Tagpsychiatric services

Reading of the Week: Should You Google Your Patients? Can Telemedicine Help with Medication Adherence?

From the Editor

A few years ago, a patient told me that he had won the lottery. When I expressed some surprise (and skepticism), he replied: google my name. I did, and he had won the lottery.

We google restaurant suggestions, people in the news, and our partner’s new bff.  But is googling your patients ethical? Is it advisable?

In the first selection, we look at a new paper from Psychiatric Services. Yale University’s Charles C. Dike and his co-authors consider these questions and more. They conclude: “Except in emergencies, it is advisable to obtain a patient’s informed consent before performing an Internet or social media search for information about the patient or the patient’s family and significant others.”

3888Does a good history include a good google of your patients?

For the second selection, we consider another paper from Psychiatric Services; the authors ask whether telemedicine can help with medication adherence. In this study, the University of Greifswald’s Lara N. Schulze and her co-authors use texting and phone calls. Spoiler alert: the intervention worked.

And a quick request: I’m looking for feedback on the Reading series. Please take a few minutes to complete the (anonymous) online survey: https://www.surveymonkey.com/r/GP5XXMB.

Note: there will be no Readings for the next two weeks.

DG

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Reading of the Week: How to Think about Practice Today – And Tomorrow? A New CJP Paper, a Podcast, and a Report

From the Editor

How do we practice today – and how will we practice in the future?

This week’s Reading includes three selections.

In the first selection, we consider how we practice today, with a new paper by University of Ontario Institute of Technology’s David Rudoler and his co-authors. Drawing on administrative data, they look for practice patterns, finding three distinct ones. Spoiler alert: practice patterns are very different, with 30% of psychiatrists seeing just two or fewer patients per month.

Then, we look ahead. In the second selection, we consider a new podcast discussing digital psychiatry. I talk with Dr. John Torous of the Harvard-affiliated Beth Israel Deaconess Medical Center. And, yes, he has tips on good apps for your patients.

Finally, in the third selection, we consider the recent Ontario government report on ending hallway medicine. The authors look to the future, and make several suggestions, including embracing the potential of digital health care.

messaging-appsApps – the future?

Enjoy.

DG

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Reading of the Week: Measurement-based Care – Big Idea, Not-So-Big Reality

From the Editor

Imagine the excitement if a new antidepressant came to market that boasted that it could achieve the symptom reduction of other antidepressants in about half the time, yet had no significant new side effects.

There is no new antidepressant, but there is a study to mull: In 2015, The American Journal of Psychiatry published a paper on measurement-based care for people with depression, and the patients in the measurement group achieved remission in about half the time compared to people seeing a psychiatrist without the guidance of measurement. Though the paper has limitations, it also suggests the incredible potential of measurement-based care.

The measuring tape isolated on white backgroundThe measuring tape isolated on white background

In the first selection, we consider a new review paper published in JAMA Psychiatry. Kaiser Permanente Washington Health Research Institute’s Cara C. Lewis and her co-authors contemplate the potential of measurement-based care – and its reality (greatly underused). They make six points of observation and discussion before going on to propose an agenda.

In the second selection, we look at a paper by the University of Pennsylvania’s David W. Oslin and his co-authors who use survey data to consider the use of measurement-based care in a paper published by Psychiatric Services.

DG

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Reading of the Week: Vulnerable Youth & ‘13 Reasons Why’ — the New Psych Services Paper; Also, Dr. Orford Considers his Brother’s Suicide in JAMA

From the Editor

It’s a hit show. Is it dangerous?

Since its launch, 13 Reasons Why has been highly controversial; the storyline of the Netflix series revolves around a teenager’s decision to suicide – which is graphically depicted over three minutes in one episode.

In this week’s Reading, we look at a new Psychiatric Services paper. University of Michigan’s Dr. Victor Hong and his co-authors consider the impact of the show on youth seeking psychiatric care for suicide-related risk. While other studies have analyzed the response in the larger community (including google searches), this study focuses on a vulnerable population. They find: “For certain youths, watching the series correlated with a perceived nonzero elevation in their suicide risk; identification with the main female character and strong affective reactions may be markers of increased risk associated with viewing the show.”

13-reasons-picBig buzz, big problem?

In the other selection, we look at a short essay recently published in JAMA. In “Grief After Suicide,” Dr. Orford discusses the suicide of his brother. The Deakin University intensivist notes that: “As a physician, I have cared for thousands of patients and families in the last hours and days of life. I have listened, watched, and learned.” The loss of his brother, however, continues to have a major effect on his life, three decades later.

DG

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Reading of the Week: Social Media & Paranoia — the new Acta Paper; Also, How Do We Change Docs? A Reader Responds

From the Editor

Politicians tweet about townhall meetings; celebrities put vacation pictures on Instagram; your cousin in Europe has her own YouTube channel.

Our world is very different than it was just a few short years ago. (Fun fact: Facebook – a decade and a half old – claims to have more than 2 billion active monthly users.)

