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Choi JJ, Maeng DD, Wittink MN, Olivares TE, Brazill K, Lee HB. Enhanced Primary Care for Severe Mental Illness Reduces Inpatient Admission and Emergency Room Utilization Rates. Popul Health Manag 2024. [PMID: 39356228 DOI: 10.1089/pop.2024.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2024] Open
Abstract
Cardiovascular disease (CVD) is a leading cause of premature mortality among patients with severe mental illness (SMI). Effective care delivery models are needed to address this mortality gap. This study examines the impact of an enhanced primary care (PC) program that specializes in the treatment of patients with SMI, called Medicine in Psychiatry Service-Primary Care (MIPS-PC). Using multipayer claims data in Western New York from January 1, 2016 to December 31, 2021, patients with SMI and CVD were identified using International Classification of Diseases, Tenth Revision codes. National Provider Identification numbers of MIPS-PC providers were then used to identify those patients who were treated by MIPS-PC during the period. These MIPS-PC-treated patients were compared against a cohort of one-to-one propensity score matched contemporaneous comparison group (ie, patients receiving PC from providers unaffiliated with MIPS-PC). A difference-in-difference approach was used to identify the treatment effects of MIPS-PC on all-cause emergency department (ED) visits and hospitalization rates. The MIPS-PC group was associated with a downtrend in the acute care utilization rates over a 3-year period following the index date (ie, date of first MIPS-PC or other PC provider encounter), specifically a lower hospitalization rate in the first year since the index date (25%; P < 0.001). ED visit rate reduction was significant in the third-year period (18%; P = 0.021). In summary, MIPS-PC treatment is associated with a decreasing trend in acute care utilization. Prospective studies are needed to validate this effect of enhanced PC in patients with SMI and CVD.
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Affiliation(s)
- Joy J Choi
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Daniel D Maeng
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Marsha N Wittink
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Telva E Olivares
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Kevin Brazill
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Hochang B Lee
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
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2
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Angerhofer Richards J, Cruz M, Stewart C, Lee AK, Ryan TC, Ahmedani BK, Simon GE. Effectiveness of Integrating Suicide Care in Primary Care : Secondary Analysis of a Stepped-Wedge, Cluster Randomized Implementation Trial. Ann Intern Med 2024. [PMID: 39348695 DOI: 10.7326/m24-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2024] Open
Abstract
BACKGROUND Primary care encounters are common among patients at risk for suicide. OBJECTIVE To evaluate the effectiveness of implementing population-based suicide care (SC) in primary care for suicide attempt prevention. DESIGN Secondary analysis of a stepped-wedge, cluster randomized implementation trial. (ClinicalTrials.gov: NCT02675777). SETTING 19 primary care practices within a large health care system in Washington State, randomly assigned launch dates. PATIENTS Adult patients (aged ≥18 years) with primary care visits from January 2015 to July 2018. INTERVENTION Practice facilitators, electronic medical record (EMR) clinical decision support, and performance monitoring supported implementation of depression screening, suicide risk assessment, and safety planning. MEASUREMENTS Clinical practice and patient measures relied on EMR and insurance claims data to compare usual care (UC) and SC periods. Primary outcomes included documented safety planning after population-based screening and suicide risk assessment and suicide attempts or deaths (with self-harm intent) within 90 days of a visit. Mixed-effects logistic models regressed binary outcome indicators on UC versus SC, adjusted for randomization stratification and calendar time, accounting for repeated outcomes from the same site. Monthly outcome rates (percentage per 10 000 patients) were estimated by applying marginal standardization. RESULTS During UC, 255 789 patients made 953 402 primary care visits and 228 255 patients made 615 511 visits during the SC period. The rate of safety planning was higher in the SC group than in the UC group (38.3 vs. 32.8 per 10 000 patients; rate difference, 5.5 [95% CI, 2.3 to 8.7]). Suicide attempts within 90 days were lower in the SC group than in the UC group (4.5 vs. 6.0 per 10 000 patients; rate difference, -1.5 [CI, -2.6 to -0.4]). LIMITATION Suicide care was implemented in combination with care for depression and substance use. CONCLUSION Implementation of population-based SC concurrent with a substance use program resulted in a 25% reduction in the suicide attempt rate in the 90 days after primary care visits. PRIMARY FUNDING SOURCE National Institute of Mental Health.
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Affiliation(s)
- Julie Angerhofer Richards
- Kaiser Permanente Washington Heath Research Institute and Department of Health Systems and Population Health, University of Washington, Seattle, Washington (J.A.R.)
| | - Maricela Cruz
- Kaiser Permanente Washington Heath Research Institute and Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington (M.C.)
| | - Christine Stewart
- Kaiser Permanente Washington Heath Research Institute, Seattle, Washington (C.S.)
| | - Amy K Lee
- Kaiser Permanente Washington Heath Research Institute and Kaiser Permanente Washington Department of Mental Health and Wellness, Seattle, Washington (A.K.L., G.E.S.)
| | - Taylor C Ryan
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington (T.C.R.)
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research (CHSR), Henry Ford Health System, Detroit, Michigan. (B.K.A.)
| | - Gregory E Simon
- Kaiser Permanente Washington Heath Research Institute and Kaiser Permanente Washington Department of Mental Health and Wellness, Seattle, Washington (A.K.L., G.E.S.)
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Smith AM, Prom MC, Ng LC. A Qualitative Investigation of Characteristics Impacting Clinical Decision-Making in Integrated Behavioral Health Care. J Behav Health Serv Res 2024; 51:561-587. [PMID: 38982024 PMCID: PMC11445319 DOI: 10.1007/s11414-024-09891-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/11/2024]
Abstract
To support implementation of integrated behavioral health care (IBHC) models in local settings, providers may benefit from clinical decision-making support. The present analysis examines perspectives on patient characteristics appropriate or inappropriate for, and currently managed within, IBHC at a large medical center to inform recommendations for provider decision-making. Twenty-four participants (n = 13 primary care providers; n = 6 behavioral health providers; n = 5 administrators) in an IBHC setting were interviewed. Thematic analysis was conducted with acceptable interrater reliability (κ = 0.75). Responses indicated behavioral health symptom and patient characteristics that impact perceptions of appropriateness for management in IBHC, with high variability between providers. Many patients with characteristics identified as inappropriate for IBHC were nonetheless currently managed in IBHC. Interactions between patient ability to engage in care and provider ability to manage patient needs guided decisions to refer a patient to IBHC or specialty care. A heuristic representing this dimensional approach to clinical decision-making is presented to suggest provider decision-making guidance informed by both patient and provider ability.
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Affiliation(s)
- Ash M Smith
- Boston Medical Center, 720 Harrison Ave, Boston, MA, 02118, USA
- Psychology Department, The Graduate Center, City University of New York, New York, NY, USA
| | - Maria C Prom
- Boston Medical Center, 720 Harrison Ave, Boston, MA, 02118, USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Lauren C Ng
- Boston Medical Center, 720 Harrison Ave, Boston, MA, 02118, USA.
- Psychiatry Department, Boston University School of Medicine, Boston, MA, USA.
- Department of Psychology, University of California Los Angeles, Psychology Building 1285, Box 951563, Los Angeles, CA, 90095, USA.
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Campbell RL, Bridges AJ. Harnessing the Power of Integrated Behavioral Health to Enhance Insomnia Intervention in Primary Care. J Clin Med 2024; 13:5629. [PMID: 39337116 PMCID: PMC11433510 DOI: 10.3390/jcm13185629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 09/10/2024] [Accepted: 09/20/2024] [Indexed: 09/30/2024] Open
Abstract
Insomnia is prevalent in primary care and associated with co-morbid physical and mental health conditions and poor health outcomes. While there are effective treatments for insomnia in specialty mental health care, many patients have difficulty accessing these interventions. To begin, patients do not always report their sleep challenges to physicians; meanwhile, primary care providers often do not screen for insomnia symptoms. Furthermore, patients may experience several barriers to accessing specialty care for insomnia treatment, such as a limited number of available providers, financial burden, lack of transportation, and low perceptions of treatment effectiveness. Primary care behavioral health (PCBH) is well-equipped to address the challenges of accessing evidence-based care for insomnia through (1) identifying sleep issues, (2) providing psychoeducation on the possible treatments for insomnia, (3) intervening with poor sleep habits and acute insomnia early to prevent chronic insomnia, and (4) delivering appropriate evidence-based interventions for chronic insomnia. Primary care clinics should leverage behavioral health providers to increase screening and embed interventions into routine care for the benefit of improved outcomes for patients with insomnia and other sleep challenges.
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Affiliation(s)
| | - Ana J Bridges
- Department of Psychological Science, University of Arkansas, Fayetteville, AR 72701, USA
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Goodie JL, Hunter CL, Dobmeyer AC. Optimising and personalising behavioural healthcare in the US Department of Defense through Primary Care Behavioral Health. BMJ Mil Health 2024; 170:420-424. [PMID: 37045539 DOI: 10.1136/military-2022-002312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/11/2023] [Indexed: 04/14/2023]
Abstract
Over the past 25 years, one way the US Department of Defense (DoD) has worked to optimise and personalise the delivery of behavioural healthcare is by integrating behavioural health providers into primary care settings. Using the Primary Care Behavioral Health (PCBH) model for integration allows behavioural health providers to see service members and their families for brief and targeted appointments. These appointments are focused on ensuring that the patient receives the care that is needed, while reducing the barriers (eg, delays in receiving care, negative stigma, isolated from other medical care) that are often associated with seeking behavioural healthcare. We review the primary components of the PCBH model, detail the history of how the DoD implemented the PCBH model, review the training methods used by the DoD and briefly describe some of the research that has been conducted by the DoD evaluating the PCBH model.
