Collaborative Care Model Research Articles

The current state of the Multidisciplinary Heart Team Approach: a systematic review.

The heart team (HT) approach, recommended for managing cardiovascular diseases (CVDs), emphasizes multidisciplinary collaboration. Despite its potential benefits, evidence on its effectiveness and implementation is varied and sparse. This review assesses the HT approach's impact on patient outcomes and care delivery in cardiovascular care. A systematic review was conducted across MEDLINE, EMBASE, PubMed, Cochrane, and Google Scholar up to July 2023, focusing on studies that implemented an HT approach in coronary and heart valve disease management. Exclusion criteria included non-human studies, case reports, and studies not focusing on HT outcomes. From 6270 identified articles, 20 met the inclusion criteria. These studies demonstrated significant variability in HT composition and organisation, coupled with a lack of standardized metrics for evaluating clinical outcomes and the impact of the HT. Significant variability was observed in HT composition, with 13 of the 20 studies did not utilize structured templates, those that did demonstrated more consistent decision-making. In mitral valve interventions, HTs were linked to reduced in-hospital mortality and improved long-term survival (5-year survival probability of 0.74 vs 0.70, p = 0.04). In aortic valve interventions, 80% of patients underwent tailored valve procedures following HT evaluation. The HT approach in cardiovascular care demonstrates improved patient outcomes, particularly in specialized interventions for mitral and aortic valve diseases and CAD management. Despite these positive findings, the variability in HT implementation and the need for standardized outcome metrics call for further advances to optimize this collaborative care model.

Mental Illness is as Catastrophic as Physical Illness, If Not More!

As per the data released by the Mental Health Survey (NMHS) 2015-16, 10.6% (1) of the adults in India have something or other clinical mental illness, and many more suffer silently with subclinical symptoms. In India, the contribution of mental illness to disability-adjusted life-years (DALYs) in the year 2017 was 4.7% with an uprise of 88% from 2.5% in the year 1990. Social stress, highly competitive ecosystems, peer pressure, and erratic working schedules are some of the predisposing factors for the high prevalence of mental illness in urban areas. Mental illness has a larger economic burden on patients and it impacts even the purchasing power of the entire family. World over, mental neurological and substance use disorders collectively known as MNSUDs are recognized as a sizable factor contributing to the non-communicable diseases (NCDs) category with substantial impact on morbidity and disability. Unfortunately, in India, only 5% (one out of twenty) patients seek treatment for mental illness, and only 0.06% of the total health budget is for mental health programs. More non-medical community-based research is needed to fathom the gigantic mental illness across socioeconomic sects of society. Key Words: Mental Illness, DALYs, Mental Health Survey (NMHS) 2015-16, Post-Traumatic Stress Disorder (PTSD), Disease Burden, Bipolar Disorders, Social Stress, Suicidal Tendencies, Depression among women, Collaborative Care Models (CCMs), National Mental Health Program (NMHP), socio-ecological community intervention.

Critical Analysis of The Intersections Between Nursing and Midwifery

Nursing and midwifery are two health professions related to the scope of practice. However, they differ, especially in women's and children's health services. It recently became important to address overlaps between these fields, particularly about collaborative care models. To this end, this paper aims to investigate the complex role, shared tasks and dynamics, and issues relating to nurses and midwives in today's society. It explores the role of the professions in patient care, defines the areas of convergence and drawbacks of these professions, and analyzes the effect of these professions on patient care. Some issues include role confusion, variation in professional training, and constraints of the overall health system, which are outlined in addition to the suggested approaches to enhance relations between nursing and midwifery.

