Collateral Damage: Reversing the Trends of Pandemic-Triggered Mental Illness

By Lisa Rue, PhD., cliexa Senior Advisor Adolescent Behavioral Health

 

Findings from a 2021 study of cliexa’s holistic screening (cliexa-OPTIONS) for adolescents and young adults confirms early suspicions regarding mental health issues among adolescents and young adults. The collateral damage resulting from lockdowns during the Covid-19 national response has been devastating, with young people struggling to cope with a range of issues, including how to manage negative feelings of depression, along with anxiety and thoughts of suicide.

 

Independent research presented this month by Dr. William Merchant from the Department of Applied Statistics and Research Methods (ASRM) and Dr. Stephen Wright from the Department of Applied Psychology and Counselor Education (APCE) at the University of Northern Colorado found dramatic increases in the frequency of patients and clients (ages 14-24 years) dealing with a mental health challenge. The percentages are outlined in Figure 1.

Figure 1. Percentages of UNC Students Exhibiting Various Mental Health Issues (N=202)

Parents and clinicians are facing difficulties in supporting these adolescents and young people. The continuum of mental health and wellness fluctuates regularly, increasing or decreasing depending on individual resiliency and support. While little can be done about individual genetic predisposition to depression or anxiety, certain measures can support young people by building resiliency or protective factors when increased risk is identified. Parents and clinicians can encourage resiliency and protective factors by asking a few targeted questions, such as:

 

Do you have a trusted adult, friend or family member that you can chat with? If not, can we think of someone together? Sometimes just being able to talk to someone about how you are feeling helps us cope.

 

Tell me some good things about yourself? What are some areas that you know you do well in that you can continue to develop? Let’s make a plan to spend more time building your skills and confidence in these areas.

 

Do you think people are respecting you? How do you think you can get people to respect your position and listen to your concerns? Sharing your concerns without getting angry will help communicate your concerns and validate

 

What makes you happy? What can you do to spend more time on things that make you happy?

 

What are some of your goals in the next 6 months? Two years? What are some steps you can take to meet those goals?

 

How has the pandemic affected your behavior and actions toward others? What can we control with respect to how we treat others during this difficult time?

 

A new resource available now, is the Dibble Institute’s new website for teens called Me and My Emotions (MeandMyEmotions.org), is a timely resource. Young people will find a wealth of information that they can use on their own to build resiliency, mindfulness skills, and improve mental wellness.

 

 

If mental health struggles sound familiar, remind your loved ones that they are not alone, and that life will eventually get back to normal. During this temporary struggle, it’s important to avoid using alcohol and other drugs to cope.  Instead, focus on increasing your protective factors to decrease risks and create balance.

 

For more information about this study and its benefits, click here.

Dr. Dhaliwal, who recently joined cliexa’s executive management team will be leading strategic growth at cliexa. Dr. Dhaliwal, is a physician entrepreneur, has been serving as CEO of Momentum Healthcare Staffing, board member of two VC funds and other healthcare startups. Dr. Dhaliwal also served as the Associate Medical Director of Prognos Health. With his innovative approach and passion in healthcare technology, Dr. Dhaliwal as a practicing physician is highly optimistic about putting a dent on today’s healthcare challenges by partnering with cliexa.

 

“As a physician and executive, I am excited to be a member of cliexa family. cliexa is truly an innovative solution to not only increase clinical efficiency but also to improve reimbursement within institutions. It will be a great journey to work with cliexa staff and advisors to grow this one stop shop solution, providing a complete platform for patient journey.” said Dr. Dhaliwal.

 

cliexa since the inception in late 2016, expanded its solutions offering, intelligent patient triage and onboarding, integrated EMR solutions, quality and compliance add-ons and remote patient monitoring. In June 2021, cliexa and American College of Cardiology announced the launch of cliexa-PULSE, device and EMR agnostic patient engagement and remote patient monitoring platform that leverages patient-centered data with multiple co-morbidities. cliexa uses patented clinical data processing algorithms (USPTO Patent# 10628555: evidence-based data collection, processing and indexing algorithms) and now leveraging American College of Cardiology’s proprietary risk algorithms for cardiovascular conditions.