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Affiliation(s)
- Jeffrey L Goodie
- Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - C L Hunter
- Medical Affairs, Defense Health Agency, Arlington, Virginia, USA
| | - A C Dobmeyer
- Medical Affairs, Defense Health Agency, Arlington, Virginia, USA
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Shepardson RL, Weisberg RB, Wade M, Maisto SA, Funderburk JS. Brief modular anxiety intervention for primary care: Hybrid I pilot randomized controlled trial of feasibility, acceptability, effectiveness, and implementation potential. J Affect Disord 2024; 361:497-507. [PMID: 38810782 DOI: 10.1016/j.jad.2024.05.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/30/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Anxiety is highly prevalent, but undertreated, in primary care. Brief, non-pharmacological interventions are needed. Modular Anxiety Skills Training (MAST), a cognitive-behavioral anxiety intervention, was developed for primary care and tailored for a Veteran sample (MAST-V). The purpose of this mixed methods pilot study was to evaluate MAST-V's feasibility, acceptability, and implementation potential, and preliminarily examine its effectiveness compared to Primary Care Behavioral Health (PCBH) usual care. METHODS This hybrid I randomized controlled trial (conducted 2019-2021) assigned 35 primary care patients (Mage = 47, 17 % female, 27 % racial/ethnic minority) with clinically significant anxiety symptoms to receive MAST-V or PCBH usual care. Participants completed validated measures of anxiety symptoms and functional impairment at 0, 4, 8, 12, and 16 weeks. RESULTS Participants attended more sessions in MAST-V than usual care. After necessary adjustments to reduce session duration, MAST-V will likely fit within PCBH practice parameters. Participants in both conditions valued treatment, but treatment satisfaction, credibility, and therapeutic alliance were higher for MAST-V. Study therapists achieved high treatment fidelity and rated MAST-V as highly feasible, acceptable, and appropriate for PCBH. They identified ways to address potential barriers to implementation. MAST-V was more effective than usual care in reducing anxiety symptoms and impairment. LIMITATIONS This was a small pilot study at a single site using study therapists. Results should be considered preliminary until replicated in a full-scale clinical trial. CONCLUSIONS This brief modular anxiety intervention, which was designed with implementation in mind, may help to address the anxiety treatment gap in primary care.
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Affiliation(s)
- Robyn L Shepardson
- Center for Integrated Healthcare, Syracuse VA Medical Center. USA; Department of Psychology, Syracuse University. USA.
| | - Risa B Weisberg
- VA, Boston Healthcare System. USA; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine. USA; Department of Family Medicine, Alpert Medical School, Brown University. USA
| | - Michael Wade
- Center for Integrated Healthcare, Syracuse VA Medical Center. USA
| | - Stephen A Maisto
- Center for Integrated Healthcare, Syracuse VA Medical Center. USA; Department of Psychology, Syracuse University. USA
| | - Jennifer S Funderburk
- Center for Integrated Healthcare, Syracuse VA Medical Center. USA; Department of Psychology, Syracuse University. USA; Department of Psychiatry, University of Rochester. USA
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Moore MB, Gilrain K, Brosig C, Leffler JM, Gupta S, Fizur P. Current Landscape of Psychologists in Academic Health Centers: Roles and Structural Models. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10040-6. [PMID: 39179749 DOI: 10.1007/s10880-024-10040-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2024] [Indexed: 08/26/2024]
Abstract
With mental health needs consistently increasing in our communities and medical centers, we want to ensure that institutions are aware of the benefit and value that psychologists bring to their system and provide several pathways for consideration and structure to understand how to support the salaries and careers of psychologists working within AHCs. Leadership and administration within Academic Health Centers (AHC) often do not understand the value and measurement of productivity for psychologists being added to the medical teams. The current article aims to present varied structural models and demonstrate how productivity is reviewed for psychologists across different institutions and departments. The authors will outline the many roles that psychologists serve within academic health centers as well as the value those roles bring to the system. The overarching goal is to provide an educational article that serves as a tool for recruitment of psychologists that leaders and faculty can refer to when approaching administration in AHCs to understand the systems and roles of psychologists within medical settings. This information can be utilized to help create new positions for psychologists, aid in recruitment efforts and provide transparency for faculty currently working within AHCs who may not be aware of the varied opportunities.
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Affiliation(s)
- Michelle B Moore
- Department of Psychiatry, Louisiana State University Health Sciences Center, 2021 Perdido Street, New Orleans, LA, 70112, USA
| | - Kelly Gilrain
- Department of Medicine, Cooper University Health Care, One Cooper Plaza, D227, Camden, NJ, 08103, USA.
| | - Cheryl Brosig
- Department of Pediatrics, Medical College of Wisconsin/Children's Wisconsin, 9000 W. Wisconsin Avenue, MS713, Milwaukee, WI, 53201, USA
| | - Jarrod M Leffler
- Department of Psychiatry, Virginia Commonwealth University & Children's Hospital of Richmond, 1308 Sherwood Avenue, Richmond, VA, 23220, USA
| | - Shikha Gupta
- Department of Psychiatry, University of Missouri School of Medicine, 1 Hospital Drive, Columbia, MO, 65203, USA
| | - Philip Fizur
- Department of Medicine, Cooper University Health Care, One Cooper Plaza, Dorrance 253, Camden, NJ, 08103, USA
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Cooper ZW, Mowbray O, Ali MK, Johnson LCM. Addressing depression and comorbid health conditions through solution-focused brief therapy in an integrated care setting: a randomized clinical trial. BMC PRIMARY CARE 2024; 25:313. [PMID: 39179982 PMCID: PMC11342549 DOI: 10.1186/s12875-024-02561-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 08/05/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Co-occurring physical and mental health conditions are common, but effective and sustainable interventions are needed for primary care settings. PURPOSE Our paper analyzes the effectiveness of a Solution-Focused Brief Therapy (SFBT) intervention for treating depression and co-occurring health conditions in primary care. We hypothesized that individuals receiving the SFBT intervention would have statistically significant reductions in depressive and anxiety symptoms, systolic blood pressure (SBP), hemoglobin A1C (HbA1c), and body mass index (BMI) when compared to those in the control group. Additionally, we hypothesized that the SFBT group would have increased well-being scores compared to the control group. METHODS A randomized clinical trial was conducted at a rural federally qualified health center. Eligible participants scored ≥ 10 on the Patient Health Questionnaire (PHQ-9) and met criteria for co-occurring health conditions (hypertension, obesity, diabetes) evidenced by chart review. SFBT participants (n = 40) received three SFBT interventions over three weeks in addition to treatment as usual (TAU). The control group (n = 40) received TAU over three weeks. Measures included depression (PHQ-9) and anxiety (GAD-7), well-being (Human Flourishing Index), and SFBT scores, along with physical health outcomes (blood pressure, body mass index, and hemoglobin A1c). RESULTS Of 80 consented participants, 69 completed all measures and were included in the final analysis. 80% identified as female and the mean age was 38.1 years (SD = 14.5). Most participants were white (72%) followed by Hispanic (15%) and Black (13%). When compared to TAU, SFBT intervention participants had significantly greater reductions in depression (baseline: M = 18.17, SD = 3.97, outcome: M = 9.71, SD = 3.71) and anxiety (baseline: M = 14.69, SD = 4.9, outcome: M = 8.43, SD = 3.79). SFBT intervention participants also had significantly increased well-being scores (baseline: M = 58.37, SD = 16.36, outcome: M = 73.43, SD = 14.70) when compared to TAU. Changes in BMI and blood pressure were not statistically significant. CONCLUSION The SFBT intervention demonstrated efficacy in reducing depressive and anxiety symptoms and increasing well-being but did not affect cardio-metabolic parameters over a short period of intervention. TRIAL REGISTRATION The study was pre-registered at ClinicalTrials.gov Identifier: NCT05838222 on 4/20/2023. *M = Mean, SD = Standard deviation.