Implementing a Collaborative Care Model for Child and Adolescent Mental Health in Qatar: Addressing Workforce and Access Challenges

Implementing a Collaborative Care Model for Child and Adolescent Mental Health in Qatar: Addressing Workforce and Access Challenges

Impact of Integrated Pharmacist-Nurse-Radiology-Dietitian Teams on Polypharmacy Patient Outcomes: A Comprehensive Analysis

Polypharmacy, defined as the concurrent use of five or more medications, is a significant challenge in modern healthcare. It affects 10-20% of community-dwelling adults and 40-50% of people aged 65 years and older. This study presents a comprehensive assessment of the impact of integrated healthcare teams comprising pharmacists, nurses, radiologists, and dietitians on polypharmacy patient outcomes. The results indicated significant improvements across multiple domains: medication appropriateness scores increased by 65%, adverse drug events decreased by 45%, and hospital readmission rates decreased by 40%. Each professional contributed something unique: pharmacists reduced inappropriate medications through comprehensive medication reviews by 65%; hospital readmissions were reduced by nurses, who applied quality-enhanced care coordination for the best interest of the patient by 35%; radiologists increased treatment accuracy by 40%, providing advanced diagnostic support; and dietitians decreased drug-nutrient interaction complications by 55%. Economic analysis revealed substantial cost savings of approximately $2,500 per patient annually, and a 35% reduction in emergency department utilization. Patient-centered outcomes demonstrated a 55% increase in health-related quality of life and 60% improvement in medication adherence. Implementation barriers, resource constraints, and limitations in the reimbursement structure exist, but evidence strongly supports the effectiveness of such integrated healthcare teams in polypharmacy patient management. The study concluded that such collaborative care models are vital for better patient outcomes and healthcare resource utilization in an evolving practice around advanced medication management.

Collaborative Care Model for Patients With Opioid Use Disorder and Mental Illness

This cohort study uses data from a randomized clinical trial for opioid use disorder (OUD) co-occurring with mental illness to examine patient characteristics associated with collaborative care model engagement and fidelity.

Healthcare dashboard technologies and data visualization for lipid management: A scoping review

BackgroundLipid disorders significantly increase cardiovascular disease (CVD) risk, the leading cause of mortality worldwide. Effective lipid management is critical for improving health outcomes. Traditional screening methods face challenges due to data complexity and the need for timely decision-making. Data visualization and dashboard technologies offer clear, actionable insights and supporting informed decision-making. This study investigates the use of these technologies in lipid management and their impacts on the quadruple aim of healthcare.MethodsThis scoping review followed the Joanna Briggs Institute (JBI) approach, focusing on studies involving dashboard technologies or data visualization in lipid management. A comprehensive search across multiple databases (Embase, Web of Science, PubMed, Scopus, CINAHL) and gray literature was conducted, including English-language publications from 2014 to 2024. Data were analyzed using quantitative descriptive and qualitative content analysis to evaluate the key features, clinical applications, and outcomes.ResultsTwenty-seven studies met the inclusion criteria, primarily focusing on dashboard utilization by physicians for managing diabetes and CVD, utilizing electronic medical records and clinical guidelines. Key analysis methods included comparing key performance indicators (KPIs) (85.2%) and trend analysis (74.1%). Lipid management workflows emphasized prevention (88.9%) and treatment planning (77.8%). Interventions included care packages (comprehensive sets of interventions for patient care), decision support systems, web-based tools, and mobile health solutions. Regarding Quadruple Aim outcomes: 12 studies focused on improving population health (8 positive, 4 no change), 9 on clinical outcomes (5 positive, 4 no change), 6 on provider work life (5 positive), 5 on patient experience (positive changes in education and time management), and 2 on cost reduction (1 positive, 1 negative).ConclusionsDashboards are important tools in managing lipid disorders in managing lipid disorders, integrating with educational tools, collaborative care models, and decision support systems. Although they are effective in enhancing population health and clinical experiences, their impact on patient outcomes and cost reduction requires further exploration. Future research should focus on detailed evaluations of dashboard impacts on patient outcomes and cost-effectiveness, emphasizing precision prevention of chronic diseases.

Long-term effects of collaborative dementia care on quality of life and caregiver well-being.

