Psychiatric services最新文献_第2页

How State Administrative Structures Influence Implementation Outcomes for Wraparound Care Coordination. 国家行政结构如何影响全面护理协调的实施结果。

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-06-01 Epub Date: 2025-03-27 DOI: 10.1176/appi.ps.20240288

Jonathan R Olson, Kimberly M Estep, Kimberly A Coviello, Olivia Linkous, Eric J Bruns

{"title":"How State Administrative Structures Influence Implementation Outcomes for Wraparound Care Coordination.","authors":"Jonathan R Olson, Kimberly M Estep, Kimberly A Coviello, Olivia Linkous, Eric J Bruns","doi":"10.1176/appi.ps.20240288","DOIUrl":"10.1176/appi.ps.20240288","url":null,"abstract":"Objective: The purpose of this study was to examine how inner-context (organizational) and outer-context (system) variables affect implementation outcomes for wraparound care coordination, an evidence-based strategy for youths with complex behavioral health needs.Methods: This study focused on data from 1,178 providers in 10 states that used one of two state-level administrative structures to implement wraparound care coordination; four states used care management entities (CMEs), and six used community mental health centers (CMHCs). Implementation completeness and duration were assessed with the Stages of Implementation Completion tool, and practice fidelity was assessed with the Coaching Observation Measure for Effective Teams. Multilevel models were used to compare CMEs with CMHCs at the state level in terms of implementation completeness, duration, and fidelity.Results: Compared with CMHC states, CME states had higher mean fidelity scores among practitioners (0.37 vs. 0.24; t=8.02, df=1,136, p<0.001), completed more implementation activities, and completed most implementation activities faster. Multilevel models found that the duration of the preimplementation phase was positively associated with fidelity (b<0.001, t=3.62, df=10.85, p=0.004) and that the duration of the implementation phase was negatively associated with fidelity (b<-0.001, t=-6.64, df=7.04, p<0.001).Conclusions: The results reinforce that systems-level strategies such as wraparound care coordination require considerable time to plan and implement and that state-level administrative structures meaningfully influence implementation outcomes and service quality. Taking the time to design hospitable inner and outer contexts is crucial to implementation efficiency, completeness, and quality.","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"547-553"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Screening for Early Emerging Mental Experiences: Feasibility of Psychosis Screening in Integrated Care Settings. 筛查早期出现的心理经验：精神病筛查在综合护理设置的可行性。

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-06-01 Epub Date: 2025-04-23 DOI: 10.1176/appi.ps.20240244

Kristen A Woodberry, Elizabeth Bernier, Katherine M Elacqua, David M Weiss, Stacey M Ouellette, Jonathan Fanburg, Deborah Q Hagler, Kathleen A Herlihy, Paul L Hyman, Rebecca B Jaynes, Saras Yerlig, Amy M Mayhew

{"title":"Screening for Early Emerging Mental Experiences: Feasibility of Psychosis Screening in Integrated Care Settings.","authors":"Kristen A Woodberry, Elizabeth Bernier, Katherine M Elacqua, David M Weiss, Stacey M Ouellette, Jonathan Fanburg, Deborah Q Hagler, Kathleen A Herlihy, Paul L Hyman, Rebecca B Jaynes, Saras Yerlig, Amy M Mayhew","doi":"10.1176/appi.ps.20240244","DOIUrl":"10.1176/appi.ps.20240244","url":null,"abstract":"Objective: This study aimed to assess the feasibility of the screening for early emerging mental experiences model, which is designed to screen for psychosis in settings with integrated primary and mental health care.Methods: Psychosis screening, triage, and engagement processes (July 2021-June 2022) were implemented in four integrated care practices serving approximately 7,000 patients in the targeted age range (14-26 years). Practice and community stakeholders participated in the project's design and development. Psychosis care specialists provided training and case consultation to general medical providers and behavioral health clinicians (BHCs). The BHCs screened all patients referred for selective screening. One practice aimed to universally screen patients ages 14-26 attending well visits.Results: Training sessions were attended by 100% (N=6) of the BHCs and by 79% (N=27 of 34) of the primary care providers. The BHCs selectively screened and triaged 266 patients (89% of their new patients). Providers conducted universal screening of 606 patients (67% of that site's well visits). The screening samples were >90% White and >55% rural, consistent with the clinics' populations. Rates of positive selective screens were consistent with published rates in similar populations. Of the recorded screening-related activities, 92% (146 of 159) were completed within the billable intake time, and 11% (N=17) of these patients were engaged in a psychosis-relevant discussion. The providers reported that the project was important and positive.Conclusions: Systematic assessment of psychosis symptoms, followed by triage and engagement, appeared to be feasible and acceptable to patients and providers in integrated care settings.","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"540-546"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Exploring the Widening Trend in Racial and Ethnic Differences in Youth Mental Health Service Use. 探讨青少年心理健康服务使用中种族差异的扩大趋势。

