Dinesh Mittal, MD. Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR

Transcription

1 Dinesh Mittal, MD Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR

2 Koroukian et al., Am J Preventive Medicine 2012;42 (6): Li et al., Health Affairs30,NO. 7 (2011):

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4 PC providers had significantly more negative attitudes toward the vignette patient with schizophrenia compared to the patient without schizophrenia. Both MH and PC providers had lower expectations and they were less likely to refer patient with schizophrenia for weight reduction program. Stigmatizing attitudes influence health decisions of providers. Mittal D, Corrigan P, Sherman M, Chekuri L, Han, X, Reaves C, Snigdha M, Morris S, Sullivan G. Healthcare Providers Attitudes towards Persons with Schizophrenia. Psychiatric Rehabilitation Journal, 37(4): Sullivan G, Mittal D, Reaves C, Haynes T, Han X, Mukherjee S, Morris S, Marsh L, Corrigan P. Influence of Schizophrenia Diagnosis on Providers Practice Decisions. Journal of Clinical Psychiatry, 76(8): , Corrigan PW, Mittal D, Reaves CM, et al. Mental health stigma and primary health care decisions. Psychiatry Res 2014; 218:

5 Education: didactic approach; contrast the myths of SMI with facts to dispel ignorant stereotypes. Contact: experiential approach; challenge stigma by providing presentation of lived experience of SMI by high-functioning persons with SMI, followed by interaction with the targeted audience. Corrigan, Morris, Michaels, et al., Challenging the Public Stigma of Mental Illness: A Meta-Analysis of Outcome Studies. Psychiatric Services. 2012

6 Developed based on a qualitative study (7 focus groups that included 83 providers in 5 VAMCs) All healthcare providers need to be targeted Healthcare provider (preferable) or patient with lived experience of mental illness are credible messengers A local provider with lived experience of mental illness = more credible Providers desired information on existing disparities physical healthcare for persons with SMI Face-to-face presentation was preferred over video Do not use TMS or mandate; offer 2-4 times a year 6

7 To test the feasibility and impact of using an external facilitation strategy (EFS) to support implementation of the two evidence-based interventions. To evaluate the effectiveness of two intervention strategies Contact vs Education to reduce stigmatizing attitudes towards persons with Serious Mental Illness (SMI). Hypothesis: Contact superior to Education.

8 SAVE: Serving All Veterans Equally

9 Total of 39 PC providers participated at the two sites Contact Intervention: N = 19 Education Intervention: N = 20

10 Social Distance Scale Social avoidance of people with diagnosis of mental illness Attribution of Mental Illness Scale Tendency to blame individuals with mental illness for having illness Provider Stigma Scale Negative attitudes towards individuals with mental illness Comfort with their own mental illness

11 Demographics: Bivariate analyses to evaluate potential differences in key demographic characteristics Measures of Provider Attitudes: Repeated Measures ANOVA to assess how: Intervention group means differ (intervention effect) Group means change over time (time effect), and Differences between group means change over time (time x intervention effect)

12 Variable Contact Education p-value Female, N (%) 16 (84%) 18 (90%) 0.66 a White, N (%) 17 (89%) 14 (70%) 0.24 a Age > 50 N (%) 11 (58%) 10 (53%) 0.74 Nursing Profession, N (%) 14 (74%) 16 (80%) 0.72 a Years of Practice, mean ± sd 19.1 ± ± b a Fisher s exact test b Wilcoxon rank sum test

13 Mean scores (higher is more negative) 35 Provider stigma scale Attribution Questionnaire 15 Social distance scale Baseline Post test 1 month Booster 3 month Follow up Time points Dotted line = Contact Solid line = Education

14 Attribution Questionnaire Treatment 0.01 Time 0.88 Treatment-by-Time 0.25 Social Distance Scale Treatment 0.60 Time 0.02 Treatment-by-Time 0.68 Provider Stigma Measure Treatment 0.13 Time 0.48 Treatment-by-Time 0.07 P-value

15 Participants and PC chiefs regarding the contact intervention: Liked the content of SAVE intervention. Admired the candidness during the physician s presentation. Viewed presenter as credible. Viewed that intervention was much needed and impactful because it increased awareness of biases towards persons with mental illness and disparities in physical health care.

16 It is feasible to implement stigma reduction interventions in PC. Education intervention appears promising. Qualitative interviews demonstrate that contact intervention was well liked and impactful. Both interventions may need to be improved?

17 HSR&D Grant # IIR QUERI RRP Grant # RRP CeMHOR Research Team o Sylvia Porchia, MPH o Karen Drummond, PhD o Matthew Jennings, MD o Kathy Merchant, RN o Richard Owen, MD o Song Ounpraseuth, PhD o Jeffrey Smith, PhD Mentors o Patrick Corrigan, PsyD o Richard Owen, MD o Greer Sullivan, MD o JoAnn Kirchner, MD

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