Patient Preferences for Patient Portal-Based Telepsychiatry in a Safety Net Hospital Setting During COVID-19: Cross-sectional Study.

BACKGROUND: Patient portals are a safe and secure way for patients to connect with providers for video-based telepsychiatry and help to overcome the financial and logistical barriers associated with face-to-face mental health care. Due to the COVID-19 pandemic, telepsychiatry has become increasingly important to obtaining mental health care. However, financial and technological barriers, termed the "digital divide," prevent some patients from accessing the technology needed to use telepsychiatry services. OBJECTIVE: As an extension to a clinic's outreach project during COVID-19 to improve patient engagement with video-based visits through the hospital's patient portal among adult behavioral health patients at an urban safety net hospital, we aim to assess patient preference for patient portal-based video visits or telephone-only visits and to identify the demographic variables associated with their preference. METHODS: Patients in an outpatient psychiatry clinic were contacted by phone, and preference for telepsychiatry by phone or video through a patient portal, as well as device preference for video-based visits, were documented. Patient demographic characteristics were collected from the electronic medical record. RESULTS: A total of 128 patients were reached by phone. A total of 79 (61.7%) patients chose video-based visits, and 69.6% (n=55) of these patients preferred to access the patient portal through a smartphone. Older patients were significantly less likely to agree to video-based visits. CONCLUSIONS: Among behavioral health patients at a safety net hospital, there was relatively low engagement with video-based visits through the hospital's patient portal, particularly among older adults.

The association between hope and mortality in homebound elders.

OBJECTIVE: Despite high rates of mortality and depression, there is limited knowledge of how depressive symptoms, especially feeling of hopefulness, affect mortality in the homebound elderly. METHODS: We conducted a secondary analysis of data from a community sample of 1034 adults, age 60 years and older. The Center for Epidemiologic Studies Depression Scale was used to evaluate the mood symptoms and feeling of hopefulness at baseline. The death data were collected within an 8-year follow-up period. Analysis of variance and Chi-square were used to compare the clinical conditions among the groups of individuals who feel hopeful always, sometimes, and rarely. Logistic regression was used to explore the association between the hopefulness about the future and mortality as an outcome. RESULTS: In the 8-year follow-up period, frequency of feeling hopeful, but not other individual depressive symptoms, was associated with mortality rate. The mortality rate among those who always, sometimes, and rarely felt hopeful were 21.6%, 26.4%, and 35.7%, respectively (P = 0.002). Logistic regression also confirmed that individuals who rarely feel hopeful had higher odds of decease within the 8-year follow-up period than those who always felt hopeful (OR = 1.74, CI = 1.14-2.65) after adjusting for age and medical conditions. CONCLUSIONS: Baseline hopefulness predicts mortality outcome among the homebound elderly in the community. Identifying individuals who are depressed with hopelessness in the elderly and providing early intervention may improve the mortality rate. Copyright © 2017 John Wiley & Sons, Ltd.

Development of a scale to measure quality of visits with relatives with dementia.

OBJECTIVES: The purpose of this study was to develop a Family Visit Scale for Dementia (FAVS-D) measuring the quality of visits between nursing home residents with dementia and their family members. DESIGN: Scale development using a two step process based on survey data. SETTING: One Veterans Administration and eleven community nursing homes. PARTICIPANTS: One hundred and fifteen family members visiting residents with dementia. MEASUREMENTS: Responses to a preliminary scale of 41 items, developed from a qualitative study, and responses to a 15 item scale, generated from the preliminary scale by eliminating items that were answered "does not apply" by a significant number of family members and by sequential iterations that removed items with low or high item total correlations or with high item-item correlations. Questionnaires were anonymously completed by family members after visit with a relative with dementia. RESULTS: Final FAVS-D has 14 item after eliminating 1 question that family members considered confusing. The mean score of FAVS-D was 18.7 + 6.6 (mean + SD) with a range of -10 to 28. After leaving out one outlier value, the distribution of FAVS-D score was not different from normal distribution. Reliability coefficient alpha for FAVS-D was 0.77. The factor analysis produced 4 factors: factor 1 (7 items, ? = .82) related to nursing staff interaction with residents and visitors, factor 2 (4 items, ? = .73) related to meaningfulness of the visit, factor 3 (2 items, ? = .85) related to cleanliness and factor 4 (1 item) related to the connection established between the visitor and the resident. There was a significant difference between total FAVS-D scores of two facilities that provided most of the questionnaires. Subscores for nursing staff and meaningfulness factors in these two facilities were also significantly different, while subscores for cleanliness and connection were similar. CONCLUSIONS: This study indicates that it is possible to measure family visit satisfaction. The most important factors of FAVS-D, are factor 1 related to nursing staff activity and explaining 25% of variance, and factor 2 related to meaningfulness of the visit and explaining 16% of variance. When the facility staff becomes more involved with families of their residents and helps them make visit more meaningful, the families feel more satisfied with the visits.

