Primary Care Psychologists Research Articles

Wellbeing of parents raising the children with autism spectrum disorder and the role of psychologists

IntroductionRecent research show the rise of the prevalence of the autism spectrum disorder (ASD) worldwide. At the same time, care for ASD children was found to affect the psychological health of parents or guardians of ASD children. The aim was to identify the wellbeing of parents raising the ASD children and to explore the experiences of primary care (PHC) psychologists in providing support to them.Material and methodsWe conducted a cross-sectional study. Parents of ASD children took part in the survey. Wellbeing was assessed using Parental Well-Being Scale including physical and emotional health, stress, social support, and quality of life. Ten primary care psychologists were also interviewed.Results327 parents of ASD children participated in our study. Mean wellbeing score for all parents was 52.6±15.65 pts. The highest aspect of wellbeing was enjoyment in looking after child (mean 7.29 pts) and quality of life (mean 6.87 pts). The strongest predictor of parental wellbeing was presence of disability diagnosis for ASD child related (6.33 pts), lower parental wellbeing (Beta=0.20, p<0.001). The interview results show the insufficient competence of psychologists to work with parents of children with ASD.ConclusionsOn the parental well-being scale, the highest scores are observed for enjoyment in looking after child and quality of life. Insufficient work is carried out by PHC psychologists with parents of children with ASD. There is a need for future training of psychologists in the management of children with ASD and their parents

The difficulties of Adult ADHD management within a Community Mental Health Team

IntroductionADHD is a neurodevelopmental disorder characterised by: inattention, hyperactivity and impulsivity.Diagnosis of ADHD in adults is complex, owing to the need for retrospective evidence that symptoms began in childhood as well as the high rates of comorbid mental health conditions. There are no public specialized clinics for adults with ADHD in Ireland. In their absence, referrals are sent to general adult psychiatry.ObjectivesAn audit of standards of care received by patients with ADHD against those set by the NICE guidelines.MethodsCare received pre and 8 weeks post MDT (multi-disciplinary team) educational session. Inclusion criteria: existing adult community mental health team (CMHT) patients with a diagnosis of ADHD. Recommendations as per NICE guideline used for assessment: Specialist MDT team input, OT/ Psychology input, MDT review of reports, Specialist consultant with training in diagnosis and treatment, Diagnosis based on structured assessment e.g. DIVA, Detailed psychiatric assessment, Physical health monitoring before commencing treatment (e.g. ECG), Ongoing physical health monitoring (BP, HR, weight), Patient regularly attending follow upResultsThere were 7 patients with diagnosed ADHD attending the CMHT, 4 male, 3 female aged 19-42yo. 4 patients were diagnosed privately (average age at diagnosis 31yrs). 2 were diagnosed by CAMHS. And 1 was diagnosed by primary care psychology (age 27). 8 weeks following MDT meeting; 2 patients had been commenced on ADHD medication. Those on the wait list for OT/psychology remained on the wait list.ConclusionsADHD is a specialised area which requires a specialist MDT led by a consultant with expertise in diagnosis and treatment. As evidenced by this audit, despite the best efforts of adult psychiatric services, teams are not sufficiently resourced to meet the needs of adults with ADHD and fall short of the expected standards of care.Disclosure of InterestNone Declared

Implementing digital mental health interventions at scale: one-year evaluation of a national digital CBT service in Ireland