Collaborative dementia care models with care navigation, including the Care Ecosystem, improve outcomes for persons living with dementia (PLWDs) and their caregivers. The effects of continuous care over long periods have not been studied. In this randomized clinical trial with 456 PLWD-caregiver dyads with high caregiver burden, we evaluated the cumulative 5-year treatment effect on PLWD quality of life, health care utilization, caregiver depression, self-efficacy, and burden. Five-year participation was associated with higher quality of life, lower caregiver depression, and higher caregiver self-efficacy (all p's<0.05) with a trend for lower burden (p=0.07). Treatment effects were most robust during the first 2 years. The effects on emergency department visits and hospitalizations were not significant. The benefits of collaborative dementia care on PLWD quality of life and caregiver well-being are sustained for 5 years, and the dyads may experience the greatest benefit during the first 2 years. Collaborative dementia care with care navigation was evaluated over 5 years using a randomized clinical trial. The care was associated with better quality of life for the person with dementia and well-being for the caregiver. The most robust treatment effects were in the first 2 years.

Collaborative Care to Improve Quality of Life for Anxiety and Depression in Posttraumatic Epilepsy (CoCarePTE): Protocol for a Randomized Hybrid Effectiveness-Implementation Trial.

Anxiety and depression in people with epilepsy are common and associated with poor outcomes; yet, they often go untreated due to poor mental health specialist access. Collaborative care is an integrated care model with a strong evidence base in primary care and medical settings, but it has not been evaluated in neurology clinics. Evaluating implementation outcomes when translating evidence-based interventions to new clinical settings to inform future scaling and incorporation into real-world practice is important. The Collaborative Care for Posttraumatic Epilepsy (CoCarePTE) trial aims to evaluate the effectiveness (improvement in emotional quality of life) and implementation of a collaborative care intervention for people with anxiety or depressive symptoms and posttraumatic epilepsy. CoCarePTE is a 2-site, randomized, single-blind, hybrid type 1 effectiveness-implementation trial that will randomize 60 adults to receive either neurology-based collaborative care or usual care. Adults receiving neurological care at participating centers with anxiety or depressive symptoms and a history of at least mild traumatic brain injury before epilepsy onset will be enrolled. The collaborative care intervention is a 24-week stepped-care model with video or telephone calls every 2 weeks by a care manager for measurement-based anxiety and depression care, seizure care monitoring, and brief therapy intervention delivery. This is supplemented by antidepressant prescribing recommendations by psychiatrists for neurologists via case conferences and care manager-facilitated team communication. In step 2 of the intervention, individuals with <50% symptom reduction by 10 weeks will receive an added 8-session remote cognitive behavioral therapy program. The study is powered to detect a moderate improvement in emotional quality of life. As a hybrid type 1 trial, effectiveness is the primary focus, with the primary outcome being a change in emotional quality of life at 6 months in the intervention group compared to control. Secondary effectiveness outcomes are 6-month changes in depression, anxiety, and overall quality of life. Implementation outcomes, including fidelity, acceptability, feasibility, and appropriateness, are evaluated before implementation and at 3 months. The primary effectiveness analysis will compare changes in emotional quality of life scores from baseline to 6 months between the intervention and control arms using multiple linear regression modeling, adjusting for study site and using an intent-to-treat approach. Enrollment commenced in 2023, with modifications in the inclusion and exclusion made after the first 6 enrollees due to slow recruitment. Enrollment is expected to continue at least into early 2025. The CoCarePTE trial is novel in its use of a hybrid effectiveness-implementation design to evaluate an evidence-based mental health intervention in epilepsy, and by incorporating seizure care into a collaborative care model. If a significant improvement in emotional quality of life is found in the intervention group compared to usual care, this would support next step scaling or clinical implementation. ClinicalTrials.gov NCT05353452; https://www.clinicaltrials.gov/study/NCT05353452. DERR1-10.2196/59329.

