Development of NAMASTE (New Anxiety Management Algorithm Standardizing Treatment Experience) and Implementation in Primary Care.

Evidence-based depression treatment in primary care is well established. However, clinicians are less likely to be trained to diagnose and treat anxiety disorder, which is frequently comorbid, poses an independent risk for suicidality, and complicates disease management. The University of North Carolina's Internal Medicine Clinic developed a measurement-guided approach to identifying and treating anxiety disorder using the seven-item Generalized Anxiety Disorder Scale, treatment algorithms, medication charts, case-based training for best practices, onsite behavioral counseling, and psychiatric consultation. NAMASTE (new anxiety management algorithm standardizing treatment experience) offers a treatment approach for primary care and addresses a major unmet need in public health and medical education.

Evaluation of a depression screening and treatment program in primary care for patients with diabetes mellitus: insights and future directions.

PURPOSE: To evaluate a collaborative depression care program by assessing adherence to the program by internal medicine clinic (IMC) staff, and the program's effectiveness in treating depression in patients with diabetes mellitus. We also describe the rate of depression among patients with diabetes in the IMC. DATA SOURCES: Data for this program were obtained from a de-identified disease registry and included 1312 outpatient IMC visits in adult patients with diabetes between March 2011 and September 2011. CONCLUSIONS: Collaborative depression care results in high rates of screening for and identification of depression, high rates of antidepressant utilization, and improved depression scores; however, more focused interventions are needed to improve diabetes outcomes in patients with depression and diabetes. IMPLICATIONS FOR PRACTICE: The results indicate that the multidisciplinary IMC staff can work together with patients to identify and monitor depression within primary care. This study provides valuable information about models of depression care that can be implemented and evaluated in a clinical setting.

Self-care confidence mediates the relationship between perceived social support and self-care maintenance in adults with heart failure.

BACKGROUND: Social support may be associated with heart failure (HF) self-care; however, the mechanisms are not well understood. We examined the association between perceived support and self-care behaviors and whether self-care confidence mediates these relationships. METHODS: Cross-sectional survey of HF patients seen in outpatient clinic settings. Our outcome (HF self-care maintenance and self-care management) and mediator (HF self-care confidence) variables were assessed with the Self-Care of Heart Failure Index. Perceived emotional/informational support was assessed with the Medical Outcomes Study social support survey. We performed regression analyses to examine associations between perceived support and HF self-care behaviors. Mediation analysis was performed according to the Baron and Kenny method. RESULTS: We surveyed 150 HF patients (mean age 61 y; 51% female; 43% black). More emotional/informational support was associated with better self-care maintenance (ß = 0.13; P = .04). More emotional/information support was associated with better self-care management in unadjusted (ß = 0.23; P = .04), but not adjusted (ß = 0.20, P = .10), analysis. Self-care confidence mediates the association between perceived support and self-care maintenance (percent change in ß coefficient was 32%) and management (percent change in ß coefficient was 20%). CONCLUSION: Perceived emotional/informational support is associated with better self-care maintenance and possibly better self-care management. Greater self-care confidence is one mediating mechanism.