BackgroundIn recent years, exponential growth in digital innovations and internet access has provided opportunities to deliver health services at a much greater scale than previously possible. Evidence-based technology-enabled interventions can provide cost-effective, accessible, and resource-efficient solutions for addressing mental health issues. This study evaluated the first year of a supported digital cognitive behavioral therapy (CBT) service provided by the national health service in Ireland, which has been accessible to individuals who receive a referral from one of five referring groups: General Practitioners, Primary Care Psychology, Counselling Primary Care, Community Mental Health, and Jigsaw (a nationwide youth mental health service).MethodsA retrospective, observational study examining data from the service between April 2021 to April 2022 was conducted. Descriptive statistics on referrals, account activations, user demographics, program usage, and user satisfaction were extracted, and pre-to-post clinical outcomes for depression measured by the Patient Health Questionnaire-9 and for anxiety measured by the Generalised Anxiety Disorder-7 were analysed using linear mixed effect models.ResultsThere were 5,298 referrals and 3,236 (61%) account activations within the year. Most users were female (72.9%) and aged between 18 and 44 years (75.4%). The CBT programs were associated with significant reductions in both depression (β = 3.34, 95% CI [3.03, 3.65], p < 0.001) and anxiety (β = 3.64, 95% CI [3.36, 3.93], p < 0.001), with large effect sizes (Cohen’s d > 0.8). Time spent using the programs was also found to be a predictor of the variability in these clinical outcomes (p < 0.001), and accounting for this resulted in significantly better model fits (p < 0.001). User satisfaction ratings were also very high, exceeding 94%.ConclusionsEfforts to improve the representation of male and older adult users are warranted. However, overall, the results demonstrate how digital CBT can be provided at scale and lead to symptom reductions with large effect sizes for patients seeking help for depression and anxiety. The findings substantiate the continued use and expansion of this service in Ireland and the more widespread implementation of similar services in other international public healthcare settings.

L’implémentation des soins psychologiques de première ligne en Belgique : profil et satisfaction des psychologues et orthopédagogues de première ligne

Primary psychological care was implemented in Belgium between January and April 2019 as part of the “psy 107” mental health reform. This is part of a wider trend of strengthening primary care at the international level. Belgium, like the Netherlands (Derksen, 2009), Ireland (Corcoran et Byrne, 2017), Australia (37), England (Clark, 2018) and the United States (McDaniel, DeGruy, 2014; McGough et al., 2016), has moved towards a public health model based on a community approach to improve access to psychological care. However, the implementation of psychological treatment in primary care is still relatively recent and has been promoted by the work of clinical researchers who have reported the need to integrate mental health care into their practice (Kaitz et al., 2020). From this perspective, integration can take different forms; in fact, there is no standard model for integrated care but rather several models (Runyan, 2011; Seaton et al., 2021). In line with the “psy107” mental health reform, the federal authorities have implemented first-line psychological care in Belgium for patients aged 18 to 64 with reimbursement from the National Institute for Health and Disability Insurance (RIZIV). For the first time in history, 4 and up to 8 primary psychological sessions per year are reimbursed for mild to moderate symptoms of anxiety, depression or dependence on alcohol or sleeping pills. The implementation of these agreements resulted in the setting up of 20 adult mental health networks delimited on a territorial basis and later the creation of 11 networks dedicated to children and adolescents. In the context of the COVID-19 health crisis, this measure was extended on 2 April 2020 to include patients under 18 years of age and over 64 years of age, as well as the reimbursement of video-consultations. Each session costs the patient 4 or 11.20 euros, depending on whether or not they have an enhanced intervention. ObjectivesThe research for this study was commissioned through a public procurement tender and led to the research project “Evaluation of Primary Care Psychology” (EPCAP) conducted by researchers from two universities. The research, which started in February 2020, has four components, focusing respectively on the epidemiological profile of the patients, the place of primary care psychologists and orthopedagogists (PPLs) in the health care network, the economic analysis of this measure, and the development of recommendations for the sustainability of this project. The purpose of this article is to present the profile of psychologists and orthopedagogists, their personal satisfaction, and the implementation of collaborative practices with general practitioners. MethodsAn online survey was distributed via network coordinators to all primary care psychologists and orthopedagogists who are engaged to provide this care in at least one adult network between September 2020 and January 2021. A census of the total population was carried out in September 2020 on the basis of FPS Health files. The final sample consists of 310 psychologists and orthopedagogists, out of 641 practitioners registered for first line psychological care in September 2020, of which the vast majority (74.5 %) is female and with 25.5 % male. ResultsThe 310 professionals, most of whom are experienced clinicians, also used different epistemological approaches. The results underline a commitment on the part of these professionals to the democratization of mental health care and their desire to adopt a community-based approach by promoting the accessibility of psychological cares to all patients. The majority of PPL were satisfied with this activity and the collaboration with general practitioners. More specifically, the results highlight the fact that the implementation of collaborative practices is a contributing factor in professional fulfilment. However, certain points are a subject of expressed dissatisfaction such as disparities in remuneration and contact with colleagues and collaborators. ConclusionThe implementation of these new systems in Belgium and internationally is a major step forward in preventive and early mental health care. Taking these results into account, a new agreement was adopted on 2 November 2021 as part of the psy107 reform and was accelerated in the context of the health crisis. This new agreement is currently being implemented in the various networks with significant changes. The withdrawal of the medical prescription is an important change, while at the same time raising the question of how collaboration between GPs, PPLs and, more broadly, the care network will be organized.

