Perceptions of mental health screening and referral to treatment in National Dental-Practice Based Research Network practices: A qualitative study.

OBJECTIVES: Dental practices can have additional positive impacts on public health by implementing mental health screening and referral to treatment in dental care workflows. In this study, we examined how dental practices identify and address adult patient mental health concerns, attitudes about implementing mental health screening and referral, and potential barriers and facilitators to treatment. METHODS: We conducted semi-structured focus groups with 17 dentists, 10 dental hygienists, and 5 dental assistants/office staff in the South-Central region of the National Dental Practice-Based Research Network. Transcribed interviews were analyzed using thematic analysis. RESULTS: We identified five main themes from dental practitioners and office staff responses. Practitioners and office staff: (1) discover patient mental health concerns through record review, patient/caregiver disclosure, and patient observation; (2) respond to patients' mental health concerns by making the patient more comfortable, documenting the concern in the patient's chart, and directly addressing the mental health concern; (3) want a systematic process for mental health screening and referral to treatment in their dental office; (4) recognize potential barriers in implementing health screening and referral to treatment processes; (5) desire training on mental health matters. An overarching theme emerged: developing a trusting relationship with patients. CONCLUSIONS: Participants noted the importance of implementing systematic procedures for mental health screening and referral to services into dental practices, while also recognizing the potential barriers for integrating such processes. They also expressed a desire for quality training and resources that can support better care for patients with mental health concerns.

Pursuing Scholarship: Creating Effective Conference Submissions.

Medical educators are expected to disseminate peer-reviewed scholarly work for academic promotion and tenure. However, developing submissions for presentations at national meetings can be confusing and sometimes overwhelming. Awareness and use of some best practices can demystify the process and maximize opportunities for acceptance for a variety of potential submission categories. This article outlines logistical steps and best practices for each stage of the conference submission process that faculty should consider when preparing submissions. These include topic choice, team composition, consideration of different submission types, and strategies for effectively engaging participants.

Mental health screening and referral to treatment in dental practices: A scoping review.

OBJECTIVE: The purpose of this study was to conduct a scoping review to examine and summarize the characteristics of research related to mental health (MH) screenings and/or referrals to treatment in dental practices. METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for Scoping Reviews and searched multiple databases for terms connected with dental care, MH concerns, screening, and referral. Included articles: (1) described care provided in a dental practice, (2) described a situation where the patient is experiencing the potential MH problem, (3) did not involve dental anxiety exclusively, and (4) involved some form of MH screening and/or referral to treatment. Article analysis included a summary of key study characteristics, types of evidence, study design, and central concepts and definitions. RESULTS: The search generated 2050 records, with 26 ultimately included. Most studies involved only adults (22, 85%), but only three (12%) reported on rurality (two urban; one mixed) and only two each (8%) reported race or ethnicity. Fifteen (58%) articles were prospective and 11 (42%) were retrospective. The studies varied widely in study designs, from 11 (42%) cross-sectional methodologies to only one (4%) randomized controlled trial. Thirty-four screening tools were used to screen for symptoms of 43 MH conditions, with depression and anxiety screened for most frequently. Few articles discussed making referrals, practice workflows, or follow-up outcomes. CONCLUSIONS: Included studies provide evidence of viable options for dental practitioners regarding MH screening, referring, and conducting follow-up, but lack specificity regarding these processes. Overall, more research is needed to clarify what workflows are most efficient for dental practitioners and efficacious in identifying patients with MH concerns.

Asynchronous Telemedicine: A Systematic Literature Review.

Background: Asynchronous telemedicine (ATM), which describes telemedical interaction between a patient and provider where neither party communicates simultaneously, is an important telemedicine modality that is seeing increased use. In this article, we summarize the published peer-reviewed literature specifically related to ATM to (1) identify terms or phrases that are used to describe ATM, (2) ascertain how this research has thus far addressed the various aspects of the quadruple aim of medicine, and (3) assess the methodological rigor of research on ATM. We also divided the literature into pre- and post-COVID-19 onset periods to identify potential variations in the literature between these two periods. Methods: This systematic literature review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature search, utilizing multiple databases and applying inclusion and exclusion criteria, initially produced 2624 abstracts for review. De-duplication and screening ultimately yielded 104 articles for data extraction. Results: "Store-and-forward" and variations of "e-visit" were the most frequently used alternative terms for ATM. Care quality was the most frequently addressed aspect of the Quadruple Aim of Medicine-more than double any other category-followed by patient satisfaction. We separated cost of care into two categories: patients' cost of care and providers' cost to provide care. Patient cost of care was the third most addressed aspect of the Quadruple Aim of Medicine followed by provider well-being and provider's cost to provide care. Methodological rigor of the studies was also addressed, with only 2 quantitative studies ranked "Strong," 5 ranked "Moderate," and 97 ranked "Weak." Qualitative studies were generally acceptable but struggled methodologically with accounting for all participants and articulation of results. Conclusions: Although "store-and-forward" is somewhat more frequently used in the studies included in this review, variants of "e-visit," are growing in recent usage. Given the relative newness of modality, it is not surprising that quality of care is the most researched aspect of the Quadruple Aim of Medicine in ATM research. We anticipate more balance between these areas as research in this field matures. Primary areas of research need currently relate to practitioners-specifically their costs of providing care and well-being. Finally, future ATM research needs to address research challenges of selection bias and blinding in quantitative studies and improved participant tracking and articulation of both study design and results in qualitative studies.