 

“With Dr. Dhaliwal’s leadership in growth strategy, combined with Dr. Kowalcyzk’s clinical and business guidance, cliexa will be taking a big step in onboarding new customers and expanding its footprint with current health system contracts” said Mehmet Kazgan, Founder and CEO of cliexa.

 

 

 

 

University of Colorado College of Nursing Partners with cliexa to Launch a Mobile Application with Evidence-based Infographics

HIV disproportionately affects Latinos who experience higher prevalence, faster disease progression, more HIV-related deaths, and a marked delay in diagnosis and treatment than their white counterparts. This is a concern in geographic regions across the United States (US) as Latinos comprise the largest minority group in the US. Similar HIV-related health disparities exist in developing countries, such as the Dominican Republic (DR), where those with low socioeconomic status experience higher disease burdens and worse outcomes than those with higher socioeconomic status. These health disparities are exacerbated when affected individuals have low health literacy and are unable to understand the information needed for self-management, as inability to self-manage leads to less use of healthcare services and worse understanding of illness, health behaviors, and health outcomes.  Therefore, to improve health outcomes and reduce health disparities among Latino persons living with HIV (PLWH), clinicians must provide the health information needed for effective self-management to diverse Latino PLWH in a meaningful way.

In response to these concerns, Dr. Samantha Stonbraker, Assistant Professor at the University of Colorado College of Nursing, rigorously and iteratively developed the Info Viz for Health intervention to assist clinicians to provide this health information to PLWH through several NIH-funded studies. She first identified a need for this intervention (T32 NR013454).1-3 Then, she worked with an expert visualization team at Columbia University in New York and with health care providers and PLWH at a clinic in the Dominican Republic to develop a set of culturally relevant and evidence-based infographics to assist clinical communication (T32 NR007969).4, 5 She has since assessed the feasibility of using the Info Viz for Health intervention to improve clinical communication with, and outcomes of, PLWH in the DR.6, 7 She also adapted infographics to the cultural and clinical context of Latino PLWH living in New York (NY), who are mainly of Dominican origin/descent and also assessed their feasibility and acceptability at a clinic specializing in HIV care in Northern Manhattan (K99 NR017829).

Two critical next steps in this work were:

  • To adapt Info Viz for Health for relevance to heterogeneous Latino populations across the US by adapting them to Latinos of Mexican origin/descent as these individuals form the largest Latino group in the US and their inclusion is necessary to enhance generalizability and enable future scalability of the intervention. To do this, Dr. Stonbraker conducted a series of in-depth interviews with PLWH attending a clinic that specializes in HIV care in Denver, CO, and adapted the infographics accordingly.
  • To integrate the Info Viz for Health infographics into a mobile platform to enable ease of use and scalability. Dr. Stonbraker teamed up with cliexa, an innovative company that develops and creates digital health solutions. Together, they incorporated the Info Viz for Health into a mobile app that is now accessible on the App Stores both in Apple and Google in English and Spanish languages.

Currently, Dr. Stonbraker is conducting a multi-site randomized controlled trial (RCT) to evaluate the efficacy of using the Info Viz for Health app to improve clinical communication and treatment outcomes of Latino PLWH at clinical sites in CO and the DR. Seven providers at the two different clinical sites are using the Info Viz for Health app as a communication aid while they provide information to study participants.

The research aims of this project are to:

Aim 1 Assess the efficacy of the intervention as compared to standard care in improving treatment outcomes (CD4 count, viral load, self-efficacy to manage HIV, among others) of PLWH and determine how resultant effects vary over time (baseline to 9-months) and between sites.

Aim 2 Evaluate the feasibility, acceptability, and usability of the app among interdisciplinary and multi-cultural providers using the app.

Aim 3 Identify implementation factors of integrating the mobile app into electronic health records (HER) through in-depth interviews and leverage findings to ensure the app effectively interfaces with EHRs in the US and DR.