Parents’ experiences of an assistant psychologist enhanced primary care mental health service in Ireland

ABSTRACT Objective The aim of this study was to provide evidence of the acceptability of the primary care psychology services that have been enhanced by the employment of assistant psychologists in Ireland to the parents of children with psychological difficulties. Method Data were collected from a sample of 74 parents who responded to quantitative and qualitative questions on the experience of service questionnaire. Reflexive thematic analysis was used to analyse the questionnaire responses. Results On average 88% of participants selected ‘certainly true’ in response to the statements in the experience of service questionnaire statement they were ‘Totally satisfied’. Three major themes were developed; ‘communication is more than talking’, ‘structure can facilitate or impede’, and ‘emotional reactions’. ‘Communication is more than talking’ is organised around communication The ‘structure can facilitate or impede’ acknowledges that systems influence psychological supports. ‘Emotional reactions’ captured parents’ experiences, such as joy, frustration, and solidarity. Discussion The results demonstrate that the newly enhanced mental health service is acceptable to parents. Their voices provide ideas about what helps and hinders their experience of care.

Patients’ lived experience and reflections on long COVID: an interpretive phenomenological analysis within an integrated adult primary care psychology NHS service

BackgroundLong Covid is an unknown illness which has been shown to affect sufferers regardless of mild initial COVID-19 or age. There is still a lot unknown about long COVID illness. There has been a call to understand this illness not only from a professional standpoint but also through the lived experience of patients. Patient reported outcomes through lived experience research is one such angle. To date, no research has explored the overall lived experiences and long COVID illness trajectory perspectives of the patients. This study aimed to gather patient reported outcomes of their long COVID through lived experience research. It recruited adult participants aged 18-years and over who had been referred to a primary care integrated psychology service. The study employed qualitative research using semi-structured interviews and Interpretive Phenomenological Analysis methodology.ResultsA total of eighteen participants completed the study. From their lived experiences, the participants uncovered the varied symptoms of long COVID. They also uncovered their lived progression of living with an unknown chronic illness. Common themes included uncertainty, mental and social impacts, and the processes of self-advocacy, mastering their symptoms, subjective recovery and future coping.ConclusionThis study uncovered the lived experience of long COVID in participants. The results from this study uncovered the lived subjective biopsychosocial experiences of long COVID chronic illness. Traditionally, patients receive care and recommendations from healthcare professionals. However, as long COVID is a new illness, this care model was limited. The participants in the current study described being left with a sense of uncertainty and role confusion. However, participants were able to realize their locus of control over their long COVID illness progression. This illustrates that patients have the resources to uncover the unknowns of this new illness which could inform clinical practice and further research. This suggests that that long COVID needs to be approached from a biopsychosocial perspective which emphasises patient involvement.