But how has social media affected those with mental illness? While this is much discussed in the media, there is little in the literature. In this week’s Reading, we consider a new paper that looks at social media and mental illness, in particular psychosis. Tweet this: the University of Manchester’s Natalie Berry and her co-authors didn’t find a connection between use of social media and increased paranoia.

BELCHATOW POLAND - MAY 02 2013: Modern white keyboard with colored social network buttons.

In this week’s Reading, we consider this new paper from Acta Psychiatrica Scandinavica. We also wonder about the role of the Internet and social media for those with psychosis, drawing from a Psychiatric Services paper.

Also, the University of Toronto’s Dr. Ivan Silver writes a letter to the editor about a previous Reading.

DG

 
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Reading of the Week: Appointment Letters & Focused Therapies – Thinking Outside the Box

From the Editor

When we speak of improving the quality of mental health care, we often think about cutting-edge innovation – wearables, virtual reality, genetics, to name a few things.

This week, there are two selections. Both discuss innovations aimed at improving care – but neither could be considered particularly “cutting edge.”

In the first selection, researchers sought to improve outpatient appointment attendance with a decidedly low-tech idea: appointment letters reminding patients of the importance of follow up. Spoiler alert: it worked.

In the second selection, drawn from The New York Times, reporter Andrea Petersen discusses clinics that use a short, intense version of CBT.

Thinking outside the box

Together, these two selections illustrate some thinking outside the box.

DG

 
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Reading of the Week: Higher Volume, Better Care? The Rasmussen Paper

From the Editor

How do we improve mental health services?

Past Readings have explored many topics from measurement-based care to better access. This week, we consider a new paper by Aalborg University’s Line Ryberg Rasmussen et al. The study authors look at volume and quality of mental health care, drawing on Danish inpatient admissions.

Their finding? “This nationwide, population-based cohort study demonstrated that patients with depression who were admitted to psychiatric hospitals with very-high-volume wards were more likely to receive care in accordance with clinical guidelines, compared with those admitted to low-volume wards.”

ptelemnursing01High volume, better care (if not better cafeteria food)?

This week, we look at the Rasmussen et al. paper and consider its implications.

DG

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Reading of the Week: ECT in America – Uncommon, Uneven, and Underappreciated? The New Wilkinson Paper; Also, Cope’s Challenge to Corporate Canada

From the Editor

It’s difficult not to be excited about Bell Let’s Talk. Last week’s event set a fundraising record. Pause for a moment and appreciate how far we have traveled: a major Canadian corporation is promoting mental health awareness, raising millions of dollars in the process, and gathering praise from many, including the Prime Minister. The decline of stigma is seen across the west, with talk of tackling the opioid epidemic in New Hampshire, US, and of bettering psychological interventions in Hampshire, UK.

But how accessible is evidence-based care?

In the first selection, we consider a paper just published on ECT in the United States. Drawing on a massive database, the authors of this Psychiatric Services paper find ECT is used rarely and unevenly. In this Reading, we compare the American data to Canada’s – and draw a similar conclusion.

flag_map_of_the_contiguous_united_states_1912-1959A large country with many people – but not much ECT

And speaking of Bell Canada, in our second selection, we consider a Globe article on CEO George Cope’s recent Canada Club speech. In it, Cope challenges other businesses to implement a mental health strategy. “For business leaders… here’s the call-out: The numbers are self-funding. There’s no reason not to adopt a program in your company.”

DG

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Reading of the Week: More Demand, Less Physician Care? The New Chiu et al. Paper. Also, CAMH’s Really Big Donation

From the Editor

Canadians understand more about mental health and – with declining stigma – are more interested in services. So are they using more services and how have practice patterns changed with time?

In this week’s Reading, we consider a new paper from The Canadian Journal of Psychiatry. Chiu et al. try to answer these questions by looking at outpatient family doctor and psychiatrist visits from 2006 to 2014. They also look at ED visits and hospitalizations.

8b16181v-565x422Family docs and mental health: how much care do they deliver (and are all their patients this cute)?

They find that ED visits were up for mental health, as were hospitalizations, but physicians visits went down (all in terms of rates). They write: “The increasing acute care service use coupled with the reduction in outpatient visits suggest, overall, an increase in demand for mental health care that is not being met in ambulatory care settings.”

Also in this week’s Reading, we consider some good news: CAMH received a $100 million gift from an anonymous donor. Good news – but is it all good news for mental health charities?

DG

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Reading of the Week: Better Pay, Better Service? The CMAJ Paper on Pay for Performance in Psychiatry. Also, a Father’s Memory

From the Editor

Does pay for performance work for psychiatry?

This week’s first selection is a paper just published by CMAJ that considers that question. Drawing on Ontario data, the authors looked at practice patterns when financial incentives were introduced for psychiatrists to take care of patients after discharge and after suicide attempts. Spoiler alert: they didn’t work.

http-i-huffpost-com-gen-1291505-images-n-free-health-care-canada-628x314Paying for Performance – Getting Performance?

In this Reading, we consider the paper and the larger debate.

We also consider a short, moving essay by radio host Charles Adler on the memory of his father – and his father’s memory. The award-winning broadcaster describes his father and his Alzheimer.

DG

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