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Primary Care Physicians' Perceived Barriers on the Management of Depression in China Primary Care Setting
2017 AAGP Annual Meeting
Figure 1. Timing of mental services use by older adults (≥55 years) with earlier-life suicidal behavior by late-life suicidal behavior (N = 219).
associated with late-life suicidal behavior (p > .05), the timing of services use influenced the risk of suicidal behavior in late life. After adjusting for age, race-ethnicity, gender, and psychiatric disorders, older adults with earlier-life suicidal behavior who delayed using mental health services were nearly 2 times more likely to have late-life suicidal behavior (OR: 1.53, 95% CI: 1.16–2.01, p = .002). The proportion of older adults with earlier-life suicidal behavior who delayed using services until ≤1, 2–5, 6–10, and ≥11 years later are presented by late-life suicidal behavior in Figure 1. In general, following earlier-life suicidal behavior, using mental health services within one year was typical for older adults who did not develop late-life suicidal behavior, whereas delaying use of services for ≥11 years was highly prevalent for those who developed late-life suicidal behavior. Conclusions: This is the first study to our knowledge that examined the influence of history of mental health services use on the risk for suicidal behavior in late life. Our results highlight that older adults with earlier-life suicidal behavior who delayed using mental health services were significantly more likely to develop late-life suicidal behavior. These findings underscore that following earlier-life suicidal behavior, appropriate timing of mental health services use plays a vital role in reducing the risk for suicidal behavior in late life. This research was funded by: This work is supported by a NIH R01 grant (MD007019) that is administered by the Northern California Institute for Research and Education through resources from the San Francisco Veterans Affairs Medical Center.
Poster Number: NR 22
Primary Care Physicians’ Perceived Barriers on the Management of Depression in China Primary Care Setting Shulin Chen, MD&PhD1; Yeates Conwell, MD, MD2 1
Zhejiang University, Hangzhou, China University of Rochester Medical Center, Rochester, NY
2
Introduction: Chinese patients with depression have limited access to mental health specialty care because of myriad barriers at different levels. Recently, there has been increased interest in targeting primary care settings for managing depression, because most depressed individuals visit their primary care physicians (PCPs) during the course of their depressive episodes. The present study examined PCPs’ perceived barriers on the management of depression. Methods: A total of 295 PCPs completed a 36-item survey by mail. The survey questions included demographics, years in primary care, mental health training experience, and perceived barriers regarding the management of depression in their clinical and current practices. Chi-square and t-test analyses were used to compare the difference of demographic variables between the two districts. For the correlates of PCPs’ clinical practices and their perceived barriers, logistic regression models were used. Results: At the practice level, lack of access to mental health specialists (37.8%) was the most commonly reported barrier and at patients’ level, reluctance toward diagnosis of depression (34.6%) was the high barrier. Results have indicated that most PCPs (69.2%) felt comfortable discussing psychological issues with patients. Mental health training is significantly related to PCPs’ clinical practice. When PCPs perceived moderate to high-level practice level barriers, prescription and referral were mostly preferred.
S136
Am J Geriatr Psychiatry 25:3S, Supplement 1
2017 AAGP Annual Meeting Conclusions: These findings will guide the development of future multifaceted intervention strategies and an appropriate collaborative care model in the management of depression in China primary care settings. This research was funded by: The project was supported by Fogarty International Center, the National Institutes of Health of United States of American grant R01TW008699. This work was also supported by the Program for New Century Excellent Talents in University from the Ministry of Education China. Poster Number: NR 23
Patient Satisfaction and Engagement with an In-Home Program Providing Support During the Last 12 Months of Life Phillip Painter, MD; Ashley Brill, MS; Amy Nelson, RN, BSN; Wendy Rodkey, MCHES; Denise Streible, RN, BSN Humana Inc., Louisville, KY Introduction: Advanced care planning can help individuals with advanced illness adopt active behaviors in implementing effective quality of life/care planning communication and shared decision making processes with their family and physicians. Often at this stage of life, people have difficulty leaving the home and could benefit from in-home care. Humana Inc., a health and well-being company serving millions of people across the country, currently offers telephonic counseling on defining and conveying end-of-life preferences as well as assistance with completing online advanced directives. However, patients with advanced illness expressed an interest and need for in-person in-home care. Thus, we have partnered with Aspire Health to provide specialized in-home services to people with Humana Medicare insurance during their last 12 months of life. This study describes patient participation, satisfaction and engagement with the in-home program. Methods: This program was initiated in 8 cities: Birmingham, Mobile, Knoxville, Nashville, Memphis, Chattanooga, Houston, and Chicago; and later it expanded to some parts of Ohio. A claims-based algorithm was used to identify patients in their last year of life, and physicians then reviewed patient records to verify. Enrollment began in March of 2016 and is rolling until the goal of enrolling 1000 patients is met. The program provides a comprehensive initial, in-home assessment with unlimited access to in-home nurse practitioner (NP), social worker and chaplain visits. At a minimum, in-home NP visits are conducted monthly. Participants also have telephone access to physicians or NPs 24 