Effectiveness of collaborative care for depression in human immunodeficiency virus clinics.

Background: Depression is common among persons with the human immunodeficiency virus (HIV) and is associated with unfavorable outcomes.

Methods: A single-blind randomized controlled effectiveness trial at 3 Veterans Affairs HIV clinics (HIV Translating Initiatives for Depression Into Effective Solutions [HITIDES]). The HITIDES intervention consisted of an off-site HIV depression care team (a registered nurse depression care manager, pharmacist, and psychiatrist) that delivered up to 12 months of collaborative care backed by a Web-based decision support system.

Longitudinal association of preference-weighted health-related quality of life measures and substance use disorder outcomes.

Aim: To examine the construct validity of generic preference-weighted health-related quality of life measures in a sample of patients with a substance use disorder (SUD).

Design: Longitudinal (baseline and 6-month follow-up) data from a research study that evaluated interventions to improve linkage and engagement with SUD treatment.

Setting: A central intake unit that referred patients to seven SUD treatment centers in a Midwestern US metropolitan area.

Cost-effectiveness analysis of a rural telemedicine collaborative care intervention for depression.

Context: Collaborative care interventions for depression in primary care settings are clinically beneficial and cost-effective. Most prior studies were conducted in urban settings.

Objective: To examine the cost-effectiveness of a rural telemedicine-based collaborative care depression intervention.

Balancing health care evidence and art to meet clinical needs: policymakers' perspectives.

Rationale, aims and objectives Although many believe that evidence-based practice (EBP) has great potential, critics have identified limitations including a focus on randomized clinical trial (RCT) evidence to the exclusion of other evidence types and a disregard for the art of medicine. Others have argued, however, that proper application of EBP involves reasoned consideration of a wide variety of information; thus, the dichotomy between medical science and art may be false. We explore the views of executive-level policymakers from the Veterans Health Administration, a leader in the EBP movement, regarding what constitutes evidence and the relative importance of evidence versus practical needs when determining clinical policy.

Challenges associated with being an off-site depression care manager.

Within the context of depression care, the U.S. Department of Veterans Affairs (VA) has an ongoing depression care manager (DCM) training program.

Antipsychotic Adherence Intervention for Veterans over Forty with Schizophrenia: Results of a Pilot Study.

This pilot study tested the feasibility, acceptability, and effect sizes of a multimodal, individual intervention designed to optimize antipsychotic medication use in patients ≥40 years of age with schizophrenia or schizoaffective disorder. We randomized forty patients into two groups: usual care (UC) versus a nine-session, manualized antipsychotic adherence intervention (AAI). The AAI attempted to improve adherence by combining three psychosocial techniques: 1) education; 2) skills training; and, 3) alliance building.

Antipsychotic Adherence Intervention for Veterans over 40 with Schizophrenia: Results of a Pilot Study.

This pilot study tested the feasibility, acceptability, and effect-sizes of a multimodal, individual intervention designed to optimize antipsychotic medication use in patients >/=40 years of age with schizophrenia or schizoaffective disorder. METHODS: We randomized 40 patients into two groups: usual care (UC) or a nine-session, manualized, antipsychotic adherence intervention (AAI). The AAI attempted to improve adherence by combining three psychosocial techniques: a) education, b) skills training, and c) alliance building.

Influence of family involvement and substance use on sustained utilization of services for schizophrenia.

Objective: This observational study assessed the influence of family support and substance abuse on patterns of service use by individuals with schizophrenia.

Methods: Polychotomous logistic regression was used to analyze an existing database for 258 individuals with schizophrenia who were between the ages of 18 and 67 and were recruited from public mental health care settings. Analyses determined the extent to which two consumer-identified factors, family support and substance abuse status, influenced patterns of outpatient service use (regular, irregular, and infrequent) for schizophrenia.

The effectiveness of guideline implementation strategies on improving antipsychotic medication management for schizophrenia.

Objectives: To compare the effectiveness of a conceptually-based, multicomponent "enhanced" strategy with a "basic" strategy for implementing antipsychotic management recommendations of VA schizophrenia guidelines.

Methods: Two VA medical centers in each of 3 Veterans Integrated Service Networks were randomized to either a basic educational implementation strategy or the enhanced strategy, in which a trained nurse promoted provider guideline adherence and patient compliance. Patients with acute exacerbation of schizophrenia were enrolled and assessed at baseline and 6 months and their medical records were abstracted; 291 participants were included in analyses.

Ranking of outcome domains for use in real-time outcomes feedback laboratory by patients with schizophrenia.

The purpose of this study was to prioritize real-time outcomes from the perspective of patients with schizophrenia. Thirty-eight patients were interviewed and ranked 15 outcome domains according to their preference for communicating these outcomes with their mental health provider in the context of a real-time outcomes feedback laboratory. Subjects with schizophrenia ranked overall physical health as the most important outcome domain that they wanted to communicate to their mental health provider in the context of a real-time outcomes feedback laboratory.

Longitudinal patterns of health system retention among veterans with schizophrenia or bipolar disorder.

Inconsistent service use for schizophrenia and bipolar disorder is associated with poorer outcomes of care. We analyzed VHA National Psychosis Registry data for 164,150 veterans with these disorders to identify characteristics associated with 5-year patterns of survival and with retention in VHA care. Most cohort members (63%) survived the period with no break in VHA healthcare lasting over 12 months.

A process for developing an implementation intervention: QUERI Series.

Background: This article describes the process used by the authors in developing an implementation intervention to assist VA substance use disorder clinics in adopting guideline-based practices for treating depression. This article is one in a Series of articles documenting implementation science frameworks and tools developed by the U.S.