Formative qualitative research to guide implementation of the Collaborative Care Model in a low-barrier HIV clinic

ABSTRACT Integrated behavioral healthcare interventions have increased access to care for people with behavioral health conditions in primary care settings. However, they have not been widely implemented in low-barrier HIV care settings where undertreated behavioral health needs remain high. We conducted a formative qualitative evaluation, using in-depth interviews with purposively selected stakeholders (n = 13) and patients (n = 16), to identify anticipated barriers and facilitators to integrating care for depression and opioid use disorder for people with HIV via the Collaborative Care Model at a low-barrier HIV clinic. Patients and stakeholders expressed their enthusiasm for the Collaborative Care Model based on its perceived relative advantage over the standard of care referral system. Availability of resources, practical concerns about perceived fit with low-barrier HIV care, and anticipated suitability given other behavioral health comorbidities and patients’ complex socioeconomic needs partially tempered stakeholder perceptions of appropriateness for the Collaborative Care Model. Patients and service delivery stakeholders were receptive to the Collaborative Care Model, but felt it was moderately appropriate in the context of low-barrier HIV care, which necessitated key adaptations to core model components to improve its contextual fit.

Impact of Collaborative Nursing Care on Health Outcomes of Mental Health Day Hospital Users: A Mixed Methods Study.

Given that recovery-oriented care focuses on empowering individuals with mental health challenges, collaborative care can be an effective tool for nurses in mental health day hospitals. To deepen knowledge about the impact of collaborative nursing care for improving health outcomes of mental health day hospital users. A sequential and transformative mixed methods study was designed. In the first phase of this mixed methods study, quantitative data were collected from 144 users of mental health day hospitals. In phase two, a group of users underwent an intervention based on collaborative nursing care, through participatory action research, and qualitative data were collected. Finally, quantitative data were again collected from all users. The users who participated in the intervention group improved quantitatively in terms of the quality of the therapeutic relationship. They also improved at different stages of the recovery process, thus the qualitative results confirmed that collaborative nursing care was an essential component in their recovery process. The findings highlight the critical role of collaborative nursing care in health outcomes. The therapeutic relationship was identified as a key factor in facilitating patient empowerment. The study supports implementing collaborative nursing care models in mental health settings to enhance patient outcomes. ClinicalTrials.gov identifier: NCT04814576.

Empowering primary care physicians in child and adolescent psychiatry: a needs assessment on collaborative care in Dubai.

Child and adolescent psychiatric disorders pose significant public health concerns necessitating prompt intervention. Primary care physicians (PCPs) play a critical role as initial points of contact, facilitating early detection, management, and referral of these conditions. In Dubai, integrating mental health services into primary care faces unique challenges, highlighting the need for systemic reforms and enhanced PCP training. This study investigated perceptions, barriers, and systemic challenges encountered by PCPs in managing child and adolescent psychiatric conditions in Dubai's primary care setting. It also assessed family physicians' involvement and preparedness in this domain. Using a mixed-methods approach, we conducted a survey among family physicians in Dubai Health facilities and analyzed patient data from family medicine clinics. The survey evaluated formal training, preparedness, encounter frequency, and referral patterns for psychiatric care in young patients. Qualitative insights from open-ended survey questions provided additional understanding of specific challenges. Findings revealed significant gaps in formal training, with only 33.3% of respondents trained in child and adolescent psychiatry during medical education, and 21.1% participating in Continuing Medical Education (CME). A majority (54.4%) of PCPs felt unprepared to manage psychiatric care in young patients. Patient data analysis showed a predominance of male patients (59.9%) and identified Autism Spectrum Disorder (43.1%) as the most common condition, emphasizing the reliance on specialized care through a high referral rate (63.1%). Major barriers included time constraints, limited psychiatric knowledge, resistance to mental health services, systemic and structural issues, communication challenges, and resource shortages. Enhanced training and systemic reforms are urgently needed to integrate mental health services effectively into Dubai's primary care. Implementing structured collaborative care models, fostering interdisciplinary collaboration, and addressing systemic barriers are crucial for improving child and adolescent psychiatric condition management. These initiatives promise better patient outcomes and more efficient healthcare resource utilization.