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-06-01 Epub Date: 2025-03-19 DOI: 10.1176/appi.ps.20240334

Stephanie Rennane, Flora Sheng, Bradley D Stein, Andrew W Dick

{"title":"Exploring the Widening Trend in Racial and Ethnic Differences in Youth Mental Health Service Use.","authors":"Stephanie Rennane, Flora Sheng, Bradley D Stein, Andrew W Dick","doi":"10.1176/appi.ps.20240334","DOIUrl":"10.1176/appi.ps.20240334","url":null,"abstract":"Objective: The authors examined trends in racial and ethnic disparities in youth mental health treatment for internalizing and externalizing conditions in the United States from 2002 to 2019.Methods: Using data from the Medical Expenditure Panel Survey-Household Component, the authors analyzed trends in mental health treatment between 2002 and 2019 for youths ages 5-21 years (N=139,242). Logistic regression models predicting treatment were adjusted for age and sex and also for health status, household income, insurance coverage, and geographic region.Results: The treatment rate for internalizing conditions grew faster for White youths than for Hispanic or Black youths, and this difference tripled (from 1.6 to 5.4 percentage points) from 2002 to 2019. For externalizing conditions, the treatment rate grew twice as fast for White youths compared with Hispanic youths and 50% faster relative to Black youths. Uninsured status was significantly and negatively associated with treatment for externalizing conditions (b=-0.928, SE=0.342) but not internalizing conditions (b=-0.440, SE=0.317). Family income was most strongly linked to treatment among Hispanic youths. For internalizing conditions, adjustments for health, household income, insurance status, and region explained 18% of the treatment gap for Hispanic youths but only 6% of the gap for Black youths in 2016-2019.Conclusions: These findings highlight widening racial and ethnic disparities in youth mental health treatment. The demographic and socioeconomic factors associated with these disparities varied by type of condition. Addressing socioeconomic determinants alone is insufficient to ensure equitable access to mental health services. Tailored approaches considering clinical, cultural, and societal needs are essential to mitigate treatment disparities.","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"563-570"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Accuracy of Self-Report Questionnaires and Records-Based Risk Scores to Identify Adolescents' Risk for Self-Harm. 自我报告问卷和基于记录的风险评分识别青少年自我伤害风险的准确性。

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-06-01 Epub Date: 2025-03-19 DOI: 10.1176/appi.ps.20240427

Gregory E Simon, Christine C Stewart, Julie E Richards, Rebecca Ziebell, Gwen T Lapham, Andrea J Hoopes

