Ian M. Bennett

Creation and evaluation of a fidelity measure of collaborative care for maternal depression in Federally Qualified Health Centers

A fidelity measure based on a theoretical framework and constructed from existing clinical data was predictive of clinical outcomes. Additional work is needed to determine if these measures are useful for monitoring implementation success of the collaborative care model.

Interconception Care for Mothers During Well-Child Visits With Family Physicians: An IMPLICIT Network Study

PURPOSE Interconception care (ICC) is recommended to improve birth outcomes by targeting maternal risk factors, but little is known about its implementation. We evaluated the frequency and nature of ICC delivered to mothers at well-child visits and maternal receptivity to these practices. METHODS We surveyed a convenience sample of mothers accompanying their child to well-child visits at family medicine academic practices in the IMPLICIT (Interventions to Minimize Preterm and Low Birth Weight Infants Through Continuous Improvement Techniques) Network. Health history, behaviors, and the frequency of the child’s physician addressing maternal depression, tobacco use, family planning, and folic acid supplementation were assessed, along with maternal receptivity to advice. RESULTS Three-quarters of the 658 respondents shared a medical home with their child. Overall, 17% of respondents reported a previous preterm birth, 19% reported a history of depression, 25% were smoking, 26% were not using contraception, and 58% were not taking folic acid. Regarding advice, 80% of mothers who smoked were counseled to quit, 59% reported depression screening, 71% discussed contraception, and 44% discussed folic acid. Screening for depression and family planning was more likely when the mother and child shared a medical home (P <.05). Most mothers, nearly 95%, were willing to accept health advice from their child’s physician regardless of whether a medical home was shared (P >.05). CONCLUSIONS Family physicians provide key elements of ICC at well-child visits, and mothers are highly receptive to advice from their child’s physician even if they receive primary care elsewhere. Routine integration of ICC at these visits may provide an opportunity to reduce maternal risk factors for adverse subsequent birth outcomes.

Movement patterns in women at risk for perinatal depression: use of a mood-monitoring mobile application in pregnancy

Objectives To examine, using a smartphone application, whether mood is related to daily movement patterns in pregnant women at risk for perinatal depression. Materials and Methods Thirty-six women with elevated depression symptoms (PHQ-9 ≥ 5) in pregnancy used the application for 8 weeks. Mood was reported using application-administered surveys daily (2 questions) and weekly (PHQ-9 and GAD-7). The application measured daily mobility (distance travelled on foot) and travel radius. Generalized linear mixed-effects regression models estimated the association between mood and movement. Results Women with milder depression symptoms had a larger daily radius of travel (2.7 miles) than women with more severe symptoms (1.9 miles), P  = .04. There was no difference in mobility. A worsening of mood from the prior day was associated with a contracted radius of travel, as was being in the group with more severe symptoms. No significant relationships were found between anxiety and either mobility or radius. Discussion We found that the association of mood with radius of travel was more pronounced than its association with mobility. Our study also demonstrated that a change in mood from the prior day was significantly associated with radius but not mood on the same day that mobility and radius were measured. Conclusion This study lays the groundwork for future research on how smartphone mood-monitoring applications can combine actively and passively collected data to better understand the relationship between the symptoms of perinatal depression and physical activity that could lead to improved monitoring and novel interventions.

Implementation of evidence-based practices for complex mood disorders in primary care safety net clinics.

Introduction: Use quality improvement methods to implement evidence-based practices for bipolar depression and treatment-resistant depression in 6 Federally Qualified Health Centers. Method: Following qualitative needs assessments, implementation teams comprised of front-line providers, patients, and content experts identified, adapted, and adopted evidence-based practices. With external facilitation, onsite clinical champions led the deployment of the evidence-based practices. Evaluation data were collected from 104 patients with probable bipolar disorder or treatment-resistant depression via chart review and an interactive voice response telephone system. Results: Five practices were implemented: (a) screening for bipolar disorder, (b) telepsychiatric consultation, (c) prescribing guidelines, (d) online cognitive−behavioral therapy, and (e) online peer support. Implementation outcomes were as follows: (a) 15% of eligible patients were screened for bipolar disorder (interclinic range = 3%−70%), (b) few engaged in online psychotherapy or peer support, (c) 38% received telepsychiatric consultation (interclinic range = 0%−83%), and (d) 64% of patients with a consult were prescribed the recommended medication. Clinical outcomes were as follows: Of those screening at high risk or very high risk, 67% and 69%, respectively, were diagnosed with bipolar disorder. A third (32%) of patients were prescribed a new mood stabilizer, and 28% were prescribed a new antidepressant. Clinical response (50% reduction in depression symptoms), was observed in 21% of patients at 3-month follow-up. Discussion: Quality improvement processes resulted in the implementation and evaluation of 5 detection and treatment processes. Though varying by site, screening improved detection and a substantial number of patients received consultations and medication adjustments; however, symptom improvement was modest.