The health of black women: the performance of psychology in primary care

Resumo Este artigo objetiva analisar como as psicólogas atuantes na atenção básica percebem a influência dos efeitos psicossociais do racismo e do sexismo em suas práticas e no processo de saúde e cuidado prestado às mulheres negras. Trata-se de pesquisa qualitativa de caráter descritivo e exploratório, seguindo a perspectiva da psicologia social crítica. Foi realizado um levantamento teórico-metodológico sobre os temas relevantes, assim como a produção do instrumento de coleta de dados e entrevistas semiestruturadas. Participaram do estudo oito psicólogas que atendem o público feminino e trabalham na rede de atenção básica da cidade de Salvador (BA). Os dados foram analisados pelo método hermenêutico-dialético. Nota-se que a maioria das percepções foi associada à questão biologizante da raça/cor e à noção de cuidado voltado à visão universalista do sujeito, o que implicou a ausência de ações direcionadas à promoção da saúde de mulheres negras. Contudo, observou-se a percepção interseccional e o letramento racial nos relatos de três das participantes, o que possibilitou o desenvolvimento de tentativas de práticas antirracistas e antissexistas. Conclui-se que ainda se faz necessário explorar ações da psicologia que visem à promoção da saúde de mulheres negras e que possam associar a teoria com a prática.

Advancing integrated care through cotraining of residents and psychology postdoctoral fellows.

While integrated behavioral health (IBH) is growing as a primary care practice paradigm, there are gaps in developing the workforce needed. In particular, there are few examples of cotraining curricula in IBH for family medicine residents with postdoctoral psychology fellows. Furthermore, even fewer programs incorporate a colearning primary care practice environment featuring a targeted approach to care for patients with chronic illness using panel management and integrated care. In this article, the authors describe a cotraining experience in an urban federally qualified health center supported by a 5-year Health Resources and Services Administration Title VII grant, within a social justice mission-driven academic department to prepare both family medicine (FM) residents and primary care psychology (PCP) postdoctoral fellows for IBH practice. The article will discuss the specific components of the shared/parallel curriculum, integration of social justice and population health principles and practices, and a structured approach for resident/fellow partnership. The authors share the clinical and educational impacts of this integrated cotraining curriculum model as described by the FM residents and PCP fellows. The article describes workforce results measuring the diversity of the trainees and their postprogram jobs serving vulnerable populations. The interdisciplinary cotraining between FM residents and PCP fellows presents an innovative approach to developing workforce capacity for integrated practice in medically underserved settings. This article describes the creation and implementation of a cotraining curriculum and provides recommendations for other programs and residencies preparing their residents and future PCP psychologists to practice and teach skills in integrated care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Integrated primary care psychology training programs: Challenges and strategies.

Integrating behavioral health in primary care improves quality of care and outcomes for patients with comorbid conditions. Shortage of a trained behavioral health workforce limits adoption. Professional psychology training programs contribute to recruitment, retention, and development of skilled providers, who value and deliver behavioral health services in primary care. This study interviewed a cohort of established psychology training programs in real-world, state-wide clinical primary care settings and identified their strategies and challenges with teaching practices and program resources that impact the robust quality of training. Between December 2020 and March 2021, we conducted semistructured interviews with 12 licensed psychologists who oversaw nine integrated primary care psychology training programs at the internship and postdoctoral levels across Washington State. Data were analyzed using a thematic approach. Programs taught psychology trainees about integrated primary care via extensive onboarding, modeling and shadowing, structured learning environment, interprofessional education opportunities, flexible and cross-disciplinary supervision, and a psychologically safe space. Teaching challenges included balancing scheduled and curbside supervision, pivoting to telehealth, and aligning trainee expectations and program requirements. Training programs were funded through different and multiple sources, but most lacked a stable funding mechanism, compounded by barriers for psychology trainees to bill for services, a lack of control over organization's budgeting decisions, and instability in funding renewal. Synergistic support from program, organization, and system/policy levels are needed to align teaching activities with clinical practice environments and invest in the growth and sustainability of psychology training programs on integrated primary care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Brief psychological interventions in face-to-face and telehealth formats: a comparison of outcomes in a naturalistic setting