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Affiliation(s)
- Zach W Cooper
- School of Social Work, University of Georgia, Williams Street, Atlanta, GA, 30602, Georgia.
| | - Orion Mowbray
- School of Social Work, University of Georgia, Williams Street, Atlanta, GA, 30602, Georgia
| | - Mohammed K Ali
- Department of Family and Preventative Medicine, School of Medicine, Emory University, Atlanta, Georgia
- Emory Global Diabetes Research Center of the Woodruff Health Sciences Center, Emory University, Atlanta, Georgia
| | - Leslie C M Johnson
- Department of Family and Preventative Medicine, School of Medicine, Emory University, Atlanta, Georgia
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Larsen HI, Thomas K, Nordgren LB, Ruiz ES, Koshnaw K, Nilsen P. Implementing primary care behavioral health in Swedish primary care - study protocol for a pragmatic stepped wedge cluster trial. BMC PRIMARY CARE 2024; 25:310. [PMID: 39164634 PMCID: PMC11334537 DOI: 10.1186/s12875-024-02515-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/08/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND Mental health problems represent a large and growing public health concern. Primary care handles most of the patients with mental health problems, but there are many barriers to detection and treatment in this setting, causing under-recognition and under-treatment of patients. The service delivery model Primary Care Behavioral Health (PCBH) shows promise to manage mental health problems in primary care, but more research is needed regarding its effects on multiple levels. METHODS This project investigates the effectiveness and implementation of a large-scale implementation of PCBH in Region Östergötland, Sweden. The aim is to generate new knowledge concerning the impact of a real-world implementation and use of PCBH in routine primary care. A Pragmatic Stepped-Wedge Cluster Trial will be used: 24 PCBH primary care centres in one region will be compared with 48 standard care centres in three other regions. The model will be implemented sequentially at the PCBH centres according to a staggered timetable. Results will be investigated at patient, staff and organization levels and various forms of data will be collected: (1) local and national registry data; (2) questionnaire data; (3) interview data; and (4) document data. DISCUSSION This project investigates the effectiveness and implementation of PCBH in routine primary care. The project could result in improved mental health care for the included patients and contribute to the general good for a wider population who have mental health problems. The project's study design will make it possible to assess many important effects of the PCBH service delivery model at different levels, providing evidence of the effectiveness (or not) of the PCBH model under routine conditions in primary care. The project has the potential to generate clinically meaningful results that can provide a basis for decisions concerning further implementation and use of the model and thus for future development of mental health care provision in primary care. TRIAL REGISTRATION NCT05633940, date of registration: 2021-04-21.
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Affiliation(s)
- Hanna Israelsson Larsen
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden.
- Primary Health Care Centre in Cityhälsan Centrum and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Kristin Thomas
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Linköping, Sweden
| | - Lise Bergman Nordgren
- Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Division of Pychiatry, Region Örebro, Örebro, Sweden
| | - Erica Skagius Ruiz
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
- Primary Health Care Centre in Cityhälsan Centrum and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Kocher Koshnaw
- Primary Health Care Centre in Lambohov and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Linköping, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Kim JS, Prins A, Hirschhorn EW, Legrand AC, Macia KS, Yam SS, Cloitre M. Preliminary Investigation Into the Effectiveness of Group webSTAIR for Trauma-exposed Veterans in Primary Care. Mil Med 2024; 189:e1403-e1408. [PMID: 38442368 DOI: 10.1093/milmed/usae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION A substantial number of trauma-exposed veterans seen in primary care report significant symptoms of PTSD and depression. While primary care mental health integration (PCMHI) providers have been successful in delivering brief mental health treatments in primary care, few studies have evaluated interventions that combine mobile health resources with PCMHI groups. This pilot study assessed the potential benefits of webSTAIR, a 10-module transdiagnostic treatment for trauma-exposed individuals, supported by 5 biweekly group sessions delivered via telehealth. The transdiagnostic and mobile health nature of the treatment, as well as the therapist and peer support provided through group sessions, may offer an innovative approach to increasing access to patient-centered and trauma-informed treatment in primary care settings. MATERIALS AND METHODS Thirty-nine male and female veterans with trauma-related symptoms (i.e., PTSD and/or depression) participated in group webSTAIR. Mixed effects analyses were conducted to assess changes in PTSD and depression at pre-, mid-, and post-treatment. Baseline symptom severity was assessed as a predictor of module completion and group attendance. The project was part of a VHA quality improvement project, and IRB approval was waived by the affiliated university. RESULTS Analyses revealed significant pre-to-post improvement in both PTSD and depression outcomes with a large effect size for PTSD (Hedges' gav = 0.88) and medium to large for depression (Hedges' gav = 0.73). Of participants who completed the baseline assessment, 90% began webSTAIR; of those, 71% completed the program. Baseline symptoms of PTSD and depression did not predict group attendance or module completion. CONCLUSIONS Good outcomes and a satisfactory retention rate suggest that group webSTAIR may provide easily accessible, high-quality, and effective treatment for patients presenting with trauma-related problems without increasing therapist or system burdens. The results suggest the value of conducting a randomized controlled trial to test the effectiveness of group webSTAIR relative to PCMHI usual care or other evidence-based, disorder-specific (e.g., PTSD) treatments for trauma-exposed individuals in PCMHI.
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Affiliation(s)
- Jamie S Kim
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA
| | - Annabel Prins
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA
- American Lake Division, VA Puget Sound Health Care System, 9600 Veterans Drive Southwest, Tacoma, WA 98493-0003, USA 900-329-8387
| | - Elizabeth W Hirschhorn
- American Lake Division, VA Puget Sound Health Care System, 9600 Veterans Drive Southwest, Tacoma, WA 98493-0003, USA 900-329-8387
| | - Alison C Legrand
- American Lake Division, VA Puget Sound Health Care System, 9600 Veterans Drive Southwest, Tacoma, WA 98493-0003, USA 900-329-8387
| | - Kathryn S Macia
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA
| | - Sherry S Yam
- General Mental Health, VA Northern California Health Care System, 150 Muir Road, Martinez, CA 94553-4668, USA
| | - Marylene Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA
- Department of Psychiatry and Behavioral Health Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305-5717, USA
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11
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Ogbeide SA, Knight C, Young A, George D, Houston B, Wicoff M, Johnson-Esparza Y, Gibson-Lopez G. Current Practices in Clinical Supervision in Primary Care. J Clin Psychol Med Settings 2024; 31:316-328. [PMID: 38347384 DOI: 10.1007/s10880-023-10001-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 05/20/2024]
Abstract
The purpose of this study was to examine current clinical supervision practices within primary care settings. We used a descriptive survey design, which blends quantitative and qualitative data, and examined the current state of clinical supervision practices and approaches in primary care and the type of training the behavioral health consultants received to provide supervision to pre-licensure level behavioral health trainees. Ninety-four participants completed the survey in 2022. Seventy-one percent of respondents felt they had adequate training to be an effective integrated behavioral health (IBH) supervisor; however, most training came from sources, such as workshops, continuing education, or supervision of supervision. Further efforts to establish universal competencies and formal training programs are needed to meet the growing need for IBH services in primary care.
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Affiliation(s)
| | - Cory Knight
- University of Houston - Clearlake, Houston, TX, USA
| | | | - Deepu George
- UT Rio Grande Valley School of Medicine, Edinburg, TX, USA
| | | | - Maribeth Wicoff
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
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12
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Chakawa A, Crawford TP, Belzer LT, Yeh HW. Disparities in accessing specialty behavioral health services during the COVID-19 pandemic and why we need pediatric integrated primary care. Front Psychiatry 2024; 15:1356979. [PMID: 38800067 PMCID: PMC11116771 DOI: 10.3389/fpsyt.2024.1356979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 04/03/2024] [Indexed: 05/29/2024] Open
Abstract
Objective Youth unmet behavioral health needs are at public health crisis status and have worsened since the onset of the coronavirus disease 2019 pandemic (Covid-19). Integrating behavioral health services into pediatric primary care has shown efficacy in addressing youth behavioral health needs. However, there is limited guidance on facilitating equitable access to care in this setting, including in triaging access to co-located services (i.e., onsite outpatient behavioral health services with only the behavioral health provider) or to specialty behavioral health services in other clinics within larger health systems. Methods A retrospective, comparative study was conducted to examine variability in access to co-located and specialty behavioral health (SBH) services for a pre-Covid-19 cohort (April 2019 to March 2020; n = 367) and a mid-Covid-19 cohort (April 2020 to March 2021; n = 328), while accounting for integrated primary care consultation services. The sample included children 1-18 years old served through a large, inner-city primary care clinic. Logistic regression models were used to examine the association between scheduled and attended co-located and SBH visits, pre- and mid-Covid-19 effects, and sociodemographic factors of race and ethnicity, language, health insurance (SES proxy), age, and sex. Results The majority of youth were not directly scheduled for a co-located or SBH visit but the majority of those scheduled attended their visit(s). The odds of not being directly scheduled for a co-located or SBH visit were greater for the mid-Covid-19 cohort, Black youth, and older youth. Accounting for integrated primary care consultation visits addressed these disparities, with the exception of persisting significant differences in scheduled and attended co-located and SBH visits for Black youth even while accounting for IPC consultation. Implication Findings from the current study highlight the effective role of integrated primary care consultation services as facilitating access to initial behavioral health services, especially given that referrals to integrated primary care co-located and SBH services within the larger health system often involve barriers to care such as longer wait-times and increased lack of referral follow through. Ongoing research and equitable program development are needed to further this work.