Propiedades psicométricas de la escala de funcionalidad familiar faces-III: un estudio en adolescentes peruanos

Objetives. Our aim was to evaluate the psychometric properties of the FACES-III among Peruvian high school students. Materials and Methods. This is a psychometric cross-sectional study. A probabilistic sampling was applied, defined by three stages: stratum one (school), stratum two (grade) and cluster (section). The participants were 910 adolescent students of both sexes, between 11 and 18 years of age. The instrument was also the object of study: the Olsons FACES-III. The analysis included a review of the structure / construct validity of the measure by factor analysis and assessment of internal consistency (reliability). Results. The real-cohesion scale had moderately high reliability (Ω=.85) while the real-flexibility scale had moderate reliability (Ω=.74). The reliability found for the ideal-cohesion was moderately high (Ω=.89) like for the scale of ideal-flexibility (Ω=.86). Construct validity was confirmed by the goodness of fit of a two factor model (cohesion and flexibility) with 10 items each [Adjusted goodness of fit index (AGFI) = 0.96; Expected Cross Validation Index (ECVI) = 0.87; Normed fit index (NFI) = 0.93; Goodness of fit index (GFI) = 0.97; Root mean square error of approximation (RMSEA) = 0.06]. Conclusions. FACES-III has sufficient reliability and validity to be used in Peruvian adolescents for the purpose of group or individual assessment.

Cohort study of early literacy and childbearing over the reproductive lifecourse.

Introduction Literacy is linked to a range of health outcomes, but its association with reproductive health in high-income countries is not well understood. We assessed the relationship between early-life literacy and childbearing across the reproductive lifecourse in the USA. Study design A prospective cohort design was employed to assess early-life literacy and subsequent childbearing, using data from the National Longitudinal Survey of Youth 1979. The US youth aged 14–22 years in 1979, including 6283 women, were surveyed annually through 1994 and biannually thereafter. Literacy was assessed in 1980 using the Armed Services Vocational Aptitude Battery Reading Grade Level (RGL). Cumulative childbearing and grand multiparity (≥5 births) were assessed in 2010. Summary statistics, χ2, Kruskal-Wallis, test for trend and logistic regression, were used. Results Of 6283 women enrolled, 4025 (64%) had complete data and were included in the analyses. In 1980, these women were on average 18 years old and in 2010 they were 45. Median cumulative parity decreased for each RGL and ranged from 3.0 (<5th grade) to 2.0 (>12th grade) (p=0.001). Adjusting for race/ethnicity, poverty status, whether a woman had had a child in 1980, and age in 1980, odds of grand multiparity were 1.9 (95% CI 1.1 to 3.5) and 1.8 (95% CI 1.0 to 3.3), greater among women with <5th or 5–6th grade literacy compared with those ≥12th literacy. Discussion In the USA, early-life literacy is associated with total parity over a womans lifecourse. Literacy is a powerful social determinant of reproductive health in this high-income nation just as it has been shown to be in low-income nations.

Changing Antibiotic Prescribing in a Primary Care Network: The Role of Readiness to Change and Group Dynamics in Success

Overuse of broad-spectrum antibiotics in outpatient pediatrics remains a significant issue and there is limited evidence on how to effectively implement outpatient stewardship interventions. This study examines the relationship between readiness to change and modifiable factors affecting success of a primary care network antibiotic stewardship intervention. A survey designed to measure readiness to accept a health care innovation was administered to 209 clinicians. Practices were split in half into “high” versus “low” readiness to change. Semistructured qualitative interviews were conducted with 2 to 3 clinicians from 6 practices in each readiness group. High readiness practices trended toward greater improvements between years (8% to 26% vs 2% to 10% mean improvement). High readiness practice clinicians described more open communication, active group change process, and supportive underlying group cohesion. Low readiness practice clinicians functioned more independently and were influenced more by external forces but were developing group cohesion through the initiative. System-wide interventions should be appropriately tailored to different levels of readiness to change, specifically addressing group dynamics and their differing foci of influence.