Dinesh Mittal, MD - SBM · Dinesh Mittal, MD Center for Mental Healthcare and Outcomes Research,...
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Dinesh Mittal, MD Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR
Transcript of Dinesh Mittal, MD - SBM · Dinesh Mittal, MD Center for Mental Healthcare and Outcomes Research,...
Dinesh Mittal, MD
Center for Mental Healthcare and Outcomes Research,
Central Arkansas Veterans Healthcare System, Little Rock, AR
Koroukian et al., Am J Preventive Medicine 2012;42 (6):606-609
Li et al., Health Affairs30,NO. 7 (2011):1307–1315
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):297-303. 2014.
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):1068-74, 2015.
Corrigan PW, Mittal D, Reaves CM, et al. Mental health stigma and primary health care decisions. Psychiatry Res
2014; 218: 35–38.
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
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
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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.
SAVE: Serving All Veterans Equally
Total of 39 PC providers participated at the two
sites
◦ Contact Intervention: N = 19
◦ Education Intervention: N = 20
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
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)
Variable Contact Education p-value
Female, N (%) 16 (84%) 18 (90%) 0.66a
White, N (%) 17 (89%) 14 (70%) 0.24a
Age > 50 N (%) 11 (58%) 10 (53%) 0.74
Nursing Profession, N (%) 14 (74%) 16 (80%) 0.72a
Years of Practice, mean ± sd 19.1 ± 8.8 17.6 ± 11 0.63b
aFisher’s exact test bWilcoxon rank sum test
0
5
10
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Baseline Post test 1 month Booster 3 month Follow up
Mea
n s
core
s (h
igh
er is
mo
re n
egat
ive)
Time points
Provider stigma scale
Attribution Questionnaire
Social distance scale
Dotted line = ContactSolid line = Education
Attribution Questionnaire P-value
Treatment 0.01
Time 0.88
Treatment-by-Time 0.25
Social Distance ScaleTreatment 0.60
Time 0.02
Treatment-by-Time 0.68
Provider Stigma MeasureTreatment 0.13
Time 0.48
Treatment-by-Time 0.07
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.
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?
HSR&D Grant # IIR 08-086
QUERI RRP Grant # RRP 14-180
CeMHOR
Research Team Mentors
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
o Patrick Corrigan, PsyD
o Richard Owen, MD
o Greer Sullivan, MD
o JoAnn Kirchner, MD