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Affiliation(s)
- Ayanda Chakawa
- Division of Developmental and Behavioral Health, Section of Pediatric Psychology, Children’s Mercy Hospitals and Clinics, Kansas City, MO, United States
- University of Missouri Kansas City School of Medicine, Kansas City, MO, United States
| | - Trista Perez Crawford
- Emory Pediatric Institute, Emory School of Medicine, Atlanta, GA, United States
- Children’s Healthcare of Atlanta, Center of Behavioral and Mental Health, Atlanta, GA, United States
| | - Leslee Throckmorton Belzer
- Division of Developmental and Behavioral Health, Section of Pediatric Psychology, Children’s Mercy Hospitals and Clinics, Kansas City, MO, United States
- University of Missouri Kansas City School of Medicine, Kansas City, MO, United States
- The Beacon Program, Children’s Mercy Hospitals and Clinics, Kansas City, MO, United States
| | - Hung-Wen Yeh
- University of Missouri Kansas City School of Medicine, Kansas City, MO, United States
- Division of Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO, United States
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13
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Ogbeide SA, Bayles B. Using a Delphi Technique to Define Primary Care Behavioral Health Clinical Supervision Competencies. J Clin Psychol Med Settings 2024; 31:108-121. [PMID: 37266874 PMCID: PMC10236401 DOI: 10.1007/s10880-023-09964-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/03/2023]
Abstract
There is an increasing need for Primary Care Behavioral Health (PCBH) workforce development (i.e., increase in well-trained PCBH providers) given the growth of behavioral health (BH) integration into primary care, specifically at a time when behavioral health needs are increasing because of the COVID-19 pandemic (Kanzler and Ogbeide in Psychol Trauma 12(S1):S177-S179, https://doi.org/10.1037/tra0000761 , 2020). Therefore, it is imperative to provide current and future behavioral health clinical supervisors in primary care settings specific competencies, given there are no current competencies specific to clinical supervision within the PCBH Model. Using a Delphi process, the authors identified and reached expert consensus on competencies for BH clinical supervisors in primary care. A purposive sample (in: Patton, Qualitative evaluation and research methods, Sage, Newbury Park, 1990) of fifteen experts (n = 15) in PCBH clinical training and education evaluated quantitative and qualitative domains and specific competencies associated with PCBH supervision gathered during an initial in-depth qualitative interview. This was followed by two subsequent rounds of quantitative Delphi surveys to reach consensus. The response rates from our panel of experts were 100% (15/15) for all stages (interviews, round one and round two surveys). Three domains (Primary Care Knowledge, Clinical Supervisor Development, and Clinical Supervision Skills) were rated as essential for providing clinical supervision with PCBH for pre-licensure level learners. The development of competencies will further support BH clinical supervisor needs, professional development, and provide a concrete way to evaluate progress towards teaching and training excellence. This will also have a great impact on the development of the future BH workforce within primary care.
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Affiliation(s)
| | - Bryan Bayles
- Texas A & M University -San Antonio, San Antonio, TX, USA
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14
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Witzeman KA, Lieberman A, Beckman EJ, Ross KV, Coons HL. Integrated Care for Persons With Persistent Gynecologic Conditions. Clin Obstet Gynecol 2024; 67:247-261. [PMID: 38281176 DOI: 10.1097/grf.0000000000000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Persons with persistent gynecologic conditions frequently cope with complex biopsychosocial challenges and benefit from integrated behavioral health evaluation and treatment within gynecologic practices. Integrated care refers to the provision of behavioral health services within a health care setting which contributes to improved patient, provider, and practice outcomes, however, has not been commonly provided in traditional gynecologic practices. Several models of integrated behavioral health are reviewed. Each model holds specific applications in primary and specialty gynecology settings and may enhance the gynecologic patient experience. This article reviews current research supporting integrated care and describes implementation, funding, and evaluation to improve patient outcomes.
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Affiliation(s)
- Kathryn A Witzeman
- Department of Women's Health and Gynecology, University of Colorado School of Medicine, Rifle, Colorado
| | - Alison Lieberman
- Department of Integrated Behavioral Health, Denver Health Medical Center
| | - Elizabeth Joy Beckman
- Department of Integrated Behavioral Health and Department of Psychiatry, University of Colorado School of Medicine, Denver
| | - Kaitlin V Ross
- Department of Psychiatry, Colorado Center for Women's Behavioral Health and Wellness, University of Colorado School of Medicine/Anschutz Medical Campus, Aurora, Colorado
| | - Helen L Coons
- Women's Mental Health Associates & Health Psychology Solutions, Denver, Colorado
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15
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Bell K, Ashby BD, Scott SM, Poleshuck E. Integrating Mental Health Care in Ambulatory Obstetrical Practices: Strategies and Models. Clin Obstet Gynecol 2024; 67:154-168. [PMID: 38174556 DOI: 10.1097/grf.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Perinatal mental health is recognized as a priority component of obstetrical care. Perinatal patients often turn to their obstetrician for help with mental health concerns as they view them as their primary health care provider. Unfortunately, obstetricians face challenges in providing adequate support due to time constraints and limited expertise. Integrated behavioral health care offers a collaborative and cost-effective solution to enhance patient care and clinician satisfaction. Integrated behavioral health clinicians possess fundamental skills to care for patients throughout the reproductive lifespan and assist obstetricians in identifying and managing common mood concerns.
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Affiliation(s)
- Keisha Bell
- Departments of Psychiatry and Ob/Gyn, University of Rochester Medical Center, Rochester, New York
| | - Bethany D Ashby
- Department of Psychiatry and Ob/Gyn, University of Colorado, School of Medicine, Aurora, Colorado
| | - Stephen M Scott
- Department of Ob/Gyn and Pediatrics, University of Colorado, School of Medicine, Aurora, Colorado
| | - Ellen Poleshuck
- Departments of Psychiatry and Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
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16
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Ellbin S, Lindegård A, Jonsdottir IH, Dahlborg E. Psychologists' involvement in and experiences of treating patients with stress-related exhaustion in primary care. BMC PRIMARY CARE 2024; 25:56. [PMID: 38347454 PMCID: PMC10860213 DOI: 10.1186/s12875-024-02287-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/29/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Primary health care is the setting for most patients with stress-related mental health problems. Good care processes are important for patients with stress-related mental health problems and the complex needs of these patients has become a challenge for primary care settings which is traditionally designed to manage acute episodes of one illness. The care process of these patients is thus interesting to investigate. The aim of this study was to explore psychologists´ involvement and experiences regarding the organisation of the care process and treatment of patients seeking care for stress-related exhaustion. METHOD Fifteen psychologists (14 women and 1 man, age range 27-72 years)c from fifteen different primary health care centres in the western part of Sweden, located in both rural and urban areas were included. Qualitative content analysis of individual semi-structured interviews was conducted. RESULTS The analysis resulted in eight subcategories within the two main categories studied illuminating psychologists' involvement and experiences regarding the organisation of the care process and challenges regarding treatment of patients seeking care for stress-related exhaustion. CONCLUSION The care process of patients with stress-related exhaustion is perceived to be ineffective and not congruent with the needs of the patients. A lack of holistic overview of the care process, a lack of collaboration and poor utilization of the health care professionals' competence leads to an unstructured process forcing the patients to be the carriers and coordinators of their own care.
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Affiliation(s)
- Susanne Ellbin
- The Institute of Stress Medicine, Carl Skottsbergs gata 22B, Gothenburg, SE-413 19, Sweden
| | - Agneta Lindegård
- The Institute of Stress Medicine, Carl Skottsbergs gata 22B, Gothenburg, SE-413 19, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingibjörg H Jonsdottir
- The Institute of Stress Medicine, Carl Skottsbergs gata 22B, Gothenburg, SE-413 19, Sweden.
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Cooper ZW, Wolfer TA. Conceptualizing the Biopsychosocial-Spiritual Health Influences of Adverse Childhood Experiences and the Application of Primary Care Behavioral Health for Their Treatment. JOURNAL OF RELIGION AND HEALTH 2024; 63:619-639. [PMID: 37831309 DOI: 10.1007/s10943-023-01928-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 10/14/2023]
Abstract
Adverse Childhood Experiences (ACEs) are common and affect the overall functioning of adults, but there is a need to understand how to better address the health impact of ACEs on adults in primary healthcare settings. A narrative review was utilized to extract data from seminal articles to (1) operationalize the influence of ACEs on health outcomes, (2) assess the primary care behavioral health (PCBH) model as a mechanism to address the influence of ACEs, and (3) identify mechanisms to expand the PCBH model to explicitly address spiritual determinants of health. The extracted data revealed that ACEs influence the biological, psychological, social, and spiritual health of patients providing a rationale for integrating psychosocial and spiritual treatment within primary healthcare settings. Simultaneously, the PCBH model integrates psychosocial interventions into existing primary care services but does not explicitly address spiritual determinants. Recommendations for expansion include (1) training for clinicians on evidence-based interventions to address spirituality, (2) spiritual screening tools in PCBH settings, and (3) consultation with chaplains as needed.
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Affiliation(s)
- Zachary W Cooper
- School of Social Work, University of Georgia, 279 Williams St, Athens, GA, 30602, USA.
| | - Terry A Wolfer
- College of Social Work, University of South Carolina, Columbia, SC, USA
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18
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Petruzzi L, Milano N, Chen Q, Noel L, Golden R, Jones B. Social workers are key to addressing social determinants of health in integrated care settings. SOCIAL WORK IN HEALTH CARE 2024; 63:89-101. [PMID: 38104559 DOI: 10.1080/00981389.2023.2292565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023]
Abstract
Social workers play an important role in assessing social determinants of health (SDH) and providing behavioral health services in integrated care settings. Evidence suggests that integrated care interventions improve quality of life and other patient outcomes. However, the ambiguous role of social workers on the interdisciplinary team, the lack of protocol in SDH screening and intervention, and restrictions due to healthcare reimbursement limit social workers' ability to intervene. Future directions include standardizing integrated care models, evaluating integrated care's efficacy to address SDH, incorporating SDH into interprofessional training including role clarification and reimbursing for SDH assessment and intervention.