PurposeIn this study, the authors aimed to compare the effectiveness of low-intensity psychological interventions provided face-to-face (FTF) with those provided by telephone and video-based modalities, in a primary care psychology service for individuals with mild-to-moderate mental health difficulties.Design/methodology/approachParticipants (N = 384) were service users who completed at least one intervention with the service over a two-year period between 2019 and 2021. Using psychometric measures of anxiety and low mood, a repeated measures design pre-, mid- and post-intervention evaluated service users’ clinical outcomes. Data analysis was carried out on those participants (N = 289) who had completed all three of the required psychometric measures.FindingsAll formats of intervention showed a significant and equivalent reduction in low mood and anxiety scores at the completion of the intervention, regardless of the format of therapy. This suggests no discernible difference in the effectiveness of the three formats of intervention in this service. In addition, no significant association was found between the format of intervention and service user dropout rates.Originality/valueThis study availed of data arising pre and during a pandemic as a naturalistic experiment into the use of telehealth in delivering brief psychological interventions in a frontline community service. The effectiveness of telephone and video-based brief psychological interventions was found to be comparable to that experienced by FTF interventions. This provides preliminary support for the inclusion of telehealth options for service users engaging with low-intensity psychotherapeutic services.

Referral Challenges in the Mental Health Program in the Primary Health Care System: A Qualitative Study

Background. One of the main activities that plays a significant role in the prevalence of mental illnesses is the issue of referral, and according to the evidence, the lack of proper implementation of the referral system is one of the obvious weaknesses of the primary health care (PHC) system. Therefore, this study aimed to investigate the challenges of referring mental health clients in the PHC system, and the weaknesses in this process were examined from the perspective of mental health experts in health centers. Methods. The present study is a conventional qualitative content analysis. Data were collected through semi-structured interviews with primary health care psychologists. Fifteen people were selected through purposive sampling. After transcription of the interviews, the data were analyzed based on the Graneheim and Landman model. Results. Two themes and twelve categories were acquired through the present study. The theme of intra-centered referential challenges included categories such as weaknesses in health care providers screening and low referrals, clients' lack of trust in health care providers, clients' lack of cooperation, physicians' poor cooperation, and Barriers to clients' desire to visit a psychologist. Outer-centered referential challenges also included a shortage of referral centers, lack of transparency in referrals, lack of direct referrals, poor follow-up, barriers for clients to go to a higher level, and Barriers to clients’ referral to the institute. Conclusion. The findings of the present study show that poor intra-sectoral and inter-sectoral communication is one of the main challenges that has disrupted the referral process in the field of mental health in the primary health care system. It seems that many challenges such as lack of designated referral centers, poor follow-up due to lack of referral feedback, clients' financial inability to refer to a higher level, etc. can be improved by strengthening cross-sectoral communications such as two-way communication with support organizations and psychiatric and psychotherapy centers.

How to Integrate Patient-Centered Measures in Routine Care: Lessons from Belgian Experiences

BACKGROUND Against the treatment gap and the long delays in seeking treatment for mental health problems, primary care psychology (PCP) was added to reimbursed outpatient mental health services in the Belgian healthcare system. PURPOSE Within the Evaluation of Primary Care Psychology study (EPCAP), which provides evaluation of the measure of reimbursement of PCP, the objectives were: (1) To describe the patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) of patients treated with PCP and (2) formulate guidelines to integrate patient-related findings and experiences within community mental health services. METHOD 428 patients participated in an online survey at the start of their PCP treatment in Belgium and after 3 and 6 months. Besides sociodemographic characteristics, DSM-5 mental disorders, suicidality, and service use, they were questioned about their findings (PROMs) and experiences (PREMs). RESULTS Almost 90% met the criteria of a lifetime as a 12-month DSM-5 mental disorder or STB at the start of PCP treatment. Both subjective well-being and the proportion of patients who had positive experiences regarding their PCP treatment increased with 46% resp. 23.2% after 3 months and remained stable after 6 months. CONCLUSION Although PCP in Belgium serves a clinical patient population with high proportions of lifetime and 12-month mental disorders and suicidality, their subjective well-being increased after 3 months and remained stable after 6 months. Despite differences between groups of patients, PCP seems to have a positive effect on subjective well-being of these patient in short term. Integration of PROMs and PREMs into PCP were recommended.DisclosureNo significant relationships.

Establishing a Valid, Reliable, and Efficient Chart Review Process for Research in Pediatric Integrated Primary Care Psychology.