hours a day, 7 days a week. Other palliative care services are also provided as ordered by clinicians. Participation, satisfaction and engagement was evaluated and reported between April and August of 2016. Results: A total of 4,008 patients (average age of 78 years old) were initially identified as eligible, with the majority (60%) of those residing in Tennessee, Chicago or Houston, which is representative of this population’s geographic location. The top three most common diagnoses were congestive heart failure (29%), cancer (22%) and chronic obstructive pulmonary disease (16%). As of September 26, 2016, 944 patients have participated, representing 94% of the initial program goal of 1000. The average length of time people have been in the program is 73 days. Thirty-three percent (33%) of participants have been discharged for the program for reasons including hospice enrollment, death, Aspire- or participant-determined “too healthy” for service, participant declination and changing health plans. The average length of time in the program prior to enrollment in hospice was 71 days. In a satisfaction survey, participants rated the program as very helpful (1 = very unhelpful, 5 = very helpful) in explaining illness (4.84), medication use (4.7), future planning (4.4), and managing symptoms (4.6). NPs have made 87 urgent visits in circumstances where the patient otherwise would have gone to the emergency department. A total of 188 primary care physician referrals have been processed, and 457 after-hour calls have been made to the help line when physician offices are typically closed. Of the 620 currently active participants with known advance directive (AD) status, 100% have discussed it, 63% have an AD (42% created one as part of the program) and 37% have no documented AD. Conclusions: Participants report high satisfaction with the program, underscoring the importance of in-person in-home care to patients. The enrollment, participation, and utilization of services suggest that there is a need for specialized services that can be delivered in the home during the last 12 months of life and preceding hospice. This program may prevent delaying care or difficult emergency department visits during times when a patient’s doctor’s office is closed. Poster Number: NR 24
Physical Exercise-Induced Improvement in Gait Speed and Interoceptive-Exteroceptive Network Synchronization Lanxin Ji, PhD candidate1; Xue Zhang, PhD candidate1; Kevin Manning, PhD2; David Steffens, MD2; Lihong Wang, PhD2 1
Center for Biomedical Imaging Research, Tshinghua University, Beijing, China UCONN Health Center, Farmington, CT
2
Am J Geriatr Psychiatry 25:3S, Supplement 1
S137
Figure 1. Timing of mental services use by older adults (≥55 years) with earlier-life suicidal behavior by late-life suicidal behavior (N = 219).
associated with late-life suicidal behavior (p > .05), the timing of services use influenced the risk of suicidal behavior in late life. After adjusting for age, race-ethnicity, gender, and psychiatric disorders, older adults with earlier-life suicidal behavior who delayed using mental health services were nearly 2 times more likely to have late-life suicidal behavior (OR: 1.53, 95% CI: 1.16–2.01, p = .002). The proportion of older adults with earlier-life suicidal behavior who delayed using services until ≤1, 2–5, 6–10, and ≥11 years later are presented by late-life suicidal behavior in Figure 1. In general, following earlier-life suicidal behavior, using mental health services within one year was typical for older adults who did not develop late-life suicidal behavior, whereas delaying use of services for ≥11 years was highly prevalent for those who developed late-life suicidal behavior. Conclusions: This is the first study to our knowledge that examined the influence of history of mental health services use on the risk for suicidal behavior in late life. Our results highlight that older adults with earlier-life suicidal behavior who delayed using mental health services were significantly more likely to develop late-life suicidal behavior. These findings underscore that following earlier-life suicidal behavior, appropriate timing of mental health services use plays a vital role in reducing the risk for suicidal behavior in late life. This research was funded by: This work is supported by a NIH R01 grant (MD007019) that is administered by the Northern California Institute for Research and Education through resources from the San Francisco Veterans Affairs Medical Center.
Poster Number: NR 22
Primary Care Physicians’ Perceived Barriers on the Management of Depression in China Primary Care Setting Shulin Chen, MD&PhD1; Yeates Conwell, MD, MD2 1
Zhejiang University, Hangzhou, China University of Rochester Medical Center, Rochester, NY
2
Introduction: Chinese patients with depression have limited access to mental health specialty care because of myriad barriers at different levels. Recently, there has been increased interest in targeting primary care settings for managing depression, because most depressed individuals visit their primary care physicians (PCPs) during the course of their depressive episodes. The present study examined PCPs’ perceived barriers on the management of depression. Methods: A total of 295 PCPs completed a 36-item survey by mail. The survey questions included demographics, years in primary care, mental health training experience, and perceived barriers regarding the management of depression in their clinical and current practices. Chi-square and t-test analyses were used to compare the difference of demographic variables between the two districts. For the correlates of PCPs’ clinical practices and their perceived barriers, logistic regression models were used. Results: At the practice level, lack of access to mental health specialists (37.8%) was the most commonly reported barrier and at patients’ level, reluctance toward diagnosis of depression (34.6%) was the high barrier. Results have indicated that most PCPs (69.2%) felt comfortable discussing psychological issues with patients. Mental health training is significantly related to PCPs’ clinical practice. When PCPs perceived moderate to high-level practice level barriers, prescription and referral were mostly preferred.