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Affiliation(s)
- Liana Petruzzi
- Population Health Department, Dell Medical School, University of Texas, Austin, Texas, USA
| | - Nicole Milano
- Rutgers School of Social Work, New Brunswick, New Jersey, USA
| | - Qi Chen
- Steve Hicks School of Social Work, University of Texas, Austin, Texas, USA
| | - Lailea Noel
- Steve Hicks School of Social Work, University of Texas, Austin, Texas, USA
| | - Robyn Golden
- Rush University Medical Center, New Brunswick, New Jersey, USA
| | - Barbara Jones
- Steve Hicks School of Social Work, University of Texas, Austin, Texas, USA
- Health Social Work Department, Dell Medical School, University of Texas, Austin, Texas, USA
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19
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Hostutler C, Wolf N, Snider T, Butz C, Kemper AR, Butter E. Increasing Access to and Utilization of Behavioral Health Care Through Integrated Primary Care. Pediatrics 2023; 152:e2023062514. [PMID: 37969039 DOI: 10.1542/peds.2023-062514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVES To evaluate changes in access to and utilization of behavioral health (BH) services after the integration of psychologists into primary care clinics compared with clinics without integrated psychologists. METHODS We integrated 4 of 12 primary care clinics within our academic health system. We used the median wait time for BH services as a proxy for changes in access and defined BH utilization as the percentage of primary care visits that resulted in contact with a BH clinician within 180 days. We compared changes in access and utilization from the year before integration (September 2015 to September 2016) with the 2 years after integration (October 2016 to October 2018) within integrated clinics and between integrated and nonintegrated clinics. We used difference-in-difference analysis to test the association of study outcomes with the presence of integrated psychologists. RESULTS Access and utilization were similar across all practices before integration. After integration, BH utilization increased by 143% in integrated clinics compared with 12% in nonintegrated clinics. The utilization of BH services outside of the medical home (ie, specialty BH service) decreased for integrated clinics only. In clinics with integrated psychologists, 93% of initial BH visits happened on the same day as a need was identified. The median wait time for the 7% in integrated clinics who were not seen on the same day was 11.4 days (interquartile range = 5.3-17.7) compared with 48.3 days (interquartile range = 20.4-93.6) for nonintegrated clinics. CONCLUSIONS A team-based integration model increased BH utilization and access.
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Affiliation(s)
- Cody Hostutler
- Department of Pediatric Psychology and Neuropsychology
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Noelle Wolf
- Department of Pediatric Psychology and Neuropsychology
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Tyanna Snider
- Department of Pediatric Psychology and Neuropsychology
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Catherine Butz
- Department of Pediatric Psychology and Neuropsychology
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Alex R Kemper
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Eric Butter
- Department of Pediatric Psychology and Neuropsychology
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
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20
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So M, Makofane J, Hernandez M. "We want to be heard": A Qualitative Study of Mental Health Care Access among Patients of an Urban Federally Qualified Health Center. MENTAL HEALTH SCIENCE 2023; 1:261-269. [PMID: 38774821 PMCID: PMC11104551 DOI: 10.1002/mhs2.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/12/2023] [Indexed: 05/24/2024]
Abstract
Introduction Although depression is common in primary care, challenges to timely intervention exist, particularly for communities of color and lower socioeconomic status. Our objective was to understand barriers and facilitators to mental healthcare access among a sample of patients receiving care at a federally qualified health center (FQHC) in Minnesota, United States. Methods We qualitatively interviewed 34 patients of an urban FQHC, purposively sampled on race/ethnicity, insurance status, language, and depression symptom status (based on Patient Health Questionnaire-9 responses). We inductively and deductively analyzed interview data, leveraging theory in both the codebook development and analysis processes. Results Participants, who were predominantly English-speaking, female, not privately insured, and people of color, shared numerous barriers and facilitators to accessing mental healthcare. Prominent barriers primarily concerned healthcare providers, including perceived dismissal of mental health concerns and challenges with provider continuity. Additional barriers included the costs of mental health care, communication breakdowns, the patient portal, and community-specific perceptions of mental health. Prominent facilitators included clinic organizational factors (internal and external) and staff friendliness and warmth. Other factors including consideration of patients' financial situation, integrated management of behavioral and physical health conditions, language concordant staff, the telehealth visit modality, and the clinic's social mission were also raised as facilitating access. Conclusion Patient voices from a single FQHC illustrate the challenges and possibilities of providing mental healthcare in safety net settings. Clinical, strategy, and policy solutions can be tailored to minimize barriers and optimize facilitators documented herein.
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Affiliation(s)
- Marvin So
- University of Minnesota Medical School, Minneapolis, MN
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21
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Nyman SJ, Vogel ME, Heller GM, Hella JR, Illes RA, Kirkpatrick HA. Development and Evaluation of a Health Behavior Change Clinic in Primary Care: An Interdisciplinary Partnership. J Clin Psychol Med Settings 2023; 30:909-923. [PMID: 36869987 PMCID: PMC9985097 DOI: 10.1007/s10880-023-09945-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/05/2023]
Abstract
Providing effective healthy behavior change interventions within primary care presents numerous challenges. Obesity, tobacco use, and sedentary lifestyle negatively impact the health quality of numerous medical patients, particularly in underserved patient populations with limited resources. Primary Care Behavioral Health (PCBH) models, which incorporate a Behavioral Health Consultant (BHC), can offer point-of-contact psychological consultation, treatment, and also provide opportunities for interdisciplinary psychologist-physician clinical partnerships to pair a BHC's health behavior change expertise with the physician's medical care. Such models can also enhance medical training programs by providing resident physicians with live, case-based learning opportunities when partnered with a BHC to address patient health behaviors. We will describe the development, implementation, and preliminary outcomes of a PCBH psychologist-physician interdisciplinary health behavior change clinic within a Family Medicine residency program. Patient outcomes revealed significant reductions (p < .01) in weight, BMI, and tobacco use. Implications and future directions are discussed.
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Affiliation(s)
- Scott J. Nyman
- Department of Clinical Health Psychology, Ascension Genesys Hospital, Grand Blanc, MI USA
- Departments of Family Medicine and Psychiatry, Michigan State University College of Human Medicine, Lansing, MI USA
- Department of Psychology, Ascension Genesys Family Health Center, 1460 N. Center Rd, Burton, MI 48509 USA
| | - Mark E. Vogel
- Department of Clinical Health Psychology, Ascension Genesys Hospital, Grand Blanc, MI USA
- Departments of Family Medicine and Psychiatry, Michigan State University College of Human Medicine, Lansing, MI USA
| | - Grant M. Heller
- Spectrum Health Lakeland, Saint Joseph, MI USA
- Department of Psychiatry, Michigan State University College of Osteopathic Medicine, Lansing, MI USA
| | - Jennifer R. Hella
- Department of Research, Ascension Genesys Hospital, Grand Blanc, MI USA
| | - Rose A. Illes
- Florida State University Family Medicine Residency Program at Lee Health, Fort Myers, FL USA
| | - Heather A. Kirkpatrick
- Department of Clinical Health Psychology, Ascension Genesys Hospital, Grand Blanc, MI USA
- Departments of Family Medicine and Psychiatry, Michigan State University College of Human Medicine, Lansing, MI USA
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22
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Ogbeide SA, Ingram M, Lloyd-Hazlett J. Primary Care Supervision: A Community of Practice. CLINICAL TEACHER 2023:e13704. [PMID: 37994386 DOI: 10.1111/tct.13704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/27/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND The goal of this project was to determine the feasibility of a Community of Practice (CoP) model to support behavioural health (BH) clinical supervisor professional development. APPROACH Fourteen supervisors participated in 13 CoP-focused workshops focused on supervision within the Primary Care Behavioural Health (PCBH) model over a 4-year period. These workshops occurred twice a semester (in person and virtually) for supervisors hosting students participating in a Health Resources and Services Administration (HRSA) Behavioural Health Workforce Education Training (BHWET) grant. The program focused on preparing masters-level clinical mental health counselling students to function as Behavioural Health Consultants (BHCs) in primary care settings in rural and urban areas. Supervisors completed post-workshop surveys on their satisfaction with the content and the impact of the workshop content on building their PCBH supervision skills. EVALUATION Supervisors were satisfied with the content presented during the CoP workshops as well as indicated improvements in their confidence with providing supervision within the PCBH model. Areas of improved confidence and competence included supervision in integrated health care settings, topics discussed in primary care, and telehealth visits. IMPLICATIONS Overall, this demonstrates an approach to building supervisor confidence in working with pre-licensure trainees within the PCBH model. CoP workshops show promise as an approach that institutions of higher education and health care organisation can adopt to improve clinical teaching and supervision in primary care as well as support supervisors in the community who work with trainees in primary care.