Retrospective chart review is an accessible form of research that is commonly used across medical fields but is underutilized in behavioral health. As a relatively newer area of research, the field of pediatric integrated primary care (IPC) would particularly benefit from guidelines for conducting a methodologically sound chart review study. Here, we use our experiences building a chart review procedure for a pediatric IPC research project to offer strategies for optimizing reliability (consistency), validity (accuracy), and efficiency. We aim to provide guidance for conducting a chart review study in the specific setting of pediatric IPC so that researchers can apply this methodology toward generating research in this field.

Cost-effectiveness and cost-utility evaluation of individual vs. group transdiagnostic psychological treatment for emotional disorders in primary care (PsicAP-Costs): a multicentre randomized controlled trial protocol

BackgroundEmotional disorders are common, and they have become more prevalent since the COVID-19 pandemic. Due to a high attendance burden at the specialized level, most emotional disorders in Spain are treated in primary care, where they are usually misdiagnosed and treated using psychotropic drugs. This contributes to perpetuate their illness and increase health care costs. Following the IAPT programme and the transdiagnostic approach, the PsicAP project developed a brief group transdiagnostic cognitive-behavioural therapy (tCBT) as a cost-effective alternative. However, it is not suitable for everyone; in some cases, one-on-one sessions may be more effective. The objective of the present study is to compare, in cost-benefit terms, group and individual tCBT with the treatment usually administered in Spanish primary care (TAU).MethodsA randomized, controlled, multicentre, and single-blinded trial will be performed. Adults with mild to moderate emotional disorders will be recruited and placed in one of three arms: group tCBT, individual tCBT, or TAU. Medical data and outcomes regarding emotional symptoms, disability, quality of life, and emotion regulation biases will be collected at baseline, immediately after treatment, and 6 and 12 months later. The data will be used to calculate incremental cost-effectiveness and cost-utility ratios.DiscussionThis trial aims to contribute to clinical practice research. The involvement of psychologists in primary care and the implementation of a stepped-care model for mental disorders are recommended. Group therapy and a transdiagnostic approach may help optimize health system resources and unblock waiting lists so that people can spend less time experiencing mental health problems.Trial registrationClinicalTrials.gov: NCT04847310; Protocols.io: bx2npqde. (April 19, 2021)

Pesky gNATs for children experiencing low mood and anxiety – A pragmatic randomised controlled trial of technology-assisted CBT in primary care

BackgroundCompared to the evidence base for adult populations, less is known about the effectiveness of technology-assisted CBT interventions for children aged 12 and under in real-world settings. AimsThis study aimed to evaluate the effectiveness of a technology-assisted CBT intervention called Pesky gNATs in primary care psychology services. MethodsA 2 × 3 (group by time) waitlist randomised controlled trial design was applied (n = 122), using the total internalising score from the Child Behaviour Checklist (CBCL) as the primary outcome measure; and a range of secondary outcomes. Participants were recruited from primary care services across Ireland and were assessed at baseline (Time 1), post-intervention (Time 2), and a follow-up at 3 months (Time 3). Repeated measures ANOVAs were used to analyse the data; in addition to Cohen's d for effect sizes, and the reliable change index (RCI) for clinically meaningful change. ResultsOverall, no significant between-group differences were found on primary or secondary measures. Both intervention and waitlist control groups experienced significantly positive change across all timepoints. However, participant retention rate at Time 2 was 66%; and fell to 44% at Time 3. Intervention group feedback from children and parent at Time 2 indicated high levels of acceptability and satisfaction with Pesky gNATs. The RCI showed a statistically significant result at Time 2: more participants from the intervention group (n = 9) moved from clinical to non-clinical levels on the primary outcome than did waitlist control participants (n = 0); but no differences were found at Time 3. ConclusionThis RCT did not demonstrate that Pesky gNATs is effective in providing clinically significant levels of change for low mood and anxiety. However, participant feedback showed high levels of acceptability and positive experiences However, given the high attrition rate and implementation challenges, further research is required to ascertain the effectiveness of technology-assisted CBT interventions such as Pesky gNATs.

