FMP Presentations at AMP 2022
“Integration of Family Medicine and Behavioral Health at the Chanda Center for Health, an integrative Clinic fo People with Spinal Cord INjuries”
In this study, Dr. Daoud and her colleagues found that an integrated model for care for those with unique medical and mental health needs can lead to decreased ED visits and hospitalizations, improved quality of life, and a positive impact on perceived quality of care among patients with spinal cord injuries.
“History Repeats Itself: Delayed Treatment in Autoimmune Encephalitis”
Autoimmune encephalitis presents a diagnostic challenge and is often mistaken for primary psychiatric illness. Clinical warning signs that differentiate autoimmune encephalitis from primary psychosis include rapidly progressive psychotic symptoms despite psychiatric medications, impaired consciousness and memory, speech dysfunction, neurologic deficits, and catatonia. Anti-glutamic acid decarboxylase-65 (anti-GAD65) autoimmune encephalitis is especially rare, and is often associated with dramatic, rapid response to immunomodulatory therapy. GAD65 autoimmune encephalitis is associated with other autoimmune diseases, including multiple sclerosis and sarcoidosis as in this patient. This case highlights an important area where psychiatry and medicine converge, and failure to consider medical causes of psychosis and mania may lead to inappropriate treatment and delay in diagnosis.
Complete patient presentation available here.
“Factors Associated with Antipsychotic Dosing in Inpatient Psychiatric Patients: A Retrospective Chart Review”
Current clinical and pharmacological prescribing recommendations suggest antipsychotic (AP) medications be titrated to the lowest possible effective dose, to limit acute or long-term side effect burden. Despite these guidelines, high-dose antipsychotic prescribing is a common practice during psychiatric admissions despite lack of evidence demonstrating benefit of this practice. In this study, Dr. Smith and colleagues examined reviewed the records of patients admitted to the UC Health inpatient psychiatric unit, and found that the greatest predictors of high dose antipsychotic prescribing was having a high dose on admission longer lengths of stay were more likely to be discharged on high-dose antipsychotics. These represent opportunities for improving outpatient management of SMI, increasing awareness of the dangers of high-dose antipsychotic use, and implementing improved transition of care after discharge.
Draft paper available here.
“Proactive Addiction Consultation for Hospitalized Patients with Opioid Use Disorder”
Introduction: The prevalence of patients with opioid use disorder (OUD) in hospital settings and mortality rates of individuals with OUD has increased over the past two decades.1-2 In the inpatient medical setting, addiction consultation services help facilitate care for individuals with OUD including pharmacotherapy for withdrawal, pain management, and reduction of stigma.3-4 Proactive psychiatric consultation has been shown to reduce length of stay and reduce hospital costs for patients with psychiatric issues.5-7 The purpose of this study was to pilot a proactive addiction consults model specifically for OUD to evaluate feasibility of implementation in an academic health center setting and impact on health services outcomes for this vulnerable patient population.
Methods: The proactive addiction consults model involved the identification of patients with OUD by diagnosis code through a daily report of admissions generated from our academic health center’s electronic health record (EHR). Identified patients with OUD-related diagnosis codes were randomized into either a control or intervention group. The study team then contacted the admitting teams for patients in the intervention group to suggest a proactive addictions consult, and if in agreement, the consult was conducted. The primary endpoint for the study included feasibility of the model as defined by successful completion of 40 proactive consults completed over a nine-month period (averaging one proactive consultation per week). Secondary endpoints for the study included the proportion of completed addictions consults between groups, average length of time from admission to completion of consult, rates of discharge against medical advice, and subsequent average number of emergency room visits and hospitalizations within 90 days of discharge. Enrollment was conducted between August 2021 and May 2022.
Results: A total of 221 subjects were enrolled, with 84 subjects in the intervention arm and 137 in the control arm. Preliminary data demonstrates that amongst the intervention group, 46 proactive addiction consultations were completed over a nine-month period, meeting the feasibility goal threshold for the study. At this time, data analysis for secondary endpoints is still pending but preliminary results will be available at the time of presentation.
Discussion: Preliminary data from this pilot study in an academic health center demonstrates feasibility of a proactive addictions consultation model as defined by completion of at least one proactive consultation per week. Conclusions on secondary endpoints and outcomes are still pending. Limitations of this pilot study include a limited timeframe to assess longer-term sustainability and inability to blind study groups. Future directions of research include collection of data on cost-effectiveness of the model, the model’s impact on specific health outcomes, and fidelity of replication of the model in other healthcare settings.
“Implementation of a Virtual Project ECHO Educational Model on Mental Health for Providers in Rural Guatemala”
Dr. Cockroft and his colleagues took note of the high burden of disability due to depression and mental illness in Guatemala, which is worsened by limited funding and training. This care gap disproportionately affects rural and indigenous communities. The goal of this project was to assess a Project ECHO® curriculum about mental health for students and primary care providers serving rural and indigenous communities to help address these health needs. This curriculum, in 5 sessions from April to May 2021, included short didactic presentation and case-based presentations and discussions. The researchers found that participants had improved self-efficacy for the topics that were addressed and the curriculum was feasible, acceptable, and appropriate for all participants.