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Schweitzer J, Bird A, Bowers H, Carr-Lee N, Gibney J, Schellinger K, Holt JR, Adams DP, Hensler DJ, Hollenbach K. Developing an innovative pediatric integrated mental health care program: interdisciplinary team successes and challenges. Front Psychiatry 2023; 14:1252037. [PMID: 38045623 PMCID: PMC10693412 DOI: 10.3389/fpsyt.2023.1252037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/24/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Children and adolescents often do not receive mental healthcare when they need it. By 2021, the complex impact of the COVID-19 pandemic, structural racism, inequality in access to healthcare, and a growing shortage of mental health providers led to a national emergency in child and adolescent mental health in the United States. The need for effective, accessible treatment is more pressing than ever. Interdisciplinary, team-based pediatric integrated mental healthcare has been shown to be efficacious, accessible, and cost-effective. Methods In response to the youth mental health crisis, Rady Children's Hospital-San Diego's Transforming Mental Health Initiative aimed to increase early identification of mental illness and improve access to effective treatment for children and adolescents. A stakeholder engagement process was established with affiliated pediatric clinics, community mental health organizations, and existing pediatric integrated care programs, leading to the development of the Primary Care Mental Health Integration program and drawing from established models of integrated care: Primary Care Behavioral Health and Collaborative Care. Results As of 2023, the Primary Care Mental Health Integration program established integrated care teams in 10 primary care clinics across San Diego and Riverside counties in California. Measurement-based care has been implemented and preliminary results indicate that patient response to therapy has resulted in a 44% reduction in anxiety symptoms and a 62% decrease in depression symptoms. The program works toward fiscal sustainability via fee-for-service reimbursement and more comprehensive payor contracts. The impact on patients, primary care provider satisfaction, measurement-based care, funding strategies, as well as challenges faced and changes made will be discussed using the lens of the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Discussion Preliminary results suggest that the Primary Care Mental Health Integration is a highly collaborative integrated care model that identifies the needs of children and adolescents and delivers brief, evidence informed treatment. The successful integration of this model into 10 primary care clinics over 3 years has laid the groundwork for future program expansion. This model of care can play a role addressing youth mental health and increasing access to care. Challenges, successes, and lessons learned will be reviewed.
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Affiliation(s)
- Jason Schweitzer
- Child and Adolescent Division, Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
| | - Anne Bird
- Child and Adolescent Division, Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
| | - Hilary Bowers
- Child and Adolescent Division, Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
- Children’s Primary Care Medical Group, San Diego, CA, United States
| | - Nicole Carr-Lee
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
| | - Josh Gibney
- Child and Adolescent Division, Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
| | - Kriston Schellinger
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
| | - Jasmine R. Holt
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
| | - Devin P. Adams
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
| | - Domonique J. Hensler
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
| | - Kathryn Hollenbach
- Transforming Mental Health Initiative, Rady Children’s Hospital-San Diego, San Diego, CA, United States
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States
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Farnsworth von Cederwald A, Lilja JL, Hentati Isacsson N, Kaldo V. Primary Care Behavioral Health in Sweden - a protocol of a cluster randomized trial evaluating outcomes related to implementation, organization, and patients (KAIROS). BMC Health Serv Res 2023; 23:1188. [PMID: 37907899 PMCID: PMC10619326 DOI: 10.1186/s12913-023-10180-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/18/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Providing comprehensive and continuous care for patients whose conditions have mental or behavioral components is a central challenge in primary care and an important part of improving universal health coverage. There is a great need for high and routine availability of psychological interventions, but traditional methods for delivering psychotherapy often result in low reach and long wait times. Primary Care Behavioral Health (PCBH) is a method for organizing primary care in which behavioral health staff provide brief, flexible interventions to a large part of the population in active collaboration with other providers. While PCBH holds promise in addressing important challenges, it has not yet been thoroughly evaluated. METHODS This cluster randomized trial will assess 17 primary care centers (PCCs) that are starting a PCBH implementation process. The PCCs will be divided into two groups, with one starting immediate implementation and the other acting as a control, implementing six months later. The purpose of the study is to strengthen the evidence base for PCBH regarding implementation-, organization-, and patient-level outcomes, taking into consideration that there is a partially dependent relationship between the three levels. Patient outcomes (such as increased daily functioning and reduction of symptoms) may be dependent on organizational changes (such as availability of treatment, waiting times and interprofessional teamwork), which in turn requires change in implementation outcomes (most notably, model fidelity). In addition to the main analysis, five secondary analyses will compare groups based on different combinations of randomization and time periods, specifically before and after each center achieves sufficient PCBH fidelity. DISCUSSION A randomized comparison of PCBH and traditional primary care has, to our knowledge, not been made before. While the naturalistic setting and the intricacies of implementation pose certain challenges, we have designed this study in an effort to evaluate the causal effects of PCBH despite these complex aspects. The results of this project will be helpful in guiding decisions on how to organize the delivery of behavioral interventions and psychological treatment within the context of primary care in Sweden and elsewhere. TRIAL REGISTRATION ClinicalTrials.gov: NCT05335382. Retrospectively registered on March 13th, 2022.
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Affiliation(s)
| | - Josefine L Lilja
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - Nils Hentati Isacsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Viktor Kaldo
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Shepardson RL, Funderburk JS, Weisberg RB, Maisto SA. Brief, modular, transdiagnostic, cognitive-behavioral intervention for anxiety in veteran primary care: Development, provider feedback, and open trial. Psychol Serv 2023; 20:622-635. [PMID: 35099230 PMCID: PMC10166236 DOI: 10.1037/ser0000622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anxiety is undertreated in primary care, and most treatment provided is pharmacological rather than behavioral. Integrating behavioral health providers (BHPs) using the Primary Care Behavioral Health (PCBH) model can help address this treatment gap, but brief interventions suitable for use in PCBH practice are needed. We developed a modular, cognitive-behavioral anxiety intervention, Modular Anxiety Skills Training (MAST), that is evidence-based, transdiagnostic, feasible for PCBH, and patient-centered. MAST comprises up to six 30-min sessions emphasizing skills training. This article describes the rationale for and development of MAST as well as pilot work in the Veterans Health Administration (VA) to tailor and refine MAST for delivery to Veterans in VA primary care (MAST-V) to improve feasibility for VA BHPs and acceptability to Veterans. We used a convergent mixed-methods design with concurrent data collection. In phase one, we interviewed five BHPs to obtain feedback on the treatment manual. BHPs assessed MAST-V to be highly compatible with PCBH and provided suggestions to enhance feasibility. In phase two, we conducted an open trial in which six Veterans experiencing clinically significant anxiety received and provided feedback on all nine possible modules; we also assessed changes in mental health symptoms and functioning as well as treatment satisfaction and credibility. Veterans found MAST-V to be highly acceptable, and pre-post clinical outcomes were very promising with large effect sizes. Findings from this initial pilot provide preliminary support for the feasibility, acceptability, and efficacy of MAST-V and suggest further research with a randomized clinical trial is warranted. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Robyn L. Shepardson
- Center for Integrated Healthcare, Syracuse VA Medical Center
- Department of Psychology, Syracuse University
| | - Jennifer S. Funderburk
- Center for Integrated Healthcare, Syracuse VA Medical Center
- Department of Psychology, Syracuse University
- Department of Psychiatry, University of Rochester
| | - Risa B. Weisberg
- VA Boston Healthcare System
- Department of Psychiatry, Boston University School of Medicine
- Department of Family Medicine, Alpert Medical School, Brown University
| | - Stephen A. Maisto
- Center for Integrated Healthcare, Syracuse VA Medical Center
- Department of Psychology, Syracuse University
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Trabold N, King PR, Crasta D, Iverson KM, Crane CA, Buckheit K, Bosco SC, Funderburk JS. Leveraging Integrated Primary Care to Enhance the Health System Response to IPV: Moving toward Primary Prevention Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5701. [PMID: 37174219 PMCID: PMC10178447 DOI: 10.3390/ijerph20095701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
Intimate partner violence (IPV) is a prominent public health problem in the United States, with significant health impacts that are often severe and persistent. Healthcare systems have been called upon to improve both the systematic identification and treatment of IPV largely by adopting secondary and tertiary prevention efforts. Research to date demonstrates both benefits and challenges with the current strategies employed. In this paper, we summarize current knowledge about the healthcare system's response to IPV and evaluate the strengths, limitations, and opportunities. We offer recommendations to broaden the continuum of healthcare resources to address IPV, which include a population health approach to primary prevention.
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Affiliation(s)
- Nicole Trabold
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
- Rochester Institute of Technology, College of Health Science and Technology, Rochester, NY 14623, USA
| | - Paul R King
- Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY 14215, USA
- Department of Counseling, School, and Educational Psychology, University at Buffalo, Buffalo, NY 14260, USA
| | - Dev Crasta
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY 14424, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Katherine M Iverson
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Cory A Crane
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
- Rochester Institute of Technology, College of Health Science and Technology, Rochester, NY 14623, USA
| | - Katherine Buckheit
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
| | - Stephen C Bosco
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
| | - Jennifer S Funderburk
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
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Franco MI, Staab EM, Zhu M, Knitter A, Wan W, Gibbons R, Vinci L, Shah S, Yohanna D, Beckman N, Laiteerapong N. Pragmatic Clinical Trial of Population Health, Portal-Based Depression Screening: the PORTAL-Depression Study. J Gen Intern Med 2023; 38:857-864. [PMID: 36127535 PMCID: PMC9488885 DOI: 10.1007/s11606-022-07779-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/30/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND A population health approach to depression screening using patient portals may be a promising strategy to proactively engage and identify patients with depression. OBJECTIVE To determine whether a population health approach to depression screening is more effective than screening during clinic appointments alone for identifying patients with depression. DESIGN A pragmatic clinical trial at an adult outpatient internal medicine clinic at an urban, academic, tertiary care center. PATIENTS Eligible patients (n = 2713) were adults due for depression screening with active portal accounts. Patients with documented depression or bipolar disorder and those who had been screened in the year prior to the study were excluded. INTERVENTION Patients were randomly assigned to usual (n = 1372) or population healthcare (n = 1341). For usual care, patients were screened by medical assistants during clinic appointments. Population healthcare patients were sent letters through the portal inviting them to fill out an online screener regardless of whether they had a scheduled appointment. The same screening tool, the Computerized Adaptive Test for Mental Health (CAT-MH™), was used for clinic- and portal-based screening. MAIN MEASURES The primary outcome was the depression screening rate. KEY RESULTS The depression screening rate in the population healthcare arm was higher than that in the usual care arm (43% (n = 578) vs. 33% (n = 459), p < 0.0001). The rate of positive screens was also higher in the population healthcare arm compared to that in the usual care (10% (n = 58) vs. 4% (n = 17), p < 0.001). CONCLUSION Findings suggest depression screening via a portal as part of a population health approach can increase screening and case identification, compared to usual care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03832283.