Enhancing primary care psychology services with assistant psychologists in Ireland: An evaluation of output, throughput and stakeholder satisfaction.

Primary care mental health services need to expand to assist the increased number of people reporting mild to moderate mental health difficulties. In Ireland, the primary care mental health service has been recently enhanced through the employment of Assistant Psychologists (AP) in primary care psychology. This paper provides an early and brief evaluation of the impact of the AP-enhanced model through a tripartite approach to evaluation which utilises measures of throughput, output and stakeholder satisfaction. We use data from two sources; Health service key performance indicators, and a routinely gathered minimal dataset of client measures. Results indicate that the numbers of clients seen in the period rose by 16%, that AP-delivered treatments are beneficial for clients with mild to moderate mental health difficulties, and more than 80% of clients reported being 'totally satisfied' with the care received. The data provide early evidence that the AP model is beneficial in meeting clients' needs across a range of presentations within the service admission criteria, and that the AP-enhanced model may offer a satisfactory solution to primary care needs. However, further data collection is required, and additional stakeholder input is necessary for a complete evaluation of the assistant psychologist model in primary care.

Exploring the experiences of mental health professionals engaged in the adoption of mobile health technology in Irish mental health services

BackgroundThe World Health Organization report that an estimated 793,000 people died by suicide in 2016 globally. The use of digital technology has been found to be beneficial in the delivery of Web-based suicide prevention interventions. Research on the integration of digital technology within mental health services has indicated that despite the proliferation of technology, engagement by patients and professionals in adopting such technology can be poor.ObjectivesThe current study aims to explore the experiences of 15 mental health professionals involved in integrating mobile health technology into their practice. A secondary aim was to identify the drivers and barriers to the adoption of such technology by mental health professionals, and to consider what theoretical models could best account for the data.MethodsSemi-structured interviews, conducted from July to October 2019, were used to explore the experiences of mental health professionals engaged in the adoption of mobile health technology within mental health services. Mental Health professionals and clinician managers working in HSE Child and Adolescent Mental Health, Adult Mental Health, and Primary Care Psychology services were recruited for the study. Qualitative interview data was transcribed and analysed using NVivo. Thematic Analysis was used to identify themes.ResultsFour major themes were identified: Accessibility, ‘Transitional Object’, Integration, and Trust. Within these 4 major themes, a total of 9 subthemes were identified: Service Accessibility, Immediate Access, Client Engagement, Adjunct-to-therapy, Therapeutic Relationship, Infrastructural Support, Enhancing Treatment, Trust in the Technology, Trust in the Organisation.ConclusionsOverall, Diffusion of Innovation Theory provides a useful theoretical framework which is consistent with and can adequately account for many of the Major and Subthemes identified in the data. In addition, ‘Transitional Objects’, a key concept within Object Relations Theory, could offer a means of better understanding how patients and professionals engage with digital technology within mental health services particularly.

Improving clinical outcomes for type 2 diabetes patients using teleconsultations during the COVID-19 pandemic

Background: Diabetic patients are at significant risk of serious complications and higher mortality rates if they contract COVID-19. Primary Health Care Corporation (PHCC) in Qatar launched a Diabetes Teleconsultation Clinic to proactively support high risk diabetic patients with a hemoglobin A1c (HbA1C) superior or equal to 8 mg/dL and without a primary health care encounter in the last 2-12 months, in an attempt to support this high risk population and still provide continuity of care. Methods/Case presentation: Patients meeting the criteria were proactively contacted and received a teleconsultation call from a family medicine physician. During the call, family physicians and patients reviewed individual management plans, and if agreed and required changes, the patient management plans were adjusted and monitored. Patients were additionally supported by a wider team of professionals via teleconsultations, including dieticians, health educators and primary care psychology and psychiatry services. A paired sample T-Test was conducted to compare the HbA1c mean levels for patients before and after joining the PHCC Diabetes Management Teleconsultation Clinic, after a 4-month period. Results/Findings/Recommendations: There was a statistically significant difference in the results of mean HbA1c levels for patients before joining the Diabetes Management Teleconsultation Clinic and after the intervention. Of the 384 patients analysed, the average HbA1c level before the intervention was 9.49 mg/dL, and after the intervention the average was 8.83 mg/dL (p &lt; 0.001). Conclusion: The use of teleconsultations, remote multidisciplinary team support, and collaborative patient management plans has had a positive impact on the health outcomes of 384 high-risk diabetic patients within primary care. This inclusive model of care will be replicated to support more patients as a preventative and supportive intervention not only during the COVID-19 pandemic but in the long term.

