Tag: Primary Care

What is the International Classification of Primary Care?

Published on by Andrew Marshall3 Comments

Introduction

The International Classification of Primary Care (ICPC) is a classification method for primary care encounters. It allows for the classification of the patient’s reason for encounter (RFE), the problems/diagnosis managed, primary or general health care interventions, and the ordering of the data of the primary care session in an episode of care structure.

Refer to ICPC-2 Plus.

It was developed by the WONCA International Classification Committee (WICC), and was first published in 1987 by Oxford University Press (OUP). A revision and inclusion of criteria and definitions was published in 1998. The second revision was accepted within the World Health Organisation’s (WHO) Family of International Classifications.

The classification was developed in a context of increasing demand for quality information on primary care as part of growing worldwide attention to global primary health care objectives, including the WHO’s target of “health for all”.

Brief History

The first version of ICPC, which was published in 1987, is referred to as ICPC-1. A subsequent revision which was published in the 1993 publication The International Classification of Primary Care in the European Community: With a Multi-Language Layer is known as ICPC-E.

The 1998 publication, of version 2, is referred to as ICPC-2. The acronym ICPC-2-E, refers to a revised electronic version, which was released in 2000. Subsequent revisions of ICPC-2 are also labelled with a release date.

Refer to ICPC-2 Plus.

Structure

Chapters

The ICPC contains 17 chapters:

  • A General and unspecified.
  • B Blood, blood forming organs, lymphatics, spleen.
  • D Digestive.
  • F Eye.
  • H Ear.
  • K Circulatory.
  • L Musculoskeletal.
  • N Neurological.
  • P Psychological.
  • R Respiratory.
  • S Skin.
  • T Endocrine, metabolic and nutritional.
  • U Urology.
  • W Pregnancy, childbirth, family planning.
  • X Female genital system and breast.
  • Y Male genital system.
  • Z Social problems.

Components

The ICPC classification, within each chapter, is based on 3 components coming from 3 different classifications:

  • Reason for Encounter Classification (1981).
  • International Classification of Process in Primary Care (IC-Process-PC) (1985).
  • International Classification of Health Problem in Primary Care (ICHPPC-2-d) (1976, 1983).

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/International_Classification_of_Primary_Care >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

Book: Psychoanalysis and the Cinema- The Imaginary Signifier

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Book Title:

Psychoanalysis and the Cinema- The Imaginary Signifier.

Author(s): Christian Metz.

Year: 1984.

Edition: First (1st).

Publisher: Palgrave Macmillan.

Type(s): Hardcover and Paperback.

Synopsis:

In the first half of the book Metz explores a number of aspects of the psychological anchoring of cinema as a social institution.

In the second half, he shifts his approach…to look at the operations of meaning in the film text, at the figures of image and sound concatenation. Thus he is led to consideration of metaphor and metonymy in film, this involving a detailed account of these two figures as they appear in psychoanalysis and linguistics.

Book: Psychiatric Diagnosis and Classification

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Book Title:

Psychiatric Diagnosis and Classification.

Author(s): Mario Maj, Wolfgang Gaebel, Juan Jose Lopez-Ibor, and Norman Sartorius (Editors).

Year: 2002.

Edition: First (1st).

Publisher: Wiley-Blackwell.

Type(s): Hardcover and Kindle.

Synopsis:

This book provides an overview of the strengths and limitations of the currently available systems for the diagnosis and classification of mental disorders, in particular the DSM-IV and the ICD-10, and of the prospects for future developments. Among the covered issues are: The impact of biological research The diagnosis of mental disorders in primary care The usefulness and limitations of the concept of comorbidity in psychiatry The role of understanding and empathy in the diagnostic process The ethical, legal and social aspects of psychiatric classification Psychiatric Diagnosis & Classification provides a comprehensive picture of the current state of available diagnostic and classificatory systems in psychiatry and the improvements that are needed.

COVID-19 and the Role of Primary Care in Suicide Prevention

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Research Paper Title

Role of Primary Care in Suicide Prevention During the COVID-19 Pandemic.

Background

Primary care providers have an important role in suicide prevention, knowing that among people who die by suicide, 83% have visited a primary care provider in the prior year, and 50% have visited that provider within 30 days of their death, rather than a psychiatrist.

The psychosocial impact of the coronavirus disease 2019 pandemic poses increased risk for suicide and other mental health disorders for months and years ahead.