Predictors of symptom change in the mental health of refugees and asylum seekers (MEHIRA) study examining the effects of a stepped and collaborative care model – A multicentered rater-blinded randomized controlled trial

BackgroundPredictors of symptom improvement are an essential starting point for tailoring psychological treatments to each individual and, in turn, increasing treatment efficacy overall. However, such research regarding refugees/asylum seekers from Arabic-/Farsi-speaking countries is lacking. The current study aimed to characterize predictors for symptom improvement in the Mental Health in Refugees and Asylum Seekers (MEHIRA) study, one of the most extensive multicentered controlled trials on a nationwide stepped and collaborative care model compared to routine German mental health care. MethodsVariables characterizing symptom change were chosen using backward elimination and inserted into logistic regression models for two depression endpoints, namely the Patient Health Questionnaire-9 (PHQ-9) and the Montgomery Asberg Depression Rating Scale (MADRS). ResultsSix variables were found to be at least marginally significantly associated with symptom decrease in both outcomes: baseline depressive symptom load, comorbid post-traumatic stress disorder, identifying as a refugee, years of schooling, physical health, and post-migration social status difference. Additionally, psychological health and resilience were marginally significant for one of the models. LimitationsSome predictor constructs - such as social support - were not adequately measured to replicate previous findings. Additionally, the study was underpowered for symptom change prediction of individual treatments beyond the group intervention. ConclusionsThese outcomes indicate that trauma-related elements as well as content on refugee identity and post-migration social status changes should be included in depression interventions for refugees. Further, recommendations for future outcome prediction studies are made.

Interprofessional Education Simulation Project Using the Collaborative Care Model.

Integrated behavioral health care (IBH), a team-based approach to care, involves behavioral health providers (BHP) to be utilized in primary care settings. Unfortunately, many BHP and primary care advanced practice nursing students do not receive IBH content in their educational curriculum. This article describes an innovative interprofessional simulation project (ISP) in a virtual IBH setting with primary care nurse practitioner and master's level counseling students. The ISP involved students role-playing using case studies while enacting the roles exemplified in the Collaborative Care model (CoCM). Interprofessional faculty collaborated in developing the project and training facilitators and interprofessional students. Of the students and faculty who completed a postsurvey, 87.7% reported an increase in preparedness in learning the CoCM, and 92.6% responded the preparation time for the project was "appropriate." The ISP project resulted in high satisfaction and perceived increased preparedness for students and faculty to practice and teach IBH. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Impact of Surgeon-Radiation Oncology Dyads in Oral Cavity Cancer Outcomes.

Multidisciplinary care is paramount in patient-specific decision making, especially as pertaining to oral cavity squamous cell cancer (OCSCC) treatment. Protracted surgery-postoperative-radiation (S-PORT) has a detrimental impact on OCSCC patients' outcomes. This study examined the impact of surgeon-radiation oncologist dyads on the treatment of OCSCC, focusing on S-PORT interval and disease specific outcomes. All OCSCC patients treated in a tertiary cancer center between 2009 to 2017 were included. Patients were categorized into "dyad" and "nondyad" groups defined as whether they were treated by a paired surgeon-radiation oncology team with joint multidisciplinary clinic or shared >30% patient volumes. Univariate and multivariate logistic regression were performed to identify factors associated with a prolonged S-PORT time interval (≥8 weeks). Overall survival and locoregional recurrence were estimated and compared. A total of 444 OCSCC were eligible. Treatment by a dyad was significantly less likely associated with S-PORT ≥ 8 weeks (odds ratio [OR]unadjusted: 0.65; 95% confidence interval [CI] 0.44-0.96; p = 0.03). Obtaining pre-operative radiation oncology consultation also decreased the S-PORT interval. Advanced T-category and the need for free tissue flap reconstruction increased the likelihood of prolonged S-PORT on univariate but not multivariate analysis. No significant differences were observed in overall survival or locoregional recurrence by dyad status nor S-PORT (p > 0.05). Surgeon-radiation oncology dyads significantly minimized time from surgery to postoperative radiation in OCSCC. While improvement in overall survival or locoregional recurrence was not observed, these findings support close knit collaborative multidisciplinary treatment care models, including dyad-based care.

A controlled study: Evaluating the clinical impact of a nurse-centred multidisciplinary hospice care model on anxiety, depression, and quality of life in patients with advanced malignant tumours.

