Improving Integrated Mental Health Care Through an Advanced Practice Registered Nurse-Led Program: Challenges and Successes.

Integrated and collaborative care delivery models have demonstrated efficacy for the management of psychiatric conditions in the primary care environment, yet organizations struggle with implementation of integrated efforts in clinical practice. Delivering care with a population focus versus face-to-face encounters with individual patients requires financial investment and adjustment in care delivery. We discuss the early implementation process of an advanced practice registered nurse (APRN)-led integrated behavioral health care program, including the challenges, barriers, and successes in the first 9 months of the program (January-September 2021), for an academic institution in the Midwest. A total of 161 Patient Health Questionnaire 9 (PHQ-9) and 162 Generalized Anxiety Disorder (GAD-7) rating scales were completed on 86 patients. The mean PHQ-9 score at the initial visit was 11.3 (moderate depression); after 5 visits, it decreased significantly to 8.6 (mild depression) (P < .001). The mean GAD-7 score at the initial visit was 10.9 (moderate anxiety); after 5 visits, it decreased significantly to 7.6 (mild anxiety) (P < .001). A survey completed by 14 primary care physicians 9 months after program launch revealed improvements in satisfaction with collaboration but, most notably, in perception of access to and overall satisfaction with behavioral health consultation/patient care services. Program challenges included adapting the environment to enhance leadership roles for the program and adjusting to virtual availability of psychiatric support. A case example highlights the value of integrated care along with improved depression and anxiety-related outcomes. Next steps should include efforts that capitalize on nursing leadership strengths while also promoting equity among integrated populations.

Relationship between scores from the Knee Outcome Survey and a single assessment numerical rating in patients with patellofemoral pain.

OBJECTIVE: To determine the relationship between patient-reported single numeric ratings and actual scores obtained from a validated instrument, the Knee Outcome Survey (KOS). BACKGROUND: Patient-reported outcome (PRO) measures are an important component of patient management. Information obtained from PRO measures can be used to prioritize goal setting, assist with clinical decision-making, provide evidence for effectiveness of interventions, monitor progress, and assess organizational or clinician performance. METHODS: Scores from the KOS activity of daily living (ADL) and Sports subscales completed at the time of initial examination of patients with patellofemoral pain (n = 29) were retrospectively analyzed and compared to a single assessment numerical rating. RESULTS: Bi-variate Pearson product correlation was used to determine association between the KOS-ADL and KOS-Sports with respective single assessment numerical ratings. A high correlation was observed between the KOS-ADL (0.85, p < 0.01) and KOS-Sports (0.88, p < 0.01) with a single assessment numerical rating. CONCLUSIONS: Administration and scoring of standardized outcome measures such as the KOS-ADL and KOS-Sports require several minutes to administer but correlate well with a single assessment numerical ratings. The high correlation of single assessment numerical scores to actual KOS-ADL and KOS-Sports scores may provide support for discretionary use of single numerical ratings during interim patient care visits and/or in instances when time is limited. Additional studies are needed with larger patient populations and specific diagnostic subgroups to determine additional clinical relevance.

The positive illusory bias: does it explain self-evaluations in college students with ADHD?

OBJECTIVE: To evaluate whether the positive illusory bias explains the self-evaluations of driving and work behaviors in college students with ADHD. METHOD: A total of 103 students with ADHD were compared to a sample of 94 students without ADHD. Both groups completed self-reports of their specific driving and work behaviors and then rated their overall, global performance in each area. Three specific-to-global change scores were obtained (one measuring work and two measuring driving) that were thought to be measures of the positive illusory bias. These specific-to-global change scores were analyzed using chi-square to evaluate differences between participants with and without ADHD. RESULTS: The participants with ADHD were significantly more likely than the participants without ADHD to engage in the positive illusory bias on two of the three work and driving ratings. CONCLUSION: College students with ADHD demonstrate self-evaluations that appear to reflect the positive illusory bias and that may be related to their academic functioning in the college setting and willingness to receive treatment.

Methamphetamine use and dental disease: results of a pilot study.

PURPOSE: The purpose of this study was to evaluate the feasibility of using a standard dental examination to detect methamphetamine use. METHODS: Data were collected from 31 patients in a hospital-based inpatient chemical dependency treatment unit using cross-sectional study design. Patients who reported current methamphetamine use were compared with patients who denied methamphetamine use on data from dental examinations and an in-depth substance use assessment. RESULTS: Evidence of a relationship between methamphetamine use and dental disease was not detected in this sample. Both groups had a high degree of behaviors and risk factors other than substance abuse that contributed to dental disease. CONCLUSION: Based on these data, clients who used methamphetamine could not be distinguished from those who used other substances. Both groups presented significant dental disease, however, and it may be that most, if not all, patients in this hospital-based unit had significant chronic health problems including dental disease. Although adolescent use of methamphetamine is primarily restricted to older adolescents, consequences of use are severe and early identification of drug use may forestall some of the more severe consequences.

Comparison of ferric sulfate, formocresol, and a combination of ferric sulfate/formocresol in primary tooth vital pulpotomies: a retrospective radiographic survey.

Studies have suggested that formocresol has toxic and carcinogenic potential. A search for an alternative medicament for primary tooth pulpotomies has led to ferric sulfate as a possible alternative. A retrospective study was done in a multipractitioner IHS (Indian Health Service) clinic. Radiographic success or failure was determined for 202 primary tooth pulpotomies performed with either formocresol, ferric sulfate, or a combination procedure of formocresol and ferric sulfate. The post-operative period for the pulpotomies ranged from one month to thirty-six plus months. There was no statistical difference in radiographic failure rates between formocresol, ferric sulfate, or the combination procedure when results were analyzed regardless of post-op period. However, when post-op periods were considered, formocresol performed better at > 36 months and the combination procedure showed significantly more failures at > 36 months.