This article focuses on screening tools, identification of the potentially suicidal patient in the primary care setting, and a specific focus on suicide prevention during widespread, devastating events, such as a pandemic.

Reference

Nelson, P.A. & Adams, S.M. (2020) Role of Primary Care in Suicide Prevention During the COVID-19 Pandemic. The Journal for Nurse Practitioners. doi: 10.1016/j.nurpra.2020.07.015. Online ahead of print.

Suicide Screening and Prevention

Published on by Andrew Marshall1 Comment

Reseach Paper Title

Suicide Screening and Prevention.

Background

Suicide is a major public health problem not only in the United States (US) but in many western nations as well.

In the US, it is the 10th leading cause of death, accounting for nearly 44,000 deaths each year. Suicide is also the seventh leading cause of years of potential loss of life, surpassing liver disease, diabetes, and HIV.

Each year, nearly half a million individuals present to the emergency departments in the US following attempted suicide.

Data indicate that nearly 1 out of every 7 young adults admits to having some type of suicidal ideation at some point in their lives and at least 5% have made a suicide attempt.

Suicide has repercussions way beyond the affected individual. It costs the US healthcare system over $70 billion, and untold billions of dollars are lost by the families who are affected, in terms of loss of earning.

Suicides are at an all-time high and affect both genders. Men are nearly 3.5 times more likely than women to commit suicide, and on average 123 people kill themselves every day.

The World Health Organisation (WHO) has predicted that in the next 2 years, depression will be the leading cause of disability globally. Depression is not only a North American phenomenon but is now being diagnosed in almost every nation. The annual prevalence of major depressive disorders in North America is 4.5%, but this is a gross underestimate because many individuals do not seek medical help. Depression is a serious medical disorder and associated with a high risk of suicide. Data reveals that more than 90% of individuals with a major depressive disorder do see a healthcare provider within the first 12 months of the episode and at least 45% of suicide victims have had some contact with a primary health care provider within the 4 weeks of suicide.

This indicates that if their healthcare providers are more vigilant and alert, suicide could be prevented in these individuals. These grim statistics have led to a National Strategy for Suicide Prevention in the US.

Considering that many individuals who commit suicide have a mental health disorder and have visited their primary caregiver, the focus now is on health care providers to become aware of the factors that increase the risk of suicide and to refer these individuals to mental health professionals for some type of intervention.

The current United States Preventive Services Task Force (USPSTF) recommendations are that primary caregivers should screen adolescents and adults for depression only when there are appropriate systems in place to ensure adequate diagnosis, treatment, and follow-up.

Aetiology

Many factors have been identified in individuals who commit suicides or have attempted suicide. These factors include the following:

  • Advanced age.
  • Availability of a firearm.
  • Chronic illness.
  • A family history of suicides.
  • Financial difficulties.
  • Negative life experiences.
  • Loss of job.
  • Marital status divorced.
  • Medications.
  • Mental illnesses such as depression, anxiety, post-traumatic stress disorder (PTSD).
  • Pain that is continuous.
  • A physical illness that has led to disability.
  • Race: white.
  • Gender: Male.
  • Social media.
  • Stress.
  • A sense of no purpose in life.

Other Risk Factors for Suicide

Over the years, several other factors have been identified that increases the risk of suicide and they include:

  • Major childhood adverse events, for example, sexual abuse.
  • Discriminated for being gay, lesbian, transgender or bisexual.
  • Having access to lethal means.
  • A long history of being bullied.
  • Chronic sleep problems.

In Males and Older Individuals

  • Loss of job or unemployment.
  • Low income.
  • Neurosis.
  • Social isolation.
  • Spousal loss, bereavement.
  • Affective disease.
  • Functional impairment.
  • Physical illness.

Military Personnel

  • Traumatic brain injury.
  • PTSD.
  • Other mental health issues.

The most important thing to understand is that having just one risk factor has very limited predictive value. Millions of Americans have one of these factors at any one point in time, but very few attempt suicide and even fewer die as a result. One has to look at the entire clinical picture to increase the predictive values of these risk factors.

Function

Which type of mental health disorder is associated with an increased risk of suicide?