To explore the clinical effect of a nurse-centred multidisciplinary collaborative hospice care model in patients with advanced malignant tumours. A total of 30 patients with advanced malignant tumours were hospitalised and randomly divided into a study group and a control group, each consisting of 15 cases. The study group received nurse-led multidisciplinary collaborative hospice care, whereas the control group underwent high-quality nursing intervention. Variables such as the self-rating anxiety scale (SAS) score, self-rating depression scale (SDS) score, quality of life scale (EORTC QLQ-C30) score, patient happiness, and nursing satisfaction were compared between the two groups. Post-intervention, the SAS and SDS scores in the study group were lower than those in the control group (p < 0.01). The overall quality of life score of the study group was higher than that of the control group (p < 0.01). The Memorial University of Newfoundland Scale of Happiness scores in the study group also surpassed those of the control group (p < 0.01). Additionally, nursing satisfaction in the study group exceeded that of the control group (p = 0.027). The nurse-led multidisciplinary collaborative hospice care model substantially alleviated negative emotions among patients, effectively improved their quality of life and happiness, and garnered positive evaluations of nursing satisfaction.

Psychiatric Health, Life Skills, and Opportunities for Wellness Program: Addressing psychiatric need through integrated consultation, collaboration, and brief episodes of care.

Integrated behavioral health programs bring strong benefits to patients and health organizations including reductions in overall costs. However, obstacles to funding prevent the implementation and maintenance of these programs across the country. The Psychiatric Health, Life Skills and Opportunities for Wellness (PHLOW) Program is based on the collaborative care model and seeks to provide psychiatric care through an integrated model that is financially sustainable for the organization. This pilot observational study included patients who received psychiatric care indirectly via consultations with primary care providers and directly through brief episodes of care. Patient outcomes were demonstrated by score changes on the nine-item Patient Health Questionnaire and Generalized Anxiety Disorder 7 before and after participation in brief episodes of care. Overall cost of care savings was demonstrated through change over time in risk-adjusted per-member-per-month. Patients participating in the PHLOW program showed potential drops in anxiety and depression ratings, coinciding with a reduction in mental health claims. In addition, participation in the program involved a small number of patient visits and prevented referrals to long-term psychiatry, preserving access for higher acuity presentations. This demonstration of the value of the PHLOW program has led to additional financial support of the program through the primary regional Medicaid payor, enhancing sustainability, and potentially modeling a collaboration that may be feasible for other organizations implementing integrated behavioral health programs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Association between antepartum admission and postpartum depressive symptoms

BackgroundPostpartum depression affects 14% of pregnant individuals and is a leading cause of preventable maternal mortality. Complications of pregnancy, such as preterm labor or pre-eclampsia, may require hospitalization for close monitoring and management. The impact of an antenatal hospitalization during pregnancy on postnatal depression remains understudied. ObjectiveTo evaluate whether hospital admission during pregnancy was associated with postpartum depressive symptoms in individuals who were enrolled in a collaborative care model and to evaluate whether enrollment in the collaborative care model during pregnancy mitigated this association. Study DesignThis secondary analysis of a prospective cohort study included perinatal people enrolled in a collaborative care model at a quaternary academic center between 2017 and 2021. The primary outcome was presence of moderately severe or severe postpartum depressive symptoms at 6 weeks postpartum defined as a score of 15 or greater on a PHQ-9. The prevalence of symptoms of this severity was compared between those who experienced an antepartum hospitalization and those who did not using bivariable and multivariable analyses. A Breslow Day test was used to evaluate whether any observed association between antepartum hospitalization and postpartum depressive symptoms differed based on timing of enrollment in the collaborative care model. ResultsDuring the study period, 1897 individuals met inclusion criteria. Of these, 162 (8.5%) were admitted to the hospital during pregnancy. Of those with an antepartum hospitalization, 20 (12.4%) developed moderately severe to severe postpartum depressive symptoms compared to 136 (7.8%) of those who were not hospitalized (p=.046). After adjustment for confounders identified through use of a directed acyclic graph, this difference did not persist in multivariable analysis (aOR 1.55, 95% CI [0.87−2.75]). A Breslow Day test demonstrated heterogeneity across enrollment timing, so subgroup analyses were performed for those enrolled during pregnancy (n=930) vs postpartum (n=967). Hospital admission was associated with higher rates of moderately severe to severe postpartum depressive symptoms in those enrolled in the collaborative care model postpartum (19.7% vs 10.6%, p=.015, aOR 2.25, 95% CI [1.07−4.71]), but not those enrolled antenatally (5.8% vs 5.0%, p=.735, aOR 1.09, 95% CI [0.38−3.19]). ConclusionAntepartum hospital admission was associated with higher rates of moderately severe to severe depressive symptoms. This association did not exist among individuals enrolled in collaborative care model during pregnancy, suggesting a potential protective effect afforded by engagement in a mental health support programming.