The effects of levetiracetam on alcohol consumption in alcohol-dependent subjects: an open label study.

The aim of this open-label pilot study was to assess the efficacy and safety of the novel anticonvulsant agent, levetiracetam, for the treatment of alcohol dependence. A maximal dose of 2000 mg was administered daily for 10 weeks to alcohol dependent subjects (n = 20). Mean reported ethanol intake declined significantly from 5.3 to 1.7 standard drinks per day. Levetiracetam was well tolerated by most subjects.

Family member perception of quality of their visits with relatives with dementia: a pilot study.

OBJECTIVE: The purpose of the investigation was to identify factors influencing quality of visits with institutionalized patients suffering from dementia. STUDY DESIGN: Two focus groups of family members of patients residing on a Dementia Special Care Unit. SETTING: Dementia Special Care Unit in a Veterans Administration Hospital. PARTICIPANTS: Spouses and adult children of institutionalized patients with dementia. INTERVENTION: During the focus group the family members were asked to identify factors that contribute to the quality of their visits with loved ones suffering from dementia. The group sessions were recorded and transcribed verbatim. Data obtained during the sessions were analyzed and specific factors affecting the visiting experience were identified. RESULTS: Numerous factors affecting the visiting experience were identified and were grouped into personal, interpersonal, and environmental domains. CONCLUSIONS: The presence of visitors in the long-term care setting is very important. Visiting provides a link with the families and communities, and promotes the quality of life for patients with dementia. Satisfying experience during the visits helps the families to enjoy the interaction and promotes their involvement with their institutionalized relatives. Health care providers should make efforts to improve the quality of visits.

Psychiatric emergencies in the elderly population.

This article reviews the most common behavioral emergencies in the geriatric population. Psychiatric emergencies are seen frequently by emergency physicians who face the challenge of assessing and managing patients presenting with psychosis, severe depression, agitation, suicidal intent, and substance abuse in the emergency department. The evaluation is frequently complicated by the necessity to investigate numerous domains such as underlying medical conditions, prior psychiatric disorders and substance abuse, as well as psychosocial factors. It is crucial to rule out organic causes for what appears to be psychiatric disease in the elderly. The assessment might be further complicated by the patient's limited ability to recall pertinent aspects of the history due to either cognitive impairment or acute distress. Emergency department personnel might have inadequate expertise in assessing emergencies in elderly persons, further impeding the ability to appropriately manage behavioral complications in geriatric patients. Availability of high-quality emergency care and tight collaboration with primary care providers, psychiatric consultants, and social services is crucial to optimal outcomes from acute psychiatric decompensations in the elderly.

Outcome predictors in substance use disorders.

Given the heterogeneous nature of substance abuse, it is notable that several predictors of response are independent of the primary drug of abuse or the treatment setting [208]. Although the strength of the relationship of predictor to outcome varies, the following factors have been identified consistently: severity of dependence or withdrawal; psychiatric comorbidity; substance-related problems; motivation (abstinence commitment); length of treatment; negative affective states; cognitive factors; personality traits and disorders; coping skills; multiple substance abuse; contingency contracting or coercion; genetic factors; sleep architecture; urges and craving; self-efficacy; and economic and social factors. Although it is well known that severity of dependence (including polysubstance abuse), serious psychiatric comorbidity, and social problems are associated with poor treatment response, only recently has research examined the efficacy of intervention strategies that specifically address these problems. Adequate treatment of psychiatric comorbidity and improvement in social, economic, and family functioning lead to better treatment outcomes. The development of specific techniques to enhance self-efficacy, motivation, coping skills, and functioning in the community are concrete examples of how the identification of factors associated with positive outcomes has led to the development of new treatments. Despite significant accomplishments, the field is left with many unanswered questions. Although several biologic markers, such as neuroendocrine response and sleep architecture, show promise as outcome predictors, it is not known whether these are critical factors in the initiation of substance use or its progression to dependence. Determining whether biologic markers are epiphenomena reflecting the amount and duration of substance abuse or are fundamental to the pathophysiology of dependence is a matter of urgent concern. With some exceptions, identification of biologic predictors has not led to innovative therapies. One of these exceptions is the development of naltrexone for the treatment of alcoholism, which was based in a solid theoretical rationale and followed by hypothesis-driven experiments. Similar opportunities should emerge from current basic science and clinical research. The application of pharmacogenetic techniques to the field of addiction also holds great promise. As future studies are undertaken, researchers and clinicians must be mindful that differences in outcome predictors across drugs of abuse and treatments may emerge as subgroups of individuals with addictive disorders and new therapies are identified. There is already evidence that early onset alcoholism is associated with poor response under some circumstances, yet may be a predictor of response to targeted pharmacotherapy with ondansetron [64, 112]. As the ability to subtype disorders based on meaningful biologic differences grows, it is anticipated that several relevant outcome predictors that are specific for pharmacotherapy will emerge.