ABSTRACT
OBJECTIVE: To evaluate a quality improvement intervention to improve the screening and management (e.g., referral to psychiatric care) of common mental disorders in small independent Latino primary care practices serving patient populations of predominantly low-income Latino immigrants. METHODS: In seven practices, academic detailing and consultation/liaison psychiatry were first implemented (Stage 1) and then supplemented with appointment scheduling and reminders to primary care physicians (PCPs) by clinic staff (Stage 2). Acceptability and feasibility were assessed with independent patient samples during each stage. RESULTS: Participating PCP found the interventions acceptable and noted that referrals to language-matched specialty care and case-by-case consultation on medication management were particularly beneficial. The academic detailing and consultation/liaison intervention (Stage 1) did not significantly affect PCP screening, management or patient satisfaction with care. When support for appointment scheduling and reminders (Stage 2) was added, however, PCP referral to psychiatric services increased (P=.04), and referred patients were significantly more likely to follow through and have more visits to mental health professionals (P=.04). CONCLUSION: Improving the quality of mental health care in low-resourced primary care settings may require academic detailing and consultation/liaison psychiatric intervention supplemented with staff outreach to achieve meaningful improvement in the processes of care.
Subject(s)
Hispanic or Latino , Mental Disorders/therapy , Physicians, Primary Care/education , Primary Health Care/organization & administration , Psychiatry/education , Referral and Consultation , Adult , Aged , Community Mental Health Services/organization & administration , Disease Management , Feasibility Studies , Female , Humans , Male , Mass Screening , Mental Disorders/diagnosis , Mental Disorders/ethnology , Middle Aged , Patient Acceptance of Health Care , Poverty , Quality ImprovementABSTRACT
BACKGROUND: Spanish-speaking individuals comprise a growing percentage of the United States population. They have greater difficulty than most in accessing and remaining in psychiatric treatments, including psychotherapy, their stated preference. The literature on cultural competence in treating Hispanic patients provides few details of psychotherapeutic adaptations. OBJECTIVE: This article, based on interpersonal psychotherapy (IPT) supervision for a low-socioeconomic sample of monolingual Spanish-speaking New York City patients, describes culturally specific psychotherapy. METHOD: In conducting IPT for Spanish-speaking patients with DSM-IV major depressive disorder, we reviewed cases in weekly supervision over 3 years (January 2005 to January 2008) to explore treatment themes and evaluate the congruence of IPT in addressing them. Important themes are illustrated by case example. RESULTS: Key themes include (1) the centrality of family, (2) conflicts due to migration and acculturation, (3) gender roles, (4) need to avoid humiliating or irrevocable social confrontation, and (5) equanimity in facing an unpredictable environment. CONCLUSIONS: IPT appears a compatible intervention, focusing on and adaptable to these important issues for Hispanic patients.
Subject(s)
Depressive Disorder, Major/ethnology , Depressive Disorder, Major/therapy , Emigrants and Immigrants/psychology , Hispanic or Latino/psychology , Psychotherapy/methods , Acculturation , Adult , Affect , Cultural Competency , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/psychology , Diagnostic and Statistical Manual of Mental Disorders , Female , Gender Identity , Humans , Life Change Events , Male , Marital Therapy , Middle Aged , Multilingualism , New York City , Social Values , Socioeconomic Factors , Treatment OutcomeABSTRACT
OBJECTIVE: To develop a multi-attribute outcome measure for children with asthma that allows for the calculation of quality-adjusted life years in cost-effectiveness studies and can also be used to assign preference weights to asthma-symptom-free days. STUDY DESIGN: A literature review and two interviewer-administered surveys. SETTING: Homes or community centers of participants in Seattle, United States. MAIN MEASURE: Visual analog scale (VAS), standard gamble (SG), and relative risk attitude equation techniques were used to estimate two sets of preference weights for 10 health states. The PAHOM was used to record health states of pediatric asthma patients. RESULTS: A total of 94 subjects provided complete responses without any illogical ratings to VAS questions and 101 provided the same to SG questions. The VAS preference weights of the health states range from a maximum of 1 for perfect health to a minimum of 0.03 for severe asthma symptoms, emotional problems, and activity limitations. Those based on the relative risk attitude equation constructed with both VAS and SG preference weights range from 1 to 0.06. The mean PAHOM scores of pediatric asthma patients based on VAS and converted SG preference weights were 0.70 and 0.83, respectively. CONCLUSIONS: The PAHOM calendar can be used to identify asthma patients' health outcomes, to calculate the preference weights of asthma patients' health states, and to estimate the number of symptom-free days. These factors make the PAHOM a promising instrument for use in effectiveness and cost-effectiveness studies in children with asthma.
