Conflicting Advice between Spiritual Leaders, Friends and Family, and Mental Health Providers: Impacts on Mental Health Treatment-Seeking Behaviors.

This study aimed to examine the effects of advice from religious/spiritual leaders and friends/family of a religious/spiritual person with mental health struggles on treatment-seeking. A survey was administered to adult patients of a university-affiliated psychiatric clinic in the Midwest. Participants whose friends/family members' advice conflicted with their psychiatrist's advice were six times more likely to delay seeking mental health treatment (OR: 6.09, 95% CI: 1.37, 27.01). Conflict between religious/spiritual leader's advice and psychiatrist's advice had a significant effect on delay in seeking mental health treatment (OR: 11.73, 95% CI: 2.21, 62.14), with an average delay of just over two years.

A Pilot Study Examining Factors Influencing Readiness to Progress to Indirect Supervision Among First Year Residents in a General Psychiatry Training Program.

OBJECTIVE: In the first year of training, psychiatry residents progress from direct supervision to indirect supervision but factors predicting time to transition between these levels of supervision are unknown. This study aimed to examine times for transition to indirect levels of supervision and to identify resident factors associated with slower progression. METHODS: The authors compiled data from training files from years 2011-2015, including licensing exam scores, age, gender, medical school, month of first inpatient psychiatry rotation, and transition times between levels of supervision. Correlational analysis examined the relationship between these factors. Univariate analysis further examined the relationship between medical school training and transition times between supervision levels. RESULTS: Among the factors studied, only international medical school training was positively correlated with time to transition to indirect supervision and between levels of indirect supervision. CONCLUSIONS: International medical graduate (IMG) interns in psychiatry training may benefit from additional training and support to reach competencies required for the transition to indirect supervision.

Relationship of depression screening and physician office visit duration in a national sample.

OBJECTIVE: Although depression screening in primary care is recommended by the U.S. Preventive Services Task Force, it may increase the duration of primary care physician visits that are often at or exceeding capacity. This study was conducted to evaluate the relationship between depression screening and physician visit duration in community-based, primary care physician office visits while controlling for important covariates. METHODS: Cross-sectional data from the 2005-2007 National Ambulatory Medical Care Survey were used to examine the relationship between physician-indicated depression screening and office visit duration among adults (≥18 years of age) with multivariable, ordered logistic regression. Predicted probabilities of visit duration (by 15-minute increments of one to 15, 16-30, 31-45, and 46-60 minutes) were estimated for visits where depression screening was and was not documented. RESULTS: In a sample of 14,736 physician office visits, representing an estimated population of more than 641 million visits, depression screening was significantly associated with increased visit duration (adjusted odds ratio=3.66, 95% confidence interval=2.25-5.95). A prominent shift in the proportion of visits that were from one to 15 minutes long to visits that were at least 16-30 minutes long was observed when depression screening was documented. CONCLUSIONS: Depression screening may increase the duration of physician visits. Given demands on physicians' time, the impact of increased depression screening, including the costs and benefits of using alternative methods and technologies to reduce physician time burden associated with depression screening, should be evaluated.

Variations in the probability of depression screening at community-based physician practice visits.

BACKGROUND: Despite depression screening being a US Preventive Services Task Force-recommended practice in primary care, little is known about the degree to which it is performed and the factors associated with its conduct. METHOD: Using a nationally representative sample (National Ambulatory Medical Care Survey) of adult, community-based physician practice visits during the survey years 2005 to 2007 (total = 55,143; representing approximately 1.7 billion visits nationally), we estimated the probability of depression screening and variation by visit characteristics. RESULTS: Depression screening occurred at 2.29% of adult, community-based physician practice visits. Visits with primary care physicians were more likely to include depression screening (AOR = 2.19; 95% CI, 1.31-3.65), as were visits for preventive (AOR = 4.09; 95% CI, 2.55-6.57) and chronic care (AOR = 2.00; 95% CI, 1.44-2.80) compared to visits for acute care. Compared to the Northeast, visits in the West were less likely to include depression screening (AOR = 0.27; 95% CI, 0.13-0.57), as were visits for patients having ≥ 6 visits within the past 12 months (AOR = 0.65; 95% CI, 0.42-1.00) when compared to visits for new patients. Depression screening was more common at visits for patients with ICD-9-diagnosed depression (AOR = 7.51; 95% CI, 5.38-10.50) and for females (AOR = 1.26; 95% CI, 1.00-1.57). Bivariate analyses revealed that depression screening was more common at visits for patients with hyperlipidemia (3.21% vs 2.09%, P = .0086), obesity (4.59% vs 2.08%, P < .0001), and osteoporosis (4.46% vs 2.21%, P = .0002) and less common at visits for patients with diabetes (1.58% vs 2.39%, P = .0102). CONCLUSIONS: Depression screening at community-based physician practice visits in the United States appears to be low (2.29%) and may reflect an undefined optimal screening interval or strategy in published guidelines, lack of reimbursement incentives, or incomplete documentation in the medical record. Opportunities exist to improve depression screening in males, patients with chronic disease (especially diabetes), and the western region of the United States.

Evaluating the quality of websites offering information on female hypoactive sexual desire disorder.

This study evaluates websites relevant to female hypoactive sexual desire disorder (HSDD). Its primary aim is to evaluate the quality of Internet HSDD information. One hundred and one websites, identified through simple Google searches, were scored using a tool incorporating expert consensus-derived quality criteria for HSDD. The tool included structural criteria such as currency, authorship, and disclosure of competing interests. It also included performance criteria, evaluating accuracy, and comprehensiveness, and was adapted from a published website evaluation tool for diabetes. For each website, a quality index score with a potential range from 1 to 5 (1 = poor, 5 = excellent) was calculated, and the websites were rank ordered using this score. Quality index scores ranged from 1.68 to 4.64, with 75% of websites scoring at or below 3.27. Test-retest reliability was moderate (n = 24, r = 0.6601, P = .0004). Rank ordering of the websites by quality index allowed identification of the top five highest quality websites. The majority of HSDD websites' quality scores fell in the score range from 1 to 3, indicating room for improvement in the quality of websites that address HSDD. Website evaluation tools utilizing both structural and performance quality criteria may help clinicians to assist their patients in assessing the quality of Internet health information.