{"title":"Accuracy of Self-Report Questionnaires and Records-Based Risk Scores to Identify Adolescents' Risk for Self-Harm.","authors":"Gregory E Simon, Christine C Stewart, Julie E Richards, Rebecca Ziebell, Gwen T Lapham, Andrea J Hoopes","doi":"10.1176/appi.ps.20240427","DOIUrl":"10.1176/appi.ps.20240427","url":null,"abstract":"Objective: This study aimed to evaluate screening strategies for identifying risk for self-harm among adolescents making outpatient health care visits.Methods: Health system records were used to identify a prospective cohort of adolescents completing the Patient Health Questionnaire-9 (PHQ-9) at outpatient visits between October 1, 2015, and March 15, 2020, and a retrospective cohort of adolescents experiencing self-harm events (ascertained from health records and state mortality data) during the same period. Self-harm risk scores were computed from health records. Analyses of the prospective sample examined the sensitivity and positive predictive value (PPV) of questionnaires and risk scores, separately and in combination. Analyses of the retrospective sample examined the proportion of self-harm events that could have been detected by different screening strategies.Results: The prospective sample (N=8,929) included 43,548 questionnaires, with 1,045 questionnaires followed by a self-harm event within 180 days. A score of ≥2 on PHQ-9 item 9 had a sensitivity of 0.37 and a PPV of 0.09 for self-harm within 180 days of a mental health specialty visit, with similar results for primary care visits. In the retrospective sample, 89% of adolescents made a mental health specialty visit or a primary care visit with a recorded psychiatric diagnosis in the 180 days before a self-harm event.Conclusions: Responses to PHQ-9 item 9 and risk scores computed from health records accurately identified adolescents needing additional assessment for risk for self-harm. Over 80% of adolescents experiencing self-harm could have been identified by screening during an outpatient health care visit.","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"554-562"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medical Malpractice: Coming Changes and Their Impact on Psychiatry. 医疗事故：未来的变化及其对精神病学的影响。

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-05-28 DOI: 10.1176/appi.ps.20250230

Neil S Kaye, Paul S Appelbaum

引用次数: 0

Recent Trends in Medication Treatment for Attention-Deficit Hyperactivity Disorder. 注意缺陷多动障碍药物治疗的最新趋势。

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-05-28 DOI: 10.1176/appi.ps.20240574

Haiden A Huskamp, Alisa B Busch, Richard G Frank

{"title":"Recent Trends in Medication Treatment for Attention-Deficit Hyperactivity Disorder.","authors":"Haiden A Huskamp, Alisa B Busch, Richard G Frank","doi":"10.1176/appi.ps.20240574","DOIUrl":"https://doi.org/10.1176/appi.ps.20240574","url":null,"abstract":"Objective: Attention-deficit hyperactivity disorder (ADHD) diagnosis rates and stimulant use have increased recently, particularly among adults, in the context of increased telehealth use and shortages in stimulant medications. To better understand changes in ADHD medication use and inform policy governing the prescribing of these medications, this study aimed to compare stimulant and nonstimulant fills for 2019 versus 2023.Methods: This study used national all-payer prescription claims data for 2019 (before onset of the COVID-19 pandemic) and 2023 to calculate stimulant and nonstimulant ADHD medication fill rates overall and by patient age and prescriber specialty.Results: Total ADHD medication fills increased 23.8%, from 72,849,441 in 2019 to 90,183,437 in 2023; stimulants accounted for most fills (91.4% in 2019; 88.9% in 2023). Whereas the number of stimulant fills rose 20.4% from 2019 to 2023, the number of nonstimulant fills increased at three times that rate (60.1%). Both stimulant and nonstimulant fills increased among adults, whereas stimulant fills decreased 6.5% among children (ages 0-18). Nurse practitioners and physician assistants were responsible for one in three ADHD prescription fills in 2023; nonstimulants were prescribed most commonly by these providers and by psychiatrists.Conclusions: The number of ADHD medication fills rose substantially from 2019 to 2023. Although a majority of 2023 fills were stimulants, nonstimulant fills sharply increased, even though nonstimulants are not the first-choice ADHD medication treatment. This increase was likely due in part to stimulant shortages that continue to limit access to ADHD pharmacotherapy nationwide.","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"appips20240574"},"PeriodicalIF":3.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

What Nonpsychiatrists Want From Psychiatrists: Data From Chart Review Consultation Requests in a Rural Health Care System. 非精神科医生想从精神科医生那里得到什么：来自农村卫生保健系统的图表审查咨询请求的数据。

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-05-28 DOI: 10.1176/appi.ps.20240263

Evan M Calvo, Lauren K Walsh, Victoria M T Tyrell, Christopher F Chabris, Joanne A Byars