S136
Am J Geriatr Psychiatry 25:3S, Supplement 1
2017 AAGP Annual Meeting Conclusions: These findings will guide the development of future multifaceted intervention strategies and an appropriate collaborative care model in the management of depression in China primary care settings. This research was funded by: The project was supported by Fogarty International Center, the National Institutes of Health of United States of American grant R01TW008699. This work was also supported by the Program for New Century Excellent Talents in University from the Ministry of Education China. Poster Number: NR 23
Patient Satisfaction and Engagement with an In-Home Program Providing Support During the Last 12 Months of Life Phillip Painter, MD; Ashley Brill, MS; Amy Nelson, RN, BSN; Wendy Rodkey, MCHES; Denise Streible, RN, BSN Humana Inc., Louisville, KY Introduction: Advanced care planning can help individuals with advanced illness adopt active behaviors in implementing effective quality of life/care planning communication and shared decision making processes with their family and physicians. Often at this stage of life, people have difficulty leaving the home and could benefit from in-home care. Humana Inc., a health and well-being company serving millions of people across the country, currently offers telephonic counseling on defining and conveying end-of-life preferences as well as assistance with completing online advanced directives. However, patients with advanced illness expressed an interest and need for in-person in-home care. Thus, we have partnered with Aspire Health to provide specialized in-home services to people with Humana Medicare insurance during their last 12 months of life. This study describes patient participation, satisfaction and engagement with the in-home program. Methods: This program was initiated in 8 cities: Birmingham, Mobile, Knoxville, Nashville, Memphis, Chattanooga, Houston, and Chicago; and later it expanded to some parts of Ohio. A claims-based algorithm was used to identify patients in their last year of life, and physicians then reviewed patient records to verify. Enrollment began in March of 2016 and is rolling until the goal of enrolling 1000 patients is met. The program provides a comprehensive initial, in-home assessment with unlimited access to in-home nurse practitioner (NP), social worker and chaplain visits. At a minimum, in-home NP visits are conducted monthly. Participants also have telephone access to physicians or NPs 24 hours a day, 7 days a week. Other palliative care services are also provided as ordered by clinicians. Participation, satisfaction and engagement was evaluated and reported between April and August of 2016. Results: A total of 4,008 patients (average age of 78 years old) were initially identified as eligible, with the majority (60%) of those residing in Tennessee, Chicago or Houston, which is representative of this population’s geographic location. The top three most common diagnoses were congestive heart failure (29%), cancer (22%) and chronic obstructive pulmonary disease (16%). As of September 26, 2016, 944 patients have participated, representing 94% of the initial program goal of 1000. The average length of time people have been in the program is 73 days. Thirty-three percent (33%) of participants have been discharged for the program for reasons including hospice enrollment, death, Aspire- or participant-determined “too healthy” for service, participant declination and changing health plans. The average length of time in the program prior to enrollment in hospice was 71 days. In a satisfaction survey, participants rated the program as very helpful (1 = very unhelpful, 5 = very helpful) in explaining illness (4.84), medication use (4.7), future planning (4.4), and managing symptoms (4.6). NPs have made 87 urgent visits in circumstances where the patient otherwise would have gone to the emergency department. A total of 188 primary care physician referrals have been processed, and 457 after-hour calls have been made to the help line when physician offices are typically closed. Of the 620 currently active participants with known advance directive (AD) status, 100% have discussed it, 63% have an AD (42% created one as part of the program) and 37% have no documented AD. Conclusions: Participants report high satisfaction with the program, underscoring the importance of in-person in-home care to patients. The enrollment, participation, and utilization of services suggest that there is a need for specialized services that can be delivered in the home during the last 12 months of life and preceding hospice. This program may prevent delaying care or difficult emergency department visits during times when a patient’s doctor’s office is closed. Poster Number: NR 24
Physical Exercise-Induced Improvement in Gait Speed and Interoceptive-Exteroceptive Network Synchronization Lanxin Ji, PhD candidate1; Xue Zhang, PhD candidate1; Kevin Manning, PhD2; David Steffens, MD2; Lihong Wang, PhD2 1
Center for Biomedical Imaging Research, Tshinghua University, Beijing, China UCONN Health Center, Farmington, CT
2
Am J Geriatr Psychiatry 25:3S, Supplement 1
S137