TY - JOUR
T1 - Improving Effective Mental Health Consultation for Rural Older Adults Living With Depression and Pain
T2 - Learning From the Experiences of Rural Primary Care Physicians
AU - Karp, Jordan F.
AU - Hamm, Megane
AU - Cameron, Flordeabril
AU - Lightfoot, Michael
AU - Maher, Robert
AU - Kincman, Joelle
AU - Reynolds, Charlesf
N1 - Funding Information:
Submitted: September 22, 2020; accepted September 29, 2020. Published online: March 18, 2021. Potential conflicts of interest: Dr Karp has received medication supplies for investigator-initiated trials from Pfizer and Indivior within the last 5 years, has received compensation from Otsuka for development and presention of a webinar from Otsuka (disease state, not product focused), and serves as an advisor to NightWare and Aifred Health. Drs Karp and Reynolds receive compensation from American Association for Geriatric Psychiatry for service on the editorial board of The American Journal of Geriatric Psychiatry. Dr Reynolds has received research support from the National Institutes of Health (NIH), the Patient Centered Outcomes Research Institute, the Center for Medicare and Medicaid Services, the American Foundation for Suicide Prevention, the Brain and Behavior Research Foundation, and the Commonwealth of Pennsylvania and Bristol-Meyer Squib and Pfizer have provided pharmaceutical supplies for his NIH-sponsored research. Drs Hamm, Maher, and Kincman; Ms Cameron; and Mr Lightfoot report no conflicts of interest related to the subject of this article. Funding/support: This project was supported by Grant SRG-0-200-17 awarded to Dr Karp from the American Foundation for Suicide Prevention. Role of the sponsor:The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of
Publisher Copyright:
© 2021 Physicians Postgraduate Press, Inc.
PY - 2021
Y1 - 2021
N2 - Objective: Novel approaches are needed to assist rural primary care physicians (PCPs) in caring for older patients living with depression and pain who are at an elevated suicide risk. To refine and improve a model of care (PREDICTOR: Pharmacy Identification and Primary Care Intervention of Older Adults at Risk for Suicide), we conducted qualitative interviews with rural PCPs about (1) caring for seniors with depression, pain, and suicidality and (2) their favored procedures for working with psychiatric consultants and the professional characteristics desired in an effective consultant. Methods: The study utilized a best-practice approach (including double coding) for qualitative interviews with 10 PCPs practicing in rural Pennsylvania. PCPs were interviewed about 3 themes related to caring for older adults with depression, pain, and suicidal ideation and working with psychiatric consultants. The study was conducted from January 2019 to May 2019. Results: Four primary themes emerged from the interviews. (1) Rural PCPs become comfortable managing depression in older adults out of necessity, but desire collaboration on more complex mental health care. (2) Comorbid depression and pain are universally described as related through a vicious cycle in older adults. (3) Rural PCPs experience varying comfort with prescribing opioids for pain management in older patients, but most prefer not to prescribe opioids, and some refuse to do so. (4) PCPs endorsed the PREDICTOR remote consultation model as potentially beneficial to themselves and their older patients, but strongly desired that the consultant work with them as collaborators and for a collegial professional relationship with the mental health specialist. Conclusions: Rural PCPs are comfortable with remote consultation for older patients living with depression but desire collegial relationships with these consultants, supporting a collaborative approach. We describe explicit plans for implementing these findings as we refine PREDICTOR, in efforts to promote PCP practice change.
AB - Objective: Novel approaches are needed to assist rural primary care physicians (PCPs) in caring for older patients living with depression and pain who are at an elevated suicide risk. To refine and improve a model of care (PREDICTOR: Pharmacy Identification and Primary Care Intervention of Older Adults at Risk for Suicide), we conducted qualitative interviews with rural PCPs about (1) caring for seniors with depression, pain, and suicidality and (2) their favored procedures for working with psychiatric consultants and the professional characteristics desired in an effective consultant. Methods: The study utilized a best-practice approach (including double coding) for qualitative interviews with 10 PCPs practicing in rural Pennsylvania. PCPs were interviewed about 3 themes related to caring for older adults with depression, pain, and suicidal ideation and working with psychiatric consultants. The study was conducted from January 2019 to May 2019. Results: Four primary themes emerged from the interviews. (1) Rural PCPs become comfortable managing depression in older adults out of necessity, but desire collaboration on more complex mental health care. (2) Comorbid depression and pain are universally described as related through a vicious cycle in older adults. (3) Rural PCPs experience varying comfort with prescribing opioids for pain management in older patients, but most prefer not to prescribe opioids, and some refuse to do so. (4) PCPs endorsed the PREDICTOR remote consultation model as potentially beneficial to themselves and their older patients, but strongly desired that the consultant work with them as collaborators and for a collegial professional relationship with the mental health specialist. Conclusions: Rural PCPs are comfortable with remote consultation for older patients living with depression but desire collegial relationships with these consultants, supporting a collaborative approach. We describe explicit plans for implementing these findings as we refine PREDICTOR, in efforts to promote PCP practice change.
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U2 - 10.4088/PCC.20m02725
DO - 10.4088/PCC.20m02725
M3 - Article
C2 - 34000175
AN - SCOPUS:85106613976
SN - 1523-5998
VL - 23
JO - The primary care companion for CNS disorders
JF - The primary care companion for CNS disorders
IS - 2
M1 - 20m02725
ER -