Analysis of General Practitioners' Attitudes and Beliefs about Psychological Intervention and the Medicine-Psychology Relationship in Primary Care: Toward a New Comprehensive Approach to Primary Health Care.

The biopsychosocial paradigm is a model of care that has been proposed in order to improve the effectiveness of health care by promoting collaboration between different professions and disciplines. However, its application still faces several issues. A quantitative-qualitative survey was conducted on a sample of general practitioners (GPs) from Milan, Italy, to investigate their attitudes and beliefs regarding the role of the psychologist, the approach adopted to manage psychological diseases, and their experiences of collaboration with psychologists. The results show a partial view of the psychologist’s profession that limits the potential of integration between medicine and psychology in primary care. GPs recognized that many patients (66%) would often benefit from psychological intervention, but only in a few cases (9%) were these patients regularly referred to a psychologist. Furthermore, the referral represents an almost exclusive form of collaboration present in the opinions of GPs. Only 8% of GPs would consider the joint and integrated work of the psychologist and doctor useful within the primary health care setting. This vision of the role of psychologists among GPs represents a constraint in implementing a comprehensive primary health care approach, as advocated by the World Health Organization.

Provider perspectives of implementation of an evidence-based insomnia treatment in Veterans Affairs (VA) primary care: barriers, existing strategies, and future directions

BackgroundCognitive behavioral therapy for insomnia (CBT-I) is a highly effective nonpharmacological intervention that is widely considered the gold standard for insomnia treatment. Insomnia is a prevalent and debilitating public health concern. Up to one third of the general population struggles with chronic insomnia, greatly increasing the risk for chronic pain and inflammation, depression and suicide, and cognitive decline. Over the last 10 years, the Veterans Health Administration (VHA) evidence-based psychotherapy training program has trained nearly 1000 providers to deliver CBT-I in hospitals and clinics nationwide. Despite increased access, most patients with insomnia receive sleeping medications instead of CBT-I. This is particularly concerning for vulnerable populations, like older adults, who may be at increased risk of harms from medications. The goal of this study was to obtain a broad range of perspectives on CBT-I implementation from providers who commonly utilize and deliver CBT-I. This work identifies barriers and successful strategies used to overcome these barriers to guide future implementation efforts promoting evidence-based sleep care.MethodsSemi-structured interviews, using the Consolidated Framework for Implementation Research (CFIR) as a guide, were conducted with 17 providers from five Veterans Affairs (VA) facilities (8 primary care physicians, 4 primary care psychologists, and 5 CBT-I coordinators). We used a thematic analysis approach in which common ideas were identified across interviews and then grouped into larger conceptual themes. Data were concurrently collected and analyzed with rapid assessment process (RAP) techniques.ResultsFindings suggested implementation barriers and facilitators related to the CFIR constructs of intervention characteristic (e.g., providers unfamiliar with primary evidence of CBT-I effectiveness), inner setting (e.g., sleep as a low relative priority in primary care), and outer setting (e.g., lack of external incentives for increasing CBT-I use), as well as several successful strategies, including use of local champions and supportive opinion leaders.ConclusionsThese findings suggest promising opportunities to improve implementation of CBT-I, especially at facilities with less well-established CBT-I programs. Formal implementation trials are needed to systematically determine the real-world impact of strategies such as enlisting CBT-I champions, informing opinion leaders about CBT-I services, and promoting network weaving among primary care, mental health, and sleep clinics.