Guideline implementation and patient-tailoring strategies to improve medication adherence for schizophrenia.

Objective: To determine the effectiveness of an intervention to promote medication adherence.

Method: Data were collected for adults with exacerbation of schizophrenia who were treated at one of 6 U.S.

Equity in veterans' mental health care: Veterans Affairs medical center clinics versus community-based outpatient clinics.

This study examined differences in structures and processes of mental health care at Veterans Administration (VA) primary care clinics, comparing VA medical center (VAMC) clinics to community-based outpatient clinics (CBOCs). A survey was conducted of nurse managers at 46 of 49 primary care clinics (23 VAMC clinics and 23 CBOCs) within a VA health care network in the south central United States. Integration of care and services overall was comparable between VAMC clinics and CBOCs.

A randomized trial of telemedicine-based collaborative care for depression.

Background: Evidence-based practices designed for large urban clinics are not necessarily portable into smaller isolated clinics. Implementing practice-based collaborative care for depression in smaller primary care clinics presents unique challenges because it is often not feasible to employ on-site psychiatrists.

Objective: The purpose of the Telemedicine Enhanced Antidepressant Management (TEAM) study was to evaluate a telemedicine-based collaborative care model adapted for small clinics without on-site psychiatrists.

Comparison of two enhanced consent procedures for patients with mild Alzheimer disease or mild cognitive impairment.

Objective: The objective of this study was to evaluate the feasibility, acceptability, and preliminary efficacy of two enhanced consent procedures provided to patients with Alzheimer disease or mild cognitive impairment that used either a PowerPoint presentation or an enhanced printed consent form.

Methods: Patients randomly assigned to an enhanced written consent procedure or slideshow presentation were assessed with the MacArthur Competence Assessment Tool for Clinical Research.

Results: Verbal reexplanation was associated with improved understanding in both conditions.

Impact of comorbid anxiety disorders on health-related quality of life among patients with major depressive disorder.

Objective: This study examined the impact of comorbid anxiety disorders-posttraumatic stress disorder (PTSD), generalized anxiety disorder, and panic disorder-on health-related quality of life among primary care patients enrolled in a collaborative care depression intervention study for the Department of Veterans Affairs (VA).

Methods: Baseline data were used from 324 participants in the Telemedicine Enhanced Antidepressant Management (TEAM) Study, a multisite randomized effectiveness trial targeting VA primary care patients with depression. Health-related quality of life was measured by using the Quality of Well-Being Scale, self-administered version (QWB-SA) and the mental component summary (MCS-12V) and physical component summary (PCS-12V) of the 12-item Short Form Health Survey for Veterans (SF-12V).

Differences in characteristics and outcome of delirium as based on referral patterns.

The authors studied factors associated with referral of delirium patients to psychiatry consultation and its outcome implications. Characteristics and treatment outcomes of delirium patients referred to psychiatry were compared with those not referred. Referred patients were younger, had a more hyperactive subtype, greater substance abuse, less comorbid dementia, were more likely to be recognized as having delirium, and be prescribed medications.

Correlates of health-related quality of well-being in older patients with schizophrenia.

Research on correlates of health-related quality of life (HRQOL) among older patients with schizophrenia has been very limited. This study evaluated the relative impact of positive, negative, and depressive symptoms, movement disorders, and cognitive impairment on HRQOL among middle-aged and older patients with schizophrenia or schizoaffective disorder. Participants were 199 patients aged 45 to 85 years.

Health-related quality of life and functioning of middle-aged and elderly adults with bipolar disorder.

Objective: Data characterizing bipolar disorder in older people are scarce, particularly on functional status. We evaluated health-related quality of life and functioning (HRQoLF) among older outpatients with bipolar disorder as well as the relationship of HRQoLF to bipolar illness characteristics.

Method: We compared community-dwelling middle-aged and older adults (age range, 45 to 85 years) with bipolar disorder (N=54; mean age=57.

Does improving geographic access to VA primary care services impact patients' patterns of utilization and costs?

The Department of Veterans Affairs (VA) has been establishing community-based outpatient clinics (CBOCs) across the country to improve veterans' access to and use of primary care services, thereby decreasing the need for costly specialty outpatient and inpatient care. Using a quasi-experimental, pre-post study design, we examined whether the establishment of CBOCs has affected access, use, and costs for VA patients residing in their catchment areas. Most patients residing in CBOC catchment areas did not receive care at CBOCs, resulting in only small increases in primary care utilization.

One size fits some: the impact of patient treatment attitudes on the cost-effectiveness of a depression primary-care intervention.

Background: Despite their impact on outcomes, the effect of patient treatment attitudes on the cost-effectiveness of health-care interventions is not widely studied. This study estimated the impact of patient receptivity to antidepressant medication on the cost-effectiveness of an evidence-based primary-care depression intervention.

Method: Twelve community primary-care practices were stratified and then randomized to enhanced (intervention) or usual care.

Use of electronic medical record data for quality improvement in schizophrenia treatment.

An understanding of the strengths and limitations of automated data is valuable when using administrative or clinical databases to monitor and improve the quality of health care. This study discusses the feasibility and validity of using data electronically extracted from the Veterans Health Administration (VHA) computer database (VistA) to monitor guideline performance for inpatient and outpatient treatment of schizophrenia. The authors also discuss preliminary results and their experience in applying these methods to monitor antipsychotic prescribing using the South Central VA Healthcare Network (SCVAHCN) Data Warehouse as a tool for quality improvement.