Adolescent Depression and Anxiety Treatment in Rural Schools: A Systematic Review.

Depression and anxiety are the most common mental illnesses in adolescents. Rural schools are well-positioned to narrow the access gap confronting rural adolescents experiencing depression and anxiety; however, there is a paucity of research on the treatment of depression and anxiety in rural high schools. This critical review summarized the state of the field on rural school-based interventions to reduce adolescent depression and anxiety. Literature searches were conducted using PubMed, PsychINFO, EMBASE, ERIC, and CINAHL databases. Inclusion criteria identified peer-reviewed articles evaluating rural high-school based interventions for the treatment of depression and/or anxiety. Of the 322 articles screened, 82 articles were reviewed, with four articles satisfying inclusion criteria. All studies examined a group- or classroom-based program to reduce depression. Three studies reported either significant pre- to post-intervention improvements or clinical change in depressive symptoms or coping skills; one study found null effects. While promising, there is an on-going need for additional rigorous investigations on rural high-school based interventions for the treatment of depression and anxiety among teens.

Psychiatric Comorbidity and Associated Professional Mental Health Utilization among Students in Recovery from Addiction in Southern Collegiate Recovery Communities.

OBJECTIVES: This pilot study explores the additional psychiatric problems and their associated professional mental health utilization by students in recovery from addiction in collegiate recovery communities (CRCs) across the US South. The article has three goals: introduce CRCs to a broad medical audience; identify coexisting psychiatric concerns among students in CRC programs; and determine these students' type, rate, and location of professional mental health services. METHODS: During the 2014-2015 academic year, this study recruited participants through e-mail to all known CRC directors, who had the option of forwarding a survey link to its participants. RESULTS: Fourteen percent of students in 13 known southern CRCs completed the survey. Seventy-four percent of them reported at least one coexisting psychiatric issue. The most common issue was depression, followed by anxiety. Other reported disorders included attention-deficit/hyperactivity disorder, eating disorder, bipolar disorder, posttraumatic stress disorder, psychotic disorder, and obsessive-compulsive disorder. Most of the students in southern CRCs worked with psychiatrists and other therapists off-campus on their psychiatric problems. CONCLUSIONS: This pilot study suggests that a significant number of students in southern CRCs have additional psychiatric problems that require professional mental health services.

Telemedical Asthma Education and Health Care Outcomes for School-Age Children: A Systematic Review.

BACKGROUND: Telemedicine in a school-based setting involving partnerships between a child with asthma and health care provider can provide patients and caregivers with opportunities to better manage chronic conditions, communicate among partners, and collaborate for solutions in convenient locations. OBJECTIVE: This systematic review examined outcomes for school-age children with asthma involving asthma-based telemedical education. METHODS: Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we searched 4 databases with terms related to asthma, education, and pediatrics. Included articles involved a school-based setting, children and adolescents, a telemedical mechanism for training, empirical study designs, and peer review. We extracted data regarding (a) participant background, (b) research methods and purpose, and (c) outcomes. RESULTS: A total of 408 articles were identified. Five met inclusion criteria. Three studies were randomized and 2 were cohort studies. In addition to clinical and educational outcomes, studies reported on satisfaction, self-management, asthma knowledge gain, and quality of life (QOL). We found support for caregiver/parent QOL and participant self-management behaviors. We also found mixed results for participant QOL. Clinical outcomes showed mixed support regarding airway inflammation improvement, medication use improvement, improvements in symptom burden and symptom-free days, and spirometry improvements. CONCLUSIONS: Results of real-time telemedically delivered asthma education to improve QOL, enhance symptom management ability, and reduce symptom burden were positive or nonsignificant. No study indicated negative effects due to telemedicine. Limited results indicate that patient education can, under certain circumstances, positively influence asthma burden. Further validation of intervention methods and tools as well as outcome measurement consistency is recommended.