Next steps:

  • Health care providers at all sites where infographics have been used have requested additional infographics be incorporated into the app so that they can address additional topics with their patients. Dr. Stonbraker will conduct a needs assessment to identify the pertinent topics to include next and will create rigorously designed and culturally appropriate infographics in response to identified needs.
  • The Info Viz for Health app is provider-facing and would benefit from integration with EHRs. Therefore, the next step in app development is to integrate it with Fast Healthcare Interoperability Resources (FHIR)®, which is the standard for connecting mobile apps and electronic health records (EHR). This permits scalability, as the resultant app enables clinicians to easily access evidence-based infographics from diverse settings globally.

The final product will be an app that interfaces with EHRs in resourced and under-resourced areas globally, has been rigorously tested amongst diverse Latino PLWH in distinct geographic settings in multiple languages, and includes evidence-based infographics to facilitate the clinical communication that helps patients improve their self-management and obtain better health.

References

 

  1. Stonbraker S, Smaldone A, Luft H, et al. Associations between health literacy, HIV-related knowledge, and information behavior among persons living with HIV in the Dominican Republic. Public Health Nurs. 2017;35(3):166-175. doi:10.1111/phn.12382
  2. Stonbraker S, Befus M, Lerebours Nadal L, Halpern M, Larson E. Factors associated with health information seeking, processing, and use among HIV positive adults in the Dominican Republic. AIDS Behav. 2016;21(6):1588–1600. doi:10.1007/s10461-016-1569-5
  3. Stonbraker S, Larson E. Health-information needs of HIV-positive adults in Latin America and the Caribbean: an integrative review of the literature. AIDS Care. 2016;28(10):1223-1229. doi:10.1080/09540121.2016.1173645
  4. Stonbraker S, Halpern M, Bakken S, Schnall R. Special Section on Visual Analytics in Healthcare: Developing infographics to facilitate HIV-related patient-provider communication in a limited-resource setting. Appl Clin Inform. 2019;10:597-609. doi:10.1055/s-0039-1694001
  5. Stonbraker S, Richards SD, Halpern M, Bakken S, Schnall R. Priority topics for health education to support HIV self-management in limited-resource settings. J Nurs Scholarsh. 2019;51(2):168-177. doi:10.1111/jnu.12448
  6. Stonbraker S, Flynn G, George M, et al. Feasibility and acceptability of using information visualizations to improve HIV-related communication in a limited-resource setting: A short report. AIDS Care. In Press;doi:10.1080/09540121.2021.1883517
  7. Stonbraker S, Liu J, Sanabria G, et al. Clinician Use of HIV-Related Infographics During Clinic Visits in the Dominican Republic is Associated with Lower Viral Load and Other Improvements in Health Outcomes. AIDS Behav. In Press:1-13. doi:10.1007/s10461-021-03331-8

A Better Option: cliexa’s digital platform unlocks powerful new data for sexual health screening

 

Lisa Rue, PhD, Senior Advisor

 

Now that we have come out the other side of the Covid-19 Pandemic, we have time to refocus health care efforts to improving patient-focused experiences in primary care to start to tackle another epidemic. The epidemic of sexually transmitted disease within adolescent populations. According to a 2018 report by the CDC, sexually transmitted infections are at an all-time high in adolescents.

 

A recent federal grant has provided a proof of concept opportunity for a unique collaboration between the University of Northern Colorado’s Applied Psychology and Counselor Education Program (APCE) and North Colorado Family Medicine. Doctoral students from APCE support Family Physicians at North Colorado Family Medicine using the innovative cliexa-OPTIONS platform supporting an integrated approach to adolescent health and wellness

 

Adolescent patients are screened using the cliexa-OPTIONS digital health screening before seeing their family physician. Based on their inputs, a patient’s risk for depression, anxiety, or sexual risk, are flagged and their doctor explores this risk with the patient during their brief visit. High-risk patients are referred immediately to one of our APCE doctoral students. This unique integrated care approach provides more comprehensive care before the patient leaves the office. Patients scoring high in sexual risk are asked to complete MyPLAN after they leave the clinic. They complete MyPLAN using their mobile phone in the comfort of their home. Their wellness plan is securely delivered to their mental health professional who reviews this information before the follow-up appointment.