A pilot study of psychiatry resident psychotherapy competency: the impact of resident attitude and demographics.

OBJECTIVE: In psychiatry education, psychotherapy knowledge, skills, and attitudes are new competency objectives. METHODS: Two faculty members independently ranked psychiatry residents for psychotherapy competency. A rank of 1 indicated the most competency and a rank of 15 indicated the least competency for the resident psychotherapist. Several demographic and attitudinal variables of the residents were examined for relationships with psychotherapy competence. RESULTS: When the competency rankings of the two faculty members were compared, they demonstrated a high level of agreement (spearman r = 0.74, p = 0.0016). Of the variables studied, resident age (r = .61, p = .015) and personal attitude toward psychotherapy (S=29, p = .026) were significantly associated with psychotherapy competency. Both variables remained independently significant after statistical adjustment. CONCLUSIONS: Our study indicates that psychiatry resident attitude and age may influence psychotherapy competency. These markers for psychotherapy competency may assist training programs with resident selection parameters and may enhance psychotherapy educational strategies for residents predicted to require assistance in achieving competency.

A pilot use of team-based learning in psychiatry resident psychodynamic psychotherapy education.

OBJECTIVE: Demonstrating psychotherapy competency in trainees will test the resources of psychiatry training programs. The authors outline the phases of team-based learning (TBL). METHODS: The University of Oklahoma College of Medicine, Tulsa (OUCM-T), Department of Psychiatry reorganized its psychodynamic psychotherapy didactic course using TBL. CONCLUSION: Team-based learning offers a promising alternative to traditional psychodynamic psychotherapy didactics, potentially increasing resident learning efficiency through a structured learning cycle emphasizing accountability to a learning team.

Opioid contract use is associated with physician training level and practice specialty.

Opioid contracts are widely used to manage opioid prescribing in the treatment of pain conditions, but they are not well studied. A notable gap in our knowledge of opioid contracts involves the factors that determine their use. As an initial inquiry, this study evaluated the responses of a Web-based survey of trainees and faculty in an academic medical training context to determine correlates of opioid contract use. All paid faculty, third- and fourth-year medical students, and residents in The University of Oklahoma College of Medicine were invited via email to participate in a Web-based survey of their attitudes and prescribing practices related to controlled prescription drugs. Respondents composing a subgroup of those who replied to the survey were identified by their prescription of opioids and by their designation that pain was the most likely diagnosis for which they would prescribe a controlled drug. Chi-square analysis was used to determine any correlation between contract use and respondents' demographic variables and categorical survey responses. Analysis of variance was used to determine any correlation between contract use and survey responses that involved continuous variables. Our results showed that opioid contract use was significantly associated with resident status, primary care specialty, participant estimation of alcohol and illicit drug abuse by patients, and the participant's assessment of the risks in general of prescribing controlled drugs. A majority of contract users reported that the use of this tool increased their sense of mastery and comfort with prescribing controlled drugs. The factors associated with opioid contract use found in this study suggest there are significant prescriber-specific determinants of the use of the tool, including training level, medical specialty, and risk appraisals. Opioid contracts' effects on mastery and comfort of the physician with prescribing opioids suggest that they may play an important role in facilitating appropriate pain management with opioids. Further study is needed to elucidate environmental and patient-specific factors that may influence opioid contract use.

Primary care specialty, resident status, and male gender correlate with controlled drug contract use.

OBJECTIVE: With prescription drug abuse rising, physicians are often ambivalent about prescribing controlled drugs. To address their concerns, physicians widely use controlled drug contracts (CDC); however, CDC use is poorly studied. This preliminary study characterizes CDC users and identifies factors associated with CDC use. METHOD: Data were collected from a Web-based survey of University of Oklahoma College of Medicine medical trainee and faculty attitudes and prescribing practices regarding controlled drugs. Recruited via e-mail, participants submitted responses anonymously for a 6-week period from January through March 2004. Associations between demographic variables and participants' responses were analyzed using chi2 analysis to determine correlates of CDC use. Demographic variables included training status (medical student, resident, or faculty), age, gender, and faculty specialty. Variables of interest derived from the survey were CDC use, how respondents compared the risks and benefits of controlled drugs, and patient diagnosis. RESULTS: One hundred ninety-six surveys were submitted, with an estimated response rate of 20% to 30%. CDC use correlated with male gender (p = .0099), resident status (p = .0099), primary care specialty among faculty (p = .0001), and risk/benefit assessment (p = .04) but not patient diagnosis (p = .19) or participant age (p = .40). CONCLUSIONS: Despite limitations, the study findings suggest that a physician's gender, training status, medical specialty, and comparison of the risks and benefits of controlled drugs are factors that determine CDC use.

The impact of fear of HIPAA violation on patient care.

The deadline for compliance with the privacy rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was April 14, 2003. Understandably, many psychiatrists and other mental health providers have been focusing on compliance. This brief report discusses the negative impact of efforts to implement HIPAA on patient care in a community-based mental health system. Three cases highlight several issues: fear of violating HIPAA, failure to understand HIPAA's privacy regulations, and ethical concerns. The authors discuss the key issues and address implications for practice. Several recommendations are offered for maintaining excellent patient care while complying with HIPAA.