Evaluation of the triple aim of medicine in prehospital telemedicine: A systematic literature review.

OBJECTIVES: With telemedicine becoming more widely implemented in emergency situations, understanding the quality and content of current findings that explore prehospital telemedicine is vital to establish best practices and guide future research. This systematic review examines the clinical importance of telemedicine in patient-provider ambulance-based settings with a focus on multifunctional systems for general prehospital emergency populations. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology we found 1564 abstracts, which were blind-reviewed by independent reviewers. Relevant articles were reviewed, classified, and analyzed according to research methods and technology type, as well as quality, cost, and satisfaction. The studies were also reviewed for validated evidence-based practice. RESULTS: Those studies that looked at cost, quality, and satisfaction with care generally shared favorable results. Setup notwithstanding, cost was comparable or less than controls. Care quality was also found to be in line with or slightly preferable to face-to-face care with some advantages in response time and quality. Patients and providers were satisfied with the systems. Common obstacles included limited bandwidth and small sample sizes. CONCLUSIONS: Although feasibility remains salient, research regarding the impact of ambulance-based telemedicine on patients and healthcare providers is encouraging, but nascent. As a whole, this body of literature does not yet adequately speak to the most important concerns of medicine: quality, cost, and satisfaction. More research is needed in each of these areas. However, those studies that do address these matters share hopeful results. Future research should test these mechanisms in prehospital settings with greater rigor.

Videoconferencing Psychotherapy and Depression: A Systematic Review.

Introduction:Depression is the leading cause of disability in the world. Despite the prevalence of depression, a small proportion of individuals seek mental health services. A cost-effective method for increasing access to mental health services is the implementation of telemental-health programs. This review aims to summarize the state of the field on the efficacy and effectiveness of videoconferencing psychotherapy (VCP) for the treatment of depression.Materials and Methods:Systematic literature searches were performed using PsychINFO, PubMed, and EMBASE. Specific inclusion criteria were used to identify controlled and uncontrolled studies evaluating VCP for the treatment of depression. Data extraction included study assessment quality, research design, sample size, intervention details, outcome results, intervention effect size, and statistical differences between VCP and in-person (IP) therapy.Results:Of the 1,424 abstracts screened, 92 articles were critically reviewed. Thirty-three articles were included in the review, with 14 randomized controlled studies, 4 controlled nonrandomized studies, and 15 uncontrolled studies. Sample size ranged from 1 to 243 participants. Twenty-one studies reported statistically significant reductions in depressive symptoms following VCP, and the median effect size for studies ranged from medium to the very large range. Most controlled studies reported no statistical differences between VCP and IP groups receiving the same intervention.Conclusions:VCP for the treatment of depression is a promising method for delivering mental health services. More rigorous research is needed to evaluate VCP on depression in various contexts and participants.

Videoconferencing psychological therapy and anxiety: a systematic review.

Background: The growing worldwide prevalence of individuals with anxiety disorders has increased needs for mental health services. Due to limited number of mental health providers and community resources, especially in low-income countries, individuals often seek services from primary care settings. Through collaborative care models, services via telemedicine address the mental health provider shortage. While previous reviews show telemedicine effectively treats mental illness, a gap exists for reviews on videoconferencing psychological therapy for anxiety treatment. Objective: This systematic review aims to summarize videoconferencing psychological therapy for anxiety disorder treatment. Methods: Database searches were performed with PubMed, PsychINFO and Embase. Inclusion criteria identified controlled and uncontrolled studies evaluating videoconferencing psychological therapy. Studies were appraised using the Effective Public Health Practice Project Quality Assessment tool. Data collected included research design, sample size, intervention details, outcome results, intervention effect size and differences between videoconferencing psychological therapy and face-to-face therapy. Results: The search revealed 1253 articles, with 21 meeting inclusion criteria. Sample sizes ranged from 1 to 121 participants; cognitive-behavioral therapy was most commonly evaluated. Participants' diagnoses included panic disorder with and without agoraphobia, generalized anxiety disorder, social anxiety disorder, social phobia and hypochondriasis. Three studies occurred in outpatient health care settings. Fourteen studies reported statistically significant improvement on anxiety measures; 11 reported clinically significant improvements. Effect sizes ranged from small to very large, and all controlled studies found no differences between videoconferencing and face-to face groups. Conclusion: Results provide promise for evidence-based interventions delivered via videoconferencing psychological therapy. More rigorous research is needed in various settings and populations.