Feasibility of a nurse-led, mHealth-assisted, and team-based collaborative care model for heart failure care in India: Findings from a multi-stakeholder qualitative study

Background Heart failure (HF) management is often challenging due to poor adherence to GDMT and self-care. Continuous monitoring of patients by a dedicated care manager may enhance adherence to self-care and treatment and prevent hospitalisations. For the adoption and acceptance of a collaborative care model (CCM) for HF management in Indian settings, understanding the perspectives of all stakeholders regarding its various components and feasibility is needed. Therefore, we aimed to obtain perceptions of potential challenges to care and suggestions on multiple components of the proposed CCM in managing HF and its feasibility. Methods In-depth interviews were done among HF patients, caregivers, nurses, and cardiologists from private, co-operative, and public sector tertiary care hospital settings that cater to HF patients in Kerala, India. An in-depth interview guide was used to elicit the data. Data were analysed using Python QualCoder version 2.2. We used a framework method for the analysis of data. Results A total of 22 in-depth interviews were conducted. We found that the existing care for HF in many settings was inadequate for continuous engagement with the patients. Non-adherence to treatment and other self-care measures, was noted as a major challenge to HF care. Healthcare providers and patients felt nurses were better at leading collaborative care. However, various barriers, including technical and technological, and the apprehensions of nurses in leading the CCM were identified. The stakeholders also identified the mHealth-assisted CCM as a potential tool to save money. The stakeholders also appreciated the role of nurses in creating confidence in patients. Conclusions A nurse-led, mHealth-assisted, and team-based collaborative care was recognised as an excellent step to improve patient adherence. Effective implementation of it could reduce hospitalisations and improve patients' ability to manage their HF symptoms.

Delays in bipolar depression treatment in primary care vs. integrated behavioral health and specialty care

IntroductionWhile bipolar disorder is not uncommon in primary care, collaborative care models for bipolar depression treatment are underdeveloped. Our aim was to compare initial pharmacological treatment patterns for an episode of bipolar depression in different care models, namely primary care (PC), integrated behavioral health (IBH), and mood specialty clinic (SC). MethodsA retrospective study of adults diagnosed with bipolar disorder who received outpatient care in 2020 was completed. Depressive episodes were captured based on DSM-5 criteria, ICD codes, or de novo emergent symptom burden (PHQ-9 ≥ 10). Pharmacological strategies were classified as 1) continuation of current regimen, 2) dose increase or 3) augmentation 4) switch to monotherapy or 5) a combination of more than two different strategies. Logistic regression was applied. ResultsA total of 217 encounters (PC = 32, IBH = 53, SC = 132) representing 186 unique patients were identified. PC was significantly more likely to continue the current regimen, while combination strategies were significantly more likely recommended in IBH and SC. Mood stabilizers were significantly more utilized in IBH and SC. There were no significant group differences in antidepressant use. LimitationsRetrospective study design at a single site. ConclusionsThis study provides evidence of delays in depression care in bipolar disorder. This is the first study to compare treatment recommendations for bipolar depression in different clinical settings. Future studies are encouraged to better understand this gap and to guide future clinical practice, regardless of care model, emphasizing the potential benefits of decision support tools and collaborative care models tailored for bipolar depression.