ABSTRACT
OBJECTIVES: Mindfulness is effective for reducing anxiety and depression and increasing chronic disease self-management. An accessible, insurance-reimbursable model for implementation in patient-centered medical homes within US healthcare systems has promise for patients with multi-morbid conditions. Clarifying both the dose needed to impact anxiety, depression and self-management, and the design requirements for accessible primary care implementation, is essential. METHODS: We tested feasibility, acceptability, and effectiveness of Mindfulness Training for Primary Care (MTPC), an 8-week, referral-based, insurance-reimbursable mindfulness program integrated within primary care, compared with a Low-Dose Comparator (LDC), consisting of a 60-minute mindfulness introduction plus referral to community and digital resources. Outcome measures were assessed at baseline and 8 weeks. MTPC is trauma-informed, incorporates mindfulness-oriented behavior change skills, and is designed to target anxiety, depression, stress, and chronic illness selfmanagement. Participants schedule a PCP visit to co-create a self-management action plan during week 6. RESULTS: Primary care providers (PCP) referred 344 patients over 14 months. Eighty-one participants with DSM-V anxiety disorders, depressive disorders, trauma- and stress-related disorders participated in this pilot randomized-controlled comparative effectiveness trial [MTPC (n=54); LDC (n=27)]. These data suggest that MTPC was more effective than LDC for reducing anxiety (p=0.01), enhancing mindfulness (p=0.02) and self-compassion (p=0.001), and for catalyzing selfmanagement behavior change through action plan initiation (OR=4.34, p=0.03). CONCLUSIONS: MTPC was successfully integrated into a health system, was billed to insurance, and was acceptable to a diverse primary care population. Replication with a larger study and further accessibility adaptations are needed to confirm and expand these pilot results.
ABSTRACT
BACKGROUND: Self-management of health is important for improving health outcomes among primary care patients with chronic disease. Anxiety and depressive disorders are common and interfere with self-regulation, which is required for disease self-management. An insurance-reimbursable mindfulness intervention integrated within primary care may be effective for enhancing chronic disease self-management behaviors among primary care patients with anxiety, depression, trauma, and stress-related and adjustment disorders compared with the increasingly standard practice of referring patients to outside mindfulness resources. OBJECTIVE: Mindfulness Training for Primary Care (MTPC) is an 8-week, referral-based, insurance-reimbursable program integrated into safety-net health system patient-centered medical homes. We hypothesized that MTPC would be more effective for catalyzing chronic disease self-management action plan initiation within 2 weeks, versus a low-dose comparator (LDC) consisting of a 60-min mindfulness introduction, referral to community and digital resources, and addition to a 6-month waitlist for MTPC. PARTICIPANTS: Primary care providers (PCPs) and mental health clinicians referred 465 patients over 12 months. All participants had a DSM-V diagnosis. DESIGN AND INTERVENTIONS: Participants (N = 136) were randomized in a 2:1 allocation to MTPC (n = 92) or LDC (n = 44) in a randomized controlled comparative effectiveness trial. MTPC incorporates mindfulness, self-compassion, and mindfulness-oriented behavior change skills and is delivered as insurance-reimbursable visits within primary care. Participants took part in a chronic disease self-management action planning protocol at week 7. MAIN MEASURES: Level of self-reported action plan initiation on the action plan initiation survey by week 9. KEY RESULTS: Participants randomized to MTPC, relative to LDC, had significantly higher adjusted odds of self-management action plan initiation in an intention-to-treat analysis (OR = 2.28; 95% CI = 1.02 to 5.06, p = 0.025). CONCLUSIONS: An 8-week dose of mindfulness training is more effective than a low-dose mindfulness comparator in facilitating chronic disease self-management behavior change among primary care patients.
Subject(s)
Health Behavior , Mindfulness/methods , Primary Health Care/methods , Self Care/methods , Self Care/psychology , Self-Control/psychology , Adult , Female , Health Behavior/physiology , Humans , Male , Middle Aged , Single-Blind Method , Treatment OutcomeABSTRACT
Con la finalidad de determinar el impacto del diagnóstico de lesión pre maligna de cérvix en la vida sexual de las mujeres, se realizó un estudio prospectivo y comparativo, evaluándose entre los meses de julio y septiembre del 2000, a 70 mujeres con diagnóstico de lesión pre maligna de cérvix realizado a través de citología cervical ya 70 con citología normal atendidas en el Hospital Belén de Trujillo durante el año 1999. Estas fueron entrevistadas en sus domicilios para obtener información respecto a su vida sexual y otras posibles variables. Para determinar el nivel de significancia se empleó la prueba X2, fijándose el nivel de significancia en p menor que 05, como estadísticamente significativo. Se encontró que: la frecuencia coital fue significativamente menor en las mujeres con diagnóstico de lesión pre maligna de cérvix; la satisfacción sexual no fue significativamente diferente; la iniciativa sexual fue significativamente diferente entre las mujeres con y sin diagnóstico de lesión pre maligna de cérvix.
With the purpose she gives to determine the impact he/she gives the diagnosis she gives lesion wicked pre he/she gives cervix in the sexual life he/she gives the women, she was carried out a prospective and comparative study, evaluating you among the months gives July and September gives the 2000 to 70 women with normal cytology assisted in the Hospital Nativity he/she gives Trujillo to last you the year 1999. There were interviewed in their homes to obtain information regarding their sexual life and other possible variables. To determine the level he/she gives significancia the test X2 it was used, noticing the level of sifnificance p less than 0.05, as statistically significant.Us was found that: the frequency coital was significantly smaller in the women with diagnosis gives lesion wicked pre he/she gives cervix; the sexual satisfaction was not significantly different; the sexual initiative was significantly different among the women with and without diagnosis he/she gives lesion wicked pre gives cervix.
