randomized to assessment during triage at visits (usual care) versus usual care plus assessment via portal (population health care).

Association between wait time and behavioral health appointment attendance across patient characteristics.

Adequate access to behavioral health (BH) services is a critical issue. Many patients who are referred to BH care miss their appointments. One barrier to BH care is that longer wait times decrease the likelihood of appointment attendance.

Pragmatic Clinical Trial of Population Health, Portal-Based Depression Screening: the PORTAL-Depression Study.

Background: A population health approach to depression screening using patient portals may be a promising strategy to proactively engage and identify patients with depression.

Objective: To determine whether a population health approach to depression screening is more effective than screening during clinic appointments alone for identifying patients with depression.

Design: A pragmatic clinical trial at an adult outpatient internal medicine clinic at an urban, academic, tertiary care center.

Improving Primary Care Behavioral Health Integration in an Academic Internal Medicine Practice: 2-Year Follow-Up.

This report details ongoing efforts to improve integration in the 2 years following implementation of the Primary Care Behavioral Health model at a general internal medicine clinic of an urban academic medical center. Efforts were informed by a modified version of the validated Level of Integration Measure, sent to all faculty and staff annually. At baseline, results indicated that the domains of systems integration, training, and integrated clinical practices had the greatest need for improvement.

Measuring Perceived Level of Integration During the Process of Primary Care Behavioral Health Implementation.

Provider- and staff-perceived levels of integration were measured during implementation of a primary care behavioral health clinic; these data were used to tailor and evaluate quality improvement strategies. Providers and staff at an urban, academic, adult primary care clinic completed the 32-item Level of Integration Measure (LIM) at baseline and 7 months. The LIM assesses 6 domains of integrated care.

Strategic self-presentation may enhance effects of interdisciplinary chronic pain treatment.

Objective: Strategic self-presentation (SSP) is rooted in cognitive dissonance and self-perception theories, and holds that when a person presents him/herself as having certain attributes and publicly commits to having these attributes, then he or she may then begin to behave consistently with that presentation. SSP principles were integrated into an interdisciplinary chronic pain program to test whether self-presentation as a "good coper" made in a public context would increase pre- to posttreatment gains on measures of pain severity, interference, activity level, depression, pain self-efficacy, and coping.

Method: Eighty-nine patients with chronic pain were assigned to either claim that they are coping well with pain (SSP-positive) or that they are having problems coping with pain (SSP-negative).

Who benefits from emotional expression? An examination of personality differences among gynaecological cancer patients participating in a randomized controlled emotional disclosure intervention trial.

The present study examined the role of neuroticism and extraversion in the effects of written emotional disclosure in patients diagnosed with gynaecological cancer. It was hypothesized that high levels of neuroticism would be associated with an increase in distress after emotional disclosure as mediated by heightened negative affect and avoidance post-disclosure. Conversely, we expected high extraversion to be associated with decreased distress as mediated by heightened positive moods and a decrease in avoidance.

Within-subject comparison of the subjective and psychomotor effects of a gaseous anesthetic and two volatile anesthetics in healthy volunteers.

Inhalant abuse is a serious public health problem throughout the world. The present study compared the states of intoxication produced by three inhaled anesthetics that represent two of the three major classes of abused inhalants, as classified by [Balster, R.L.

Reinforcing and subjective effects of the volatile anesthetic, sevoflurane.

Sevoflurane is a volatile anesthetic that is chemically similar to volatile substances of abuse and can be safely administered to humans in laboratory research. In this study, the reinforcing and subjective effects of five concentrations of sevoflurane (0, 0.2, 0.

The effects of a cold-water stimulus on butorphanol effects in males and females.

Using a crossover, randomized, double-blind, cumulative-dosing procedure, we examined whether a painful stimulus modulated subjective and psychomotor effects of butorphanol in eight male and eight female volunteers. During each session, volunteers received four intravenous injections of either butorphanol (0, 0.5, 1, and 2 mg/70 kg) or saline (placebo) at hourly intervals.