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Understanding collaborative care implementation in the Department of Veterans Affairs: core functions and implementation challenges
Background: The collaborative care model is an evidence-based practice for treatment of depression in which designated care managers provide clinical services, often by telephone. However, the collaborative care model is infrequently adopted in the Department of Veterans Affairs (VA). Almost all VA medical centers have adopted a co-located or embedded approach to integrating mental health care for primary care patients. Some VA medical centers have also adopted a telephone-based collaborative care model where depression care managers support patient education, patient activation, and monitoring of adherence and progress over time. This study evaluated two research questions: (1) What does a dedicated care manager offer in addition to an embedded-only model? (2) What are the barriers to implementing a dedicated depression care manager? Methods: This study involved 15 qualitative, multi-disciplinary, key informant interviews at two VA medical centers where reimbursement options were the same— both with embedded mental health staff, but one with a depression care manager. Participant interviews were recorded and transcribed. Thematic analysis was used to identify descriptive and analytical themes. Results: Findings suggested that some of the core functions of depression care management are provided as part of embedded-only mental health care. However, formal structural attention to care management may improve the reliability of care management functions, in particular monitoring of progress over time. Barriers to optimal implementation were identified at both sites. Themes from the care management site included finding assertive care managers to hire, cross-discipline integration and collaboration, and primary care provider burden. Themes from interviews at the embedded site included difficulty getting care management on leaders’ agendas amidst competing priorities and logistics (staffing and space). Conclusions: Providers and administrators see depression care management as a valuable healthcare service that improves patient care. Barriers to implementation may be addressed by team-building interventions to improve cross-discipline integration and communication. Findings from this study are limited in scope to the VA healthcare system. Future investigation of whether alternative barriers exist in implementation of depression care management programs in non-VA hospital systems, where reimbursement rates may be a more prominent concern, would be valuable
Characterization of Tris (5-amino-1,10-phenanthroline) Ruthenium(II/III) Polymer Films Using Cyclic Voltammetry and Rutherford Backscattering Spectrometry
Platinum electrodes were chemically modified with tris(5-amino-1,10-phenanthroline) ruthenium(II) via electropolymerization. The characterization of the thin films was accomplished with cyclic voltammetry (CV) and Rutherford Backscattering Spectrometry (RBS). Data indicates a strong correlation between the peak currents from the characterization cyclic voltammograms and the number of cycles of electropoly-merization. Rutherford Backscattering Spectrometry showed the same trend, and verified that film thickness is strongly dependent on the concentration of the monomer ruthenium solution. Film thickness was determined from the change in ion beam energy as it passed through the film and was calculated to be 1.0 x 1018 atoms/cm2 – 3.4 x 1018 atoms/cm2, depending upon the number of electropolymerization cycles. The electrodes also showed differences in surface roughness, which were dependent on film thickness