Browsing by Author "Ortega, Iliana"

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    A protocol for the formative evaluation of the implementation of patient-reported outcome measures in child and adolescent mental health services as part of a learning health system
    (2024-07-15) McCabe, Erin; Dyson, Michele; McNeil, Deborah; Hindmarch, Whitney; Ortega, Iliana; Arnold, Paul D.; Dimitropoulos, Gina; Clements, Ryan; Santana, Maria J.; Zwicker, Jennifer D.
    Abstract Background Mental health conditions affect one in seven young people and research suggests that current mental health services are not meeting the needs of most children and youth. Learning health systems are an approach to enhancing services through rapid, routinized cycles of continuous learning and improvement. Patient-reported outcome measures provide a key data source for learning health systems. They have also been shown to improve outcomes for patients when integrated into routine clinical care. However, implementing these measures into health systems is a challenging process. This paper describes a protocol for a formative evaluation of the implementation of patient-reported measures in a newly operational child and adolescent mental health centre in Calgary, Canada. The purpose is to optimize the collection and use of patient-reported outcome measures. Our specific objectives are to assess the implementation progress, identify barriers and facilitators to implementation, and explore patient, caregivers and clinician experiences of using these measures in routine clinical care. Methods This study is a mixed-methods, formative evaluation using the Consolidated Framework for Implementation Research. Participants include patients and caregivers who have used the centre’s services, as well as leadership, clinical and support staff at the centre. Focus groups and semi-structured interviews will be conducted to assess barriers and facilitators to the implementation and sustainability of the use of patient-reported outcome measures, as well as individuals’ experiences with using these measures within clinical care. The data generated by the patient-reported measures over the first five months of the centre’s operation will be analyzed to understand implementation progress, as well as validity of the chosen measures for the centres’ population. Discussion The findings of this evaluation will help to identify and address the factors that are affecting the successful implementation of patient-reported measures at the centre. They will inform the co-design of strategies to improve implementation with key stakeholders, which include patients, clinical staff, and leadership at the centre. To our knowledge, this is the first study of the implementation of patient-reported outcome measures in child and adolescent mental health services and our findings can be used to enhance future implementation efforts in similar settings.
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    Generalizability of the Dual Vulnerability Model to Age-modified Risk Factors of Depression
    (2021-07-12) Lukmanji, Aysha; Patten, Scott B; Ortega, Iliana; Kopala-Sibley, Daniel
    Background: The association between seasonality and depression has been demonstrated to decrease with age. This age modification has also been observed between seasonal changes and nine depressive symptoms as hypothesized by the Dual Vulnerability Model. This model posits that due to seasonal changes certain individuals have a biological vulnerability to develop somatic symptoms, and of individuals with this biological vulnerability a smaller subset will have a cognitive vulnerability. These individuals will then develop affective symptoms and consequently depression. The first objective of this study is to determine a set of risk factors for depression that exhibit age modification. The second objective is to determine if modification by age, in situations where risk factors show stronger effects in young people, is aligned with the DVM.Methods: Cross-sectional data from the Canadian Community Health Survey was used for analysis. Logistic regression was used to assess age modification in the association between 10 risk factors and depression as measured by the Patient Health Questionnaire-9 (PHQ-9). Then, logistic regression analysis was used to determine if there was an age-modified association between risk factors and symptoms of depression as measured by each item of the PHQ-9. This symptom-specific analysis was only conducted for risk factors that exhibited an age-modified association with depression overall.Results: Only sex and binge drinking exhibited age modification with overall depressive symptoms, where the association declined with age. For sex, symptoms of feeling depressed, poor/enhanced appetite, and low self-esteem exhibited age modification. For binge drinking, symptoms of feeling tired and appetite changes exhibited age modification. The association between binge drinking or sex with these symptoms was stronger in adolescents and young adults and diminished with age. Conclusions: The age modification for sex and binge drinking did not align with the DVM suggesting that the DVM may be a somewhat specific characteristic of seasonal depression.