Treatment recommendations made by a consultant psychiatrist to improve the quality of care in a collaborative mental health intervention in rural Nepal
Abstract Background The Collaborative Care Model (CoCM) for mental healthcare, where a consulting psychiatrist supports primary care and behavioral health workers, has the potential to address the large unmet burden of mental illness worldwide. A core component of this model is that the psychiatrist...
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| Format: | Article |
| Language: | English |
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BMC
2020-02-01
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| Series: | BMC Psychiatry |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12888-020-2464-1 |
| _version_ | 1818611608808587264 |
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| author | Pragya Rimal Duncan Maru Lydia Chwastiak Pawan Agrawal Deepa Rao Sikhar Swar David Citrin Bibhav Acharya |
| author_facet | Pragya Rimal Duncan Maru Lydia Chwastiak Pawan Agrawal Deepa Rao Sikhar Swar David Citrin Bibhav Acharya |
| author_sort | Pragya Rimal |
| collection | DOAJ |
| description | Abstract Background The Collaborative Care Model (CoCM) for mental healthcare, where a consulting psychiatrist supports primary care and behavioral health workers, has the potential to address the large unmet burden of mental illness worldwide. A core component of this model is that the psychiatrist reviews treatment plans for a panel of patients and provides specific clinical recommendations to improve the quality of care. Very few studies have reported data on such recommendations. This study reviews and classifies the recommendations made by consulting psychiatrists in a rural primary care clinic in Nepal. Methods A chart review was conducted for all patients whose cases were reviewed by the treatment team from January to June 2017, after CoCM had been operational for 6 months. Free text of the recommendations were extracted and two coders analyzed the data using an inductive approach to group and categorize recommendations until the coders achieved consensus. Cumulative frequency of the recommendations are tabulated and discussed in the context of an adapted CoCM in rural Nepal. Results The clinical team discussed 1174 patient encounters (1162 unique patients) during panel reviews throughout the study period. The consultant psychiatrist made 214 recommendations for 192 (16%) patients. The most common recommendations were to revisit the primary mental health diagnosis (16%, n = 34), add or increase focus on counselling and psychosocial support (9%, n = 20), increase the antidepressant dose (9%, n = 20), and discontinue inappropriate medications (6%, n = 12). Conclusions In this CoCM study, the majority of treatment plans did not require significant change. The recommendations highlight the challenge that non-specialists face in making an accurate mental health diagnosis, the relative neglect of non-pharmacological interventions, and the risk of inappropriate medications. These results can inform interventions to better support non-specialists in rural areas |
| first_indexed | 2024-12-16T15:33:02Z |
| format | Article |
| id | doaj.art-63b4fee1f44f4fc39da23fb360dd00cd |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-12-16T15:33:02Z |
| publishDate | 2020-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-63b4fee1f44f4fc39da23fb360dd00cd2022-12-21T22:26:17ZengBMCBMC Psychiatry1471-244X2020-02-012011610.1186/s12888-020-2464-1Treatment recommendations made by a consultant psychiatrist to improve the quality of care in a collaborative mental health intervention in rural NepalPragya Rimal0Duncan Maru1Lydia Chwastiak2Pawan Agrawal3Deepa Rao4Sikhar Swar5David Citrin6Bibhav Acharya7Nyaya Health NepalNyaya Health NepalDepartment of Psychiatry & Behavioral Sciences, University of WashingtonNyaya Health NepalDepartment of Global Health, University of WashingtonNyaya Health NepalNyaya Health NepalNyaya Health NepalAbstract Background The Collaborative Care Model (CoCM) for mental healthcare, where a consulting psychiatrist supports primary care and behavioral health workers, has the potential to address the large unmet burden of mental illness worldwide. A core component of this model is that the psychiatrist reviews treatment plans for a panel of patients and provides specific clinical recommendations to improve the quality of care. Very few studies have reported data on such recommendations. This study reviews and classifies the recommendations made by consulting psychiatrists in a rural primary care clinic in Nepal. Methods A chart review was conducted for all patients whose cases were reviewed by the treatment team from January to June 2017, after CoCM had been operational for 6 months. Free text of the recommendations were extracted and two coders analyzed the data using an inductive approach to group and categorize recommendations until the coders achieved consensus. Cumulative frequency of the recommendations are tabulated and discussed in the context of an adapted CoCM in rural Nepal. Results The clinical team discussed 1174 patient encounters (1162 unique patients) during panel reviews throughout the study period. The consultant psychiatrist made 214 recommendations for 192 (16%) patients. The most common recommendations were to revisit the primary mental health diagnosis (16%, n = 34), add or increase focus on counselling and psychosocial support (9%, n = 20), increase the antidepressant dose (9%, n = 20), and discontinue inappropriate medications (6%, n = 12). Conclusions In this CoCM study, the majority of treatment plans did not require significant change. The recommendations highlight the challenge that non-specialists face in making an accurate mental health diagnosis, the relative neglect of non-pharmacological interventions, and the risk of inappropriate medications. These results can inform interventions to better support non-specialists in rural areashttps://doi.org/10.1186/s12888-020-2464-1Mental healthLMICGlobal mental health, Nepal |
| spellingShingle | Pragya Rimal Duncan Maru Lydia Chwastiak Pawan Agrawal Deepa Rao Sikhar Swar David Citrin Bibhav Acharya Treatment recommendations made by a consultant psychiatrist to improve the quality of care in a collaborative mental health intervention in rural Nepal BMC Psychiatry Mental health LMIC Global mental health, Nepal |
| title | Treatment recommendations made by a consultant psychiatrist to improve the quality of care in a collaborative mental health intervention in rural Nepal |
| title_full | Treatment recommendations made by a consultant psychiatrist to improve the quality of care in a collaborative mental health intervention in rural Nepal |
| title_fullStr | Treatment recommendations made by a consultant psychiatrist to improve the quality of care in a collaborative mental health intervention in rural Nepal |
| title_full_unstemmed | Treatment recommendations made by a consultant psychiatrist to improve the quality of care in a collaborative mental health intervention in rural Nepal |
| title_short | Treatment recommendations made by a consultant psychiatrist to improve the quality of care in a collaborative mental health intervention in rural Nepal |
| title_sort | treatment recommendations made by a consultant psychiatrist to improve the quality of care in a collaborative mental health intervention in rural nepal |
| topic | Mental health LMIC Global mental health, Nepal |
| url | https://doi.org/10.1186/s12888-020-2464-1 |
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