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Affiliation(s)
| | - Erin M Staab
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Mengqi Zhu
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Wen Wan
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Robert Gibbons
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Lisa Vinci
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Sachin Shah
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Daniel Yohanna
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Nancy Beckman
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Neda Laiteerapong
- Department of Medicine, University of Chicago, Chicago, IL, USA.
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.
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Colistra AL, Ward A, Smith E. Health Disparities, Substance-Use Disorders, and Primary-Care. Prim Care 2023; 50:57-69. [PMID: 36822728 DOI: 10.1016/j.pop.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This chapter discusses the barriers related to treating substance use disorders (SUD) in primary-care building an argument that stigma is the largest health disparity left to overcome in this setting. Reviewing the history of treatment in primary-care, common medications prescribed, laws, and regulations that make this care possible in this setting. Owing to the sheer numbers of people with SUD and mental health concerns, primary-care and their related payers must recognize for many regions of the United States those community needs are related to the diagnosis and treatment of SUDs and their related behavioral and physical health problems.
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Affiliation(s)
- Angela L Colistra
- Lehigh Valley Health Network Department of Family Medicine, 707 Hamilton Street, 8th Floor, Allentown, PA 18101, USA; University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | - Andrea Ward
- Lehigh Valley Health Network Department of Family Medicine, 707 Hamilton Street, 8th Floor, Allentown, PA 18101, USA; LVPG Family Medicine-Hamburg, Lehigh Valley Health Network, 700 Hawk Ridge Drive, Hamburg, PA 19526, USA
| | - Erin Smith
- Lehigh Valley Health Network Department of Family Medicine, 707 Hamilton Street, 8th Floor, Allentown, PA 18101, USA; University of South Florida Morsani College of Medicine, Tampa, FL, USA; Neighborhood Centers of the Lehigh Valley, 218 North 2nd Street, Allentown, PA 18102, USA
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29
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McConaghy K, Rullan P, Murray T, Molloy R, Heinberg LJ, Piuzzi NS. Team Approach: Management of Mental Health in Orthopaedic Patients. JBJS Rev 2023; 11:01874474-202302000-00003. [PMID: 36763707 DOI: 10.2106/jbjs.rvw.22.00167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
» Mental health evaluation should be considered an essential part of the routine preoperative assessment and should be managed by a multidisciplinary team composed of the primary care physician, orthopaedic provider, and behavioral health specialist. » The scientific literature indicates that patients without comorbid psychiatric symptoms and adaptive coping strategies, resilience, and well-managed expectations have improved functional outcomes and satisfaction after orthopaedic procedures. » Psychological issues are multifaceted and require treatment tailored to each individual patient. Therefore, close communication between all members of the care team is required to create and execute the perioperative plan.
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Affiliation(s)
- Kara McConaghy
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Pedro Rullan
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Trevor Murray
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert Molloy
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Leslie J Heinberg
- Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio.,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio.,Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Funderburk JS, Gass JC, Wray JM, Shepardson RL. Prevalence and predictors of team-based care activities between primary care providers and embedded behavioral health providers: a national survey. J Interprof Care 2023; 37:58-65. [PMID: 34979874 DOI: 10.1080/13561820.2021.2004098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Primary care (PC) settings increasingly use team-based care activities with embedded behavioral health providers (BHPs) to enhance patient care via group medical visits, conjoint appointments, team huddles, and warm handoffs. Aim 1 was to describe the variation of team-based care activities within integrated PC clinics. Aim 2 was to explore whether factors associated with the BHP (e.g., gender, training, and experience) and the PC setting (e.g., perceived teamwork) predict engagement in team-based activities. A national sample of eligible BHPs (n = 345; 14.2% response rate) completed an anonymous survey assessing the presence/intensity of team-based care activities. 90% of BHPs reported regularly engaging in team-based care activities with PC teams. Most engagement occurred when providing feedback to PC providers (90.4% at least daily) and during warm handoffs (90.4% at least once daily). Engagement in team-based care was predicted by the level of teamwork occurring within the PC clinic (βs = .41-.47; ps < .001) and BHP characteristics, such as the number of years spent in PC (βs = .24-.26, ps < .001). Although these data are promising, with many BHPs reportedly engaging in team-based activities with PC teams, there is significant variation. Researchers should continue to explore whether the engagement in these team-based care activities enhances patient care.
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Affiliation(s)
- Jennifer S Funderburk
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Julie C Gass
- Va Center for Integrated Healthcare, Western New York Va Healthcare System, Buffalo, NY, USA.,Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jennifer M Wray
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Robyn L Shepardson
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA
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Stretton C, Chan WY, Wepa D. Demystifying Case Management in Aotearoa New Zealand: A Scoping and Mapping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:784. [PMID: 36613105 PMCID: PMC9819615 DOI: 10.3390/ijerph20010784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/14/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Community-based case managers in health have been compared to glue which holds the dynamic needs of clients to a disjointed range of health and social services. However, case manager roles are difficult to understand due to poorly defined roles, confusing terminology, and low visibility in New Zealand. AIM This review aims to map the landscape of case management work to advance workforce planning by clarifying the jobs, roles, and relationships of case managers in Aotearoa New Zealand (NZ). METHODS Our scoping and mapping review includes peer-reviewed articles, grey literature sources, and interview data from 15 case managers. Data was charted iteratively until convergent patterns emerged and distinctive roles identified. RESULTS A rich and diverse body of literature describing and evaluating case management work in NZ (n = 148) is uncovered with at least 38 different job titles recorded. 18 distinctive roles are further analyzed with sufficient data to explore the research question. Social ecology maps highlight diverse interprofessional and intersectoral relationships. CONCLUSIONS Significant innovation and adaptations are evident in this field, particularly in the last five years. Case managers also known as health navigators, play a pivotal but often undervalued role in NZ health care, through their interprofessional and intersectoral relationships. Their work is often unrecognised which impedes workforce development and the promotion of person-centered and integrated health care.
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Affiliation(s)
- Caroline Stretton
- Centre for Person Centred Research (PCR), School of Clinical Sciences, Faculty of Health and Environmental Sciences, AUT University, North Shore, Auckland 1142, New Zealand
- School of Public Health and Interdisciplinary Studies, Faculty of Health and Environmental Sciences, AUT University, North Shore, Auckland 1142, New Zealand
| | - Wei-Yen Chan
- School of Public Health and Interdisciplinary Studies, Faculty of Health and Environmental Sciences, AUT University, North Shore, Auckland 1142, New Zealand
| | - Dianne Wepa
- School of Public Health and Interdisciplinary Studies, Faculty of Health and Environmental Sciences, AUT University, North Shore, Auckland 1142, New Zealand
- School of Nursing & Healthcare Leadership, Faculty of Health Studies, University of Bradford, Bradford BD7 1DP, UK
- Mental Health and Suicide Prevention Research and Education Group, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
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Pourat N, Tieu L, Martinez AE. Measuring Behavioral Health Integration in Primary Care. Popul Health Manag 2022; 25:721-728. [PMID: 36576384 PMCID: PMC10024064 DOI: 10.1089/pop.2022.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Behavioral health integration (BHI) within primary care settings is shown to improve outcomes. However, achieving BHI requires identifying best practices and a reliable tool that can be used to measure existing levels and progress toward BHI. The objective of this study was to develop and apply a conceptual framework to measure BHI, test the approach, and examine challenges to achieving BHI. Surveys and interviews were conducted with key informants within 17 designated public hospitals in California at the midpoint of participating in a 5-year project to establish BHI. A framework and coding methodology were developed to assess BHI best practices at each hospital. BHI status was assessed in the domains of infrastructure and process. Each domain included 5 themes such as electronic health record integration and functionality (infrastructure) and interprovider communication (process). Themes were assessed using a 6-point scale for various activities under a theme and associated weights. Theme-specific values were standardized from 0% to 100% to compare BHI scores between hospitals. Overall progress toward BHI ranged from scores of 52% to 83% (mean 63%) and indicated greater contribution of infrastructure versus process implementation. Within the infrastructure domain, scores were higher for having institutional and provider support, but lagged in establishing provider proximity. Within the process domain, scores were highest for implementation of behavioral health screening, but were frequently lower for other themes such as use of care coordination and referral processes. Further research is needed to test the robustness of this approach in other settings.
