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Insurance reimbursement for a primary care mindfulness program

Posted 04.15.2019 | by AMRA

Most patients with mild-to-moderate psychological problems are diagnosed and treated in primary care rather than mental health settings. Many of these patients also suffer from physical disorders, or from physical symptoms caused or made worse by psychological factors. Mindfulness-based programs that reduce anxiety and depression and promote self-care are useful supplements to primary care treatments; however, existing barriers hinder their successful implementation. These barriers include limitations on staff time and training, staff unfamiliarity with mindfulness, and problems with insurance reimbursement.

Gawande et al [Mindfulness] studied the feasibility, acceptability, and effectiveness of a mindfulness-based primary care program in reducing symptoms and improving self-care for patients with mild-to-moderate psychological problems.

The researchers randomly assigned 81 primary care patients (69% female; average age = 44; 78% Caucasian; 44% meditation naive) with anxiety, depressive, stress- or trauma-related disorders to either a Mindfulness Training for Primary Care (MTPC) program or a low-dose comparison group. If participants were already receiving psychological help in the primary care setting, they continued to receive it as usual.

MTPC is an 8-week group program based on Mindfulness-Based Cognitive Therapy that incorporates elements of self-compassion training, values clarification, and relapse prevention. MTPC and low dose comparison group participants were asked to develop a self-care plan together with their primary care providers during the sixth week of the program. MTPC group leaders were either appropriately trained mental health clinicians or primary care physicians, with the groups being tailored to meet the insurance requirements of each discipline.

The low dose comparison control consisted of a one-hour didactic/experiential introduction to mindfulness with information on how to access community and digital mindfulness resources. Low dose comparison participants were also placed on […]

April 15th, 2019|News|

Primary care mindfulness program supports patient self care

Posted 01.18.2019 | by AMRA

While people with chronic illnesses can benefit from modifications in diet, exercise, and stress management, initiating and maintaining behavioral changes can be difficult. People with mental health problems can find it even harder to self-manage healthy lifestyle changes. Health care providers are interested in behavioral interventions that can be delivered directly in primary care settings to help patients better manage their illnesses.

Gawande et al. [Journal of General Internal Medicine] studied whether a primary care mindfulness-based intervention could promote improved patient self-management of behaviors that might favorably impact their health. They compared the effectiveness of an intensive in-house mindfulness training to a brief orientation to mindfulness coupled with referral to potential community and online mindfulness resources.

The researchers randomly assigned 136 primary care patients with depressive, anxiety, stress, adjustment, or traumatic stress diagnoses (65% female; 77% Caucasian; average age = 41 years) to either a Mindfulness Training for Primary Care (MTPC) group or a low dose comparator control. Participants who were already receiving mental health treatment were encouraged to continue it during the study.

MTPC was delivered in 8 weekly 2-hour group sessions along with a 7-hour retreat. The program was based on Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy. It included instruction on self-compassion, illness self-management, values clarification, communication, and mindful action planning.

Prior to randomization, all participants attended a one-hour orientation to mindfulness that included didactic and practice elements. Following randomization, participants in the low dose comparator control were encouraged to practice mindfulness on their own, advised to seek out mindfulness resources, and placed on a 6-month MTPC waiting list. Both MTPC and control participants received biweekly phone calls encouraging continued home practice.

In the […]

January 18th, 2019|News|

MBI and CBT provide comparable benefits in a primary care setting

Posted : 01.19.2015 | by AMRA

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Most patients with mild to moderate psychological ailments are treated in primary care settings where treatment may involve medication and/or a limited number of therapy sessions, most likely using some form of cognitive behavioral therapy (CBT). Therapists can be scarce, however, and one-to-one clinical interventions can be costly. Sundquist et al. [British Journal of Psychiatry] explored whether a group-delivered mindfulness-based intervention (MBI) offered within a primary care setting might have equivalent outcomes to routine standard treatment.

The authors recruited 215 primary care patients from 16 different Swedish primary care settings. The patients had mild to moderate depressive, anxiety, and adjustment disorders and were seeking therapy. The patients were largely middle-aged, female, and well-educated. Participants were randomly assigned to either a MBI or routine standard care, mainly CBT.

The MBI was an 8-week group treatment modeled after Mindfulness Based Stress Reduction (MBSR) and Mindfulness Based Cognitive Therapy (MBCT) and delivered by primary care psychologists and social counselors who underwent a six-session training.

The three symptom rating scales were administered before and after the 8-week intervention period. Both treatment groups improved significantly on all three scales. There were no significant differences between the MBI and standard care groups over time. The MBI treatment response was dose dependent – patients attending 5 or fewer sessions improved on only one of the three anxiety and depression measures, while those attending 6-8 sessions improved on all three. The equivalence between the MBI and standard care groups persisted even when reanalyzed using only those standard care members receiving CBT.

The findings suggest that 8 sessions of a group-delivered MBI provide essentially the same symptomatic relief as an average of six […]

January 19th, 2015|News|

MBSR Reduces Burnout in Primary Care Providers

Posted from archive: 10.07.2013 | by AMRA

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Previous studies have shown that health care providers can be taught to be mindful, but busy clinicians often don’t have the time to attend lengthy programs. Fortney et al. [Annals of Family Medicine] tested the efficacy of an abbreviated form of MBSR in alleviating/ preventing symptoms of clinician burnout. The program offered 14 hours of mindfulness instruction over a three-day weekend, followed by two 2-hour post-training sessions. Exercises emphasized mindfulness while sitting, walking, listening and speaking, mindfulness in interaction with patients, and compassion for self and others. Participants were encouraged to practice 10 to 20 minutes per day at home.

Thirty primary care providers (physicians, nurse practitioners and physician assistants) participated in the program. They were assessed at baseline, immediately after the intervention, and at 8-week and 9-month follow-up on measures of burnout, depression, anxiety, stress, resilience, and compassion. While 63 of the participants had some prior meditation experience at some point in their life, only 7 were actively practicing meditation at the start of the study.

After the intervention, the clinicians reported significant decreases in emotional exhaustion, depersonalization, anxiety, and stress, and significant increases in a sense of personal accomplishment. All of these differences were significant at nine-month follow-up. No changes in clinician resilience or compassion were found, but the clinicians’ high scores on the brief five-item compassion scale at baseline left little room for improvement. These preliminary results suggest that abbreviated MBSR holds promise as a time, efficient means of improving clinician well-being, and, as a consequence, the quality of patient care.

Reference:

Fortney, L., Luchterhand, C., Zakletskaia, L., Zgierska, A., & Rakel, D. (2013). Abbreviated mindfulness intervention for job satisfaction, quality […]

January 21st, 2014|News|