 

Results from a recent comparative case study found that two types of clinics, medical and mental health clinics, may want to include a digital health-based app (e.g., cliexa-OPTIONS) as part of their screening process. Results found that the average time to complete the screening was between 2.75- 4.26 minutes. Spending a few extra minutes prior to the appointment has big dividends for enhancing patient/client care.

 

One clinician at a rural Title X Family Planning Clinic discovered that a teenage female patient had contact with an individual who had syphilis. The patient indicated that being able to express that sensitive information initially on an iPad made it so much easier for her to talk about it later in the appointment. The patient felt comfortable in a way she would not have felt otherwise. This was a common thread for all the teenage patients seen at the clinic; they were more comfortable expressing their fears or problems using the iPad than they would have using a face-to-face interview.

 

Preliminary independent evaluation results are promising. While the two sites serve distinct populations and have different focus areas, they emphasize helping adolescents and young adults make healthy, informed, and positive decisions about their lives, including their sexual behaviors. The cliexa-OPTIONS digital sexual risk assessment app appears to have been successful at each of these sites by helping clinicians open up critical conversations with patients/clients by providing avenues for improving the quality of care they receive. Furthermore, patients appear to enjoy using the digital app and find it easy to use. Patients from both clinics reported high levels of satisfaction using the app and strongly agreed with the statement, “I would use cliexa services again.”

 

cliexa’s digital screening tools instantly flag risky sexual behaviors in adolescents beyond the traditional face-to-face assessment process. The findings suggest the application facilitates detailed information about risky sexual behavior, allowing providers to tailor questions appropriately, focusing brief clinical interventions on the most pertinent information, saving time increasing care and efficiency. 

 

By Q4 of 2022, the final results of this independent evaluation of cliexa-OPTIONS will be complete. Independent evaluation results for the quad aims of patient and clinician satisfaction, reduced cost, and improved outcomes will be an essential step to improve health care in the United States.

 

To read the full study, click here.

 

 

 

 

 

American College of Cardiology, cliexa Launch Innovative Health Monitoring Platform

The American College of Cardiology and cliexa, have collaborated through the ACC Innovation Program to launch a home health monitoring platform called cliexa-PULSE.

” cliexa-PULSE is a revolutionary app and platform that allows cardiovascular clinicians to gather information from their patients before and after visits to ensure well-being and help pivot care plans that are individually tailored to patient needs,” says Andrew M. Freeman, MD, FACC, a member of the ACC Innovation Program-cliexa Work Group. “Using the cliexa platform allows for easy EMR integration along with the ability to capture chronic care management codes resulting in efficient personalized care. Further, with the upcoming population health tool, I can follow my entire panel of patients and help those in need sooner.”

As a virtual health solution, cliexa-PULSE is designed for clinicians to track symptoms, medications, and daily activity for the management of atrial fibrillation (AFib), hypertension (HTN), congestive heart failure (CHF), and coronary artery disease (CAD). Along with remote check-in, cliexa-PULSE offers remote patient monitoring tailored to any clinical workflow and provides bulletproof compliance, documentation support and MIPS reporting metrics.

With ACC’s clinical guidance, cliexa focused on user experience, both from patient reporting and clinician population health perspectives, providing discrete data and reports real-time into the EMR systems.

Mehmet Kazgan, founder and CEO of cliexa, said, “With the clinical guidance from ACC we have been receiving while developing this platform, we have built a great foundation that can be iterated for other chronic conditions. The views and feedback from ACC’s experts in the design work group helped us further understand the real needs and challenges for cardiology patient monitoring.”

Learn more about improving care coordination and a strengthened clinician-patient partnership with ACC Innovation’s Co-developed Platform.

The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its 54,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.