Accumulated data reveal that many types of mental health disorders have been associated with an increased risk of suicide and they include the following:

  • Major depression.
  • Schizophrenia.
  • Substance abuse.
  • Alcoholism.
  • Post-traumatic stress disorder.
  • Bipolar disorder.
  • Personality disorders.
  • Emotional stress.
  • Medications and Suicides.

You can read further @ https://www.ncbi.nlm.nih.gov/books/NBK531453/.

Reference

O’Rourke, M.C., Jamil, R.T. & Siddiqui, W. (2020) Suicide Screening and Prevention. Treasure Islan, Florida: StatPearls Publishing.

Can a Novel Algorithmic Approach Operationalise the Management of Depression & Anxiety for Primary Care?

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Research Paper Title

Effects of Brief Depression and Anxiety Management Training on a US Army Division’s Primary Care Providers.

Background

There is a nation-wide gap between the prevalence of mental illness and the availability of psychiatrists. This places reliance on primary care providers (PCPs) to help meet some of these mental health needs.

Similarly, the US Army expects its PCPs to be able to manage common mental illnesses such as anxiety and depression. Therefore, PCPs must be able to close their psychiatric skills gaps via lifelong learning.

Methods

Following needs assessment of PCPs in a US Army division, the curriculum was developed. Objectives targeted pharmacological management of depression and anxiety. Behavioural intervention skills were also taught to treat insomnia.

Didactics and case-based small groups were used. A novel psychotropic decisional tool was developed and provided to learners to assist and influence their future psychiatric practice. Pre-training, immediate post-training, and 6-month assessments were done via survey to evaluate confidence and perceived changes in practice.

The curriculum was executed as a quality improvement project using the Plan, Do, Study, Act framework.

Results

Among 35 learners, immediate confidence in selecting optimal psychotropic and perceived knowledge, skill to change the dose or type of medication, and confidence in prescribing behavioural sleep improved significantly with large effect sizes.

At 6-month follow-up, learners reported that they were more likely to adjust medications for anxiety or depression and were more likely to start a new medication for anxiety or depression because of the training with moderate effect sizes. Use and satisfaction with the psychotropic decisional tool are also reported.

Conclusions

The psychotropic decisional tool illustrates a novel algorithmic approach for operationalising the management of depression and anxiety.

Similar approaches can improve the skills of a variety of PCPs in the management of psychiatric disorders.

Further studies in the military operational setting are needed to assess the effects of similar educational interventions on access to behavioural health care, suicidal behaviours, and unit medical readiness.

Reference

Amin, R. & Thomas, M.A. (2020) Effects of Brief Depression and Anxiety Management Training on a US Army Division’s Primary Care Providers. Military Medicine. doi: 10.1093/milmed/usz443. Online ahead of print.

Foster Care, Mental Health, & Primary Care Visits

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Research Paper Title

A Comparison Study of Primary Care Utilization and Mental Health Disorder Diagnoses Among Children In and Out of Foster Care on Medicaid.

Background

The purpose of this study was to compare the utilisation of primary care services and presence of mental health disorder diagnoses among children in foster care to children on Medicaid not in foster care in a large health system.

Methods

The data for this study were analysed from a clinical database of a multi-practice paediatric health system in Houston, Texas.

The sample included more than 95 000 children covered by Medicaid who had at least one primary care visit during the 2-year study period.

Results and Conclusions

The results of the study demonstrated that children not in foster care had a greater number of primary care visits and the odds of having >3 visits were significantly lower for children in foster care with a mental health disorder diagnosis.

Additionally, more than a quarter of children in foster care had a diagnosis of a mental health disorder, compared with 15% of children not in foster care.

Reference

Keefe, R.J., Van Horne, B.S., Cain, C.M., Budolfson, K., Thompson, R. & Greeley, C.S. (2020) A Comparison Study of Primary Care Utilization and Mental Health Disorder Diagnoses Among Children In and Out of Foster Care on Medicaid. Clinical Pediatrics. 59(3), pp.252-258. doi: 10.1177/0009922819898182. Epub 2020 Jan 3.

The Taluk Mental Health Programme Initiative

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Research Paper Title

Taluk Mental Health Program: The new kid on the block?

Background

This article highlights the platform and framework for the new public mental health initiative, the Taluk Mental Health Programme (TMHP), rolled out by the Government of India, as part of the expansion of the District Mental Health Programme.

In this initial phase, TMHP has been approved for ten taluks of Karnataka state.

