Review Of Recent Interventions Research Articles

Communication Commentary: Time in a Bottle: The Psychopharmacologist-Patient Relationship in “Split-Treatment” Models of Care

The doctor-patient relationship has been and remains the keystone of all medical care. It is the medium by which symptom data are gathered, diagnosesmade, thepatient is engaged in the enterprise of formulating a treatment plan, the issues of motivation and adherence are addressed, and nonjudgmental support is provided to enhance the work of healing (1). Medical communications researchers Roter and Hall (2) remarked that “talk is the main ingredient in medical care and it is the fundamental instrument by which therapeutic goals are achieved” (p. 8). They noted that we in the psychiatry field are “participating in a dramatic transformation of the identity of our profession. Clinical practice is moving toward psychopharmacological evaluation and treatment monitoring as the principal role for psychiatrists in direct service provision” (p. 13). Psychiatrists often work in teams with nonphysician therapists, casemanagers, andother specialists. This model can be very effective for individualizing care such that patients may receive appropriate multidisciplinary treatment from professionals with high levels of expertise in their areas of specialization. Access to psychiatric care is often limited. A collaborative care team or “split-treatment” model in which nonphysicians provide psychotherapy and/or other psychosocial interventions and physicians provide psychiatric assessment and psychopharmacological care allows greater psychiatric access for patients in need. In fact, Interian and colleagues

Improving Treatment Engagement of Underserved U.S. Racial-Ethnic Groups: A Review of Recent Interventions

Unequal mental health among U.S. underserved racial-ethnic populations has become a prominent national concern. Contributing to this inequity is our limited ability to engage individuals from underserved populations into treatment. To help address this, a systematic literature review was conducted to examine the evidence base for interventions that can improve mental health treatment engagement among underserved racial-ethnic minority populations. A MEDLINE search and bibliographic review yielded 1,611 studies that were reviewed according to several inclusion criteria: publication during or after 2001, U.S. adult sample, a randomized design, sufficient (≥50%) representation of underserved racial-ethnic groups, adequate sample size (≥27 participants per condition), explicit focus on mental health treatment engagement, and evaluation of an engagement outcome (for example, adherence or retention). Ten studies met inclusion criteria. Evidence supported the efficacy of collaborative care for depression as an engagement enhancement intervention among underserved racial-ethnic populations. Several other interventions demonstrated possible efficacy. The effect of the interventions on clinical outcomes, such as symptom improvement and rehospitalization, was mixed. Collaborative care for depression can be recommended for improving engagement in depression care in primary care among underserved racial-ethnic populations. Future research should continue to examine approaches with initial evidence of efficacy in order to expand the number of engagement enhancement interventions for underserved racial-ethnic adult populations. Additional issues for future engagement research include relative intervention efficacy across racial-ethnic groups, inclusion of other understudied groups (for example, Asian Americans and Native Americans), and greater clarification of the impact of improved engagement on clinical outcomes.