{"title":"What Nonpsychiatrists Want From Psychiatrists: Data From Chart Review Consultation Requests in a Rural Health Care System.","authors":"Evan M Calvo, Lauren K Walsh, Victoria M T Tyrell, Christopher F Chabris, Joanne A Byars","doi":"10.1176/appi.ps.20240263","DOIUrl":"https://doi.org/10.1176/appi.ps.20240263","url":null,"abstract":"Objective: Given the growing need for novel psychiatric service delivery, this study sought to characterize the use of an outpatient electronic consultation service, Ask-A-Doc (AAD), in a rural health care system.Methods: A qualitative codebook was developed (final interrater agreement=92%) and applied to the free text of all AAD questions (N=707) received by a psychiatry department during a 12-month period.Results: Primary care was the principal source of AAD questions (95%), with most submitted by physicians (56%) and advanced practitioners (44%). Medication management was the most common reason for AAD submission (90%). Submissions mentioned psychiatric symptoms (85%) more than diagnoses (52%). Commonly mentioned symptoms included anxiety and depression; frequently mentioned diagnoses included bipolar disorder, attention-deficit hyperactivity disorder, and major depressive disorder.Conclusions: Nonpsychiatrists find benefit in psychiatrist assistance in managing patients with mental health conditions; they generally want recommendations for medication management to target specific symptoms, not assistance with making or treating specific diagnoses.","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"appips20240263"},"PeriodicalIF":3.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

I'm So Glad My Dad Didn't See a Psychiatrist. 我真高兴我爸没去看心理医生。

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-05-21 DOI: 10.1176/appi.ps.20250080

Heather M Wobbe

引用次数: 0

Predictors and Outcomes of Detention Under Psychiatric Holding Powers. 精神科监护下拘留的预测因素和结果。

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-05-21 DOI: 10.1176/appi.ps.20240503

David Weir, Conan Brady, Art Malone, Declan M McLoughlin

{"title":"Predictors and Outcomes of Detention Under Psychiatric Holding Powers.","authors":"David Weir, Conan Brady, Art Malone, Declan M McLoughlin","doi":"10.1176/appi.ps.20240503","DOIUrl":"https://doi.org/10.1176/appi.ps.20240503","url":null,"abstract":"Objective: This study aimed to characterize the use of emergency psychiatric holding powers in Ireland, investigate predictors of their initiation, and describe clinical outcomes among patients subject to holds.Methods: This retrospective case-control study characterized and compared all voluntarily admitted patients who were either detained under holding powers (N=167 cases involving 162 unique patients) or not subject to holding powers (N=334 control patients) during a stay in one of two psychiatric hospitals in Dublin (January 2018-December 2020). These groups were examined from admission through 1 year after discharge.Results: The use of holding powers was rare (2% of voluntary admissions during the study). Patients in both groups were similar, with no significant sociodemographic differences. The case group was rated as having more severe illness at admission (p<0.001). Multivariable analyses demonstrated that detention was more likely in the presence of impaired insight (OR=4.14), psychotic symptoms (OR=7.56), and suicidal ideation (OR=2.58) at admission and with a diagnosis of bipolar disorder (OR=2.50). Mean length of stay was longer for case group (vs. control group) patients (81.37 vs. 45.74 days, z=-7.42, p<0.001), but illness improvement ratings at discharge did not significantly differ between the groups, nor did readmission rates for the year after discharge.Conclusions: Voluntarily admitted patients who became subject to holding powers had more severe illness at admission than did those without holds. The likelihood of experiencing detention increased with impaired insight, psychotic symptoms, and suicidal ideation at admission. However, the results suggested that treatment outcomes for both groups were similar.","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"appips20240503"},"PeriodicalIF":3.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Trends in Buprenorphine Dispensing by Provider Type, 2013-2023. 丁丙诺啡按供应商类型分配的趋势，2013-2023。

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-05-21 DOI: 10.1176/appi.ps.20240175

Mir M Ali, Jie Chen, Priscilla J Novak

引用次数: 0