In the authors’ collective opinion, few of the initiatives in the country could be considered as foundations for conceptualising the TMHP:

  • Research programmes and projects in the community;
  • Community intervention programmes running in two taluks of Karnataka since the past one and a half decade (Thirthahalli and Turuvekere taluks of Karnataka); and
  • The Primary Care Psychiatry Programme of National Institute of Mental Health and Neurosciences.

The article briefly describes the above initiatives and ends with further suggestions to scale up TMHP.

Reference

Manjunatha, N., Kumar, C.N., Chander, K.R., Sadh, K., Gowda, G.S., Vinay, B., Shashidhara, H.N., Parthasarathy, R., Rao, G.N., Math, S.B. & Thirthalli, J. (2019) Taluk Mental Health Program: The new kid on the block? Indian Journal of Psychiatry. 61(6), pp.635-639. doi: 10.4103/psychiatry.IndianJPsychiatry_343_19.

Children: Foster Care & Mental Health

Published on by Andrew MarshallLeave a comment

Research Paper Title

A Comparison Study of Primary Care Utilisation and Mental Health Disorder Diagnoses Among Children In and Out of Foster Care on Medicaid.

Background

The purpose of this study was to compare the utilisation of primary care services and presence of mental health disorder diagnoses among children in foster care to children on Medicaid not in foster care in a large health system.

Methods

The data for this study were analysed from a clinical database of a multi-practice paediatric health system in Houston, Texas.

The sample included more than 95 000 children covered by Medicaid who had at least one primary care visit during the 2-year study period.

Results & Conclusions

The results of the study demonstrated that children not in foster care had a greater number of primary care visits and the odds of having >3 visits were significantly lower for children in foster care with a mental health disorder diagnosis.

Additionally, more than a quarter of children in foster care had a diagnosis of a mental health disorder, compared with 15% of children not in foster care.

Reference

Keefe, R.J., Van Horne, B.S., Cain, C.M., Budolfson, K., Thompson, R. & Greeley, C.S. (2020) A Comparison Study of Primary Care Utilization and Mental Health Disorder Diagnoses Among Children In and Out of Foster Care on Medicaid. Clinical Pediatrics. doi: 10.1177/0009922819898182. [Epub ahead of print].

Primary Mental Health Integration Requires Considerable Organisational Investments

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Research Paper Title

Time and Organizational Cost for Facilitating Implementation of Primary Care Mental Health Integration.

Background

Integrating mental health services into primary care settings is complex and challenging. Although facilitation strategies have successfully supported implementation of primary care mental health integration and other complex innovations, we know little about the time required or its cost.

The objective of this study was to examine the time and organisational cost of facilitating implementation of primary care mental health integration.

Methods

One expert external facilitator and two internal regional facilitators who helped healthcare system stakeholders, e.g., leaders, managers, clinicians, and non-clinical staff, implement primary care mental health integration at eight clinics.

Implementation facilitation tailored to the needs and resources of the setting and its stakeholders.

The researchers documented facilitators’ and stakeholders’ time and types of activities using a structured spreadsheet collected from facilitators on a weekly basis. We obtained travel costs and salary information. We conducted descriptive analysis of time data and estimated organisational cost.

Results

The external facilitator devoted 263 h (0.09 FTE), including travel, across all 8 clinics over 28 months. Internal facilitator time varied across networks (1792 h versus 1169 h), as well as clinics. Stakeholder participation time was similar across networks (1280.6 versus 1363.4 person hours) but the number of stakeholders varied (133 versus 199 stakeholders).

The organisational cost of providing implementation facilitation also varied across networks ($263,490 versus $258,127). Stakeholder participation accounted for 35% of the cost of facilitation activities in one network and 47% of the cost in the other.

Conclusions

Although facilitation can improve implementation of primary care mental health integration, it requires substantial organisational investments that may vary by site and implementation effort.

Furthermore, the cost of using an external expert to transfer facilitation skills and build capacity for implementation efforts appears to be minimal.

Reference

Ritchie, M.J., Kirchner, J.E., Townsend, J.C. Pitcock. J.A., Dollar, K.M. & Liu, C.F. (2019) Time and Organizational Cost for Facilitating Implementation of Primary Care Mental Health Integration. Journal of General Internal Medicine. doi: 10.1007/s11606-019-05537-y. [Epub ahead of print].