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Affiliation(s)
- Nadereh Pourat
- Health Economics and Evaluation Research Program, UCLA Center for Health Policy Research, Los Angeles, California, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Lina Tieu
- Health Economics and Evaluation Research Program, UCLA Center for Health Policy Research, Los Angeles, California, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Ana E. Martinez
- Health Economics and Evaluation Research Program, UCLA Center for Health Policy Research, Los Angeles, California, USA
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Phillips J, Salsman NL, Rigdon D, Taylor J, Buell J, Ronis-Tobin V. Implementation of an integrated primary care behavioral health training model on campus. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022:1-4. [PMID: 36357343 DOI: 10.1080/07448481.2022.2141061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/23/2022] [Indexed: 06/16/2023]
Abstract
In the last 15 years, demand has surged among college students for mental health care and many campuses are struggling to keep up with the demand for services. Primary care services represent a pathway where individuals can receive mental health care without accessing specialty mental health services. There is evidence that integrating mental health services into primary care can reduce racial disparities in access to mental health care and provide greater access to mental health care for underserved persons. This paper describes the development and implementation of a fully integrated model of mental health care services into Xavier University's (XU) primary care clinic. In partnership with TriHealth, a local healthcare provider, and following the primary care behavioral care model, XU integrated supervised psychology doctoral students as behavior health consultants into a campus primary care clinic. Administrative, clinical care, and training processes together with preliminary findings and recommendations are shared.
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Affiliation(s)
| | | | | | - Janie Taylor
- School of Psychology, Xavier University, Cincinnati, Ohio, USA
| | - John Buell
- School of Psychology, Xavier University, Cincinnati, Ohio, USA
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Johnson K, Diallo K, Hennein R, Shelby T, Zhou X, Gupta AJ, Ludomirsky A, Weiss JM, Nunez-Smith M, Soto K, Davis JL. Centering Health Equity Within COVID-19 Contact Tracing: Connecticut's Community Outreach Specialist Program. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:728-738. [PMID: 36194817 PMCID: PMC9560910 DOI: 10.1097/phh.0000000000001608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CONTEXT The COVID-19 pandemic has disproportionately impacted vulnerable populations, including those who are non-English-speaking and those with lower socioeconomic status; yet, participation of these groups in contact tracing was initially low. Distrust of government agencies, anticipated COVID-19-related stigma, and language and cultural barriers between contact tracers and communities are common challenges. PROGRAM The Community Outreach Specialist (COS) program was established within the Connecticut Department of Public Health (DPH) COVID-19 contact tracing program to encourage participation in contact tracing and address a need for culturally competent care and social and material support among socially vulnerable and non-English-speaking populations in 11 high-burden jurisdictions in Connecticut. IMPLEMENTATION In partnership with state and local health departments, we recruited 25 COS workers with relevant language skills from target communities and trained them to deliver contact tracing services to vulnerable and non-English speaking populations. EVALUATION We conducted a cross-sectional analysis using data from ContaCT, DPH's enterprise contact tracing system. Overall, the COS program enrolled 1938 cases and 492 contacts. The proportion of residents reached (ie, called and interviewed) in the COS program was higher than that in the regular contact tracing program for both cases (70% vs 57%, P < .001) and contacts (84% vs 64%, P < .001). After adjusting for client age, sex, race and ethnicity, language, and jurisdiction, we found that the COS program was associated with increased reach for contacts (odds ratio [OR] = 1.52; 95% confidence interval [95% CI], 1.17-1.99) but not for cases (OR = 0.78; 95% CI, 0.70-0.88). Rapid qualitative analysis of programmatic field notes and meeting reports provided evidence that the COS program was feasible and acceptable to clients and contributed to COVID-19 education and communication efforts. CONCLUSION A COS program employing a client-centered, community-engaged strategy for reaching vulnerable and non-English-speaking populations was feasible and more effective at reaching contacts than standard COVID-19 contact tracing.
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Affiliation(s)
- Kelly Johnson
- Connecticut Department of Public Health, Hartford, Connecticut (Dr Johnson and Mss Diallo and Soto); Global Health Justice Partnership, Yale Law School, New Haven, Connecticut (Dr Johnson); Department of Epidemiology of Microbial Diseases (Mss Hennein and Gupta, Mr Shelby, and Dr Davis), Department of Biostatistics (Dr Zhou), Pulmonary, Critical Care and Sleep Medicine Section (Drs Davis, Zhou), and Center for Methods in Implementation and Prevention Science (Dr Davis), Yale School of Public Health, New Haven, Connecticut; Yale National Clinician Scholars Program (Drs Ludomirsky and Nunez-Smith), Equity, Research, and Innovation Center (Ms Weiss and Dr Nunez-Smith), and Center for Research Engagement (Dr Nunez-Smith), Yale School of Medicine, New Haven, Connecticut; Section of Pediatric Hospitalist Medicine, Department of Pediatrics, Yale New Haven Children's Hospital, New Haven, Connecticut (Dr Ludomirsky); and Section of General Medicine, Department of Internal Medicine, Yale New Haven Health System, New Haven, Connecticut (Ms Weiss and Dr Nunez-Smith)
| | - Kadijatou Diallo
- Connecticut Department of Public Health, Hartford, Connecticut (Dr Johnson and Mss Diallo and Soto); Global Health Justice Partnership, Yale Law School, New Haven, Connecticut (Dr Johnson); Department of Epidemiology of Microbial Diseases (Mss Hennein and Gupta, Mr Shelby, and Dr Davis), Department of Biostatistics (Dr Zhou), Pulmonary, Critical Care and Sleep Medicine Section (Drs Davis, Zhou), and Center for Methods in Implementation and Prevention Science (Dr Davis), Yale School of Public Health, New Haven, Connecticut; Yale National Clinician Scholars Program (Drs Ludomirsky and Nunez-Smith), Equity, Research, and Innovation Center (Ms Weiss and Dr Nunez-Smith), and Center for Research Engagement (Dr Nunez-Smith), Yale School of Medicine, New Haven, Connecticut; Section of Pediatric Hospitalist Medicine, Department of Pediatrics, Yale New Haven Children's Hospital, New Haven, Connecticut (Dr Ludomirsky); and Section of General Medicine, Department of Internal Medicine, Yale New Haven Health System, New Haven, Connecticut (Ms Weiss and Dr Nunez-Smith)
| | - Rachel Hennein
- Connecticut Department of Public Health, Hartford, Connecticut (Dr Johnson and Mss Diallo and Soto); Global Health Justice Partnership, Yale Law School, New Haven, Connecticut (Dr Johnson); Department of Epidemiology of Microbial Diseases (Mss Hennein and Gupta, Mr Shelby, and Dr Davis), Department of Biostatistics (Dr Zhou), Pulmonary, Critical Care and Sleep Medicine Section (Drs Davis, Zhou), and Center for Methods in Implementation and Prevention Science (Dr Davis), Yale School of Public Health, New Haven, Connecticut; Yale National Clinician Scholars Program (Drs Ludomirsky and Nunez-Smith), Equity, Research, and Innovation Center (Ms Weiss and Dr Nunez-Smith), and Center for Research Engagement (Dr Nunez-Smith), Yale School of Medicine, New Haven, Connecticut; Section of Pediatric Hospitalist Medicine, Department of Pediatrics, Yale New Haven Children's Hospital, New Haven, Connecticut (Dr Ludomirsky); and Section of General Medicine, Department of Internal Medicine, Yale New Haven Health System, New Haven, Connecticut (Ms Weiss and Dr Nunez-Smith)
| | - Tyler Shelby
- Connecticut Department of Public Health, Hartford, Connecticut (Dr Johnson and Mss Diallo and Soto); Global Health Justice Partnership, Yale Law School, New Haven, Connecticut (Dr Johnson); Department of Epidemiology of Microbial Diseases (Mss Hennein and Gupta, Mr Shelby, and Dr Davis), Department of Biostatistics (Dr Zhou), Pulmonary, Critical Care and Sleep Medicine Section (Drs Davis, Zhou), and Center for Methods in Implementation and Prevention Science (Dr Davis), Yale School of Public Health, New Haven, Connecticut; Yale National Clinician Scholars Program (Drs Ludomirsky and Nunez-Smith), Equity, Research, and Innovation Center (Ms Weiss and Dr Nunez-Smith), and Center for Research Engagement (Dr Nunez-Smith), Yale School of Medicine, New Haven, Connecticut; Section of Pediatric Hospitalist Medicine, Department of Pediatrics, Yale New Haven Children's Hospital, New Haven, Connecticut (Dr Ludomirsky); and Section of General Medicine, Department of Internal Medicine, Yale New Haven Health System, New Haven, Connecticut (Ms Weiss and Dr Nunez-Smith)
| | - Xin Zhou
- Connecticut Department of Public Health, Hartford, Connecticut (Dr Johnson and Mss Diallo and Soto); Global Health Justice Partnership, Yale Law School, New Haven, Connecticut (Dr Johnson); Department of Epidemiology of Microbial Diseases (Mss Hennein and Gupta, Mr Shelby, and Dr Davis), Department of Biostatistics (Dr Zhou), Pulmonary, Critical Care and Sleep Medicine Section (Drs Davis, Zhou), and Center for Methods in Implementation and Prevention Science (Dr Davis), Yale School of Public Health, New Haven, Connecticut; Yale National Clinician Scholars Program (Drs Ludomirsky and Nunez-Smith), Equity, Research, and Innovation Center (Ms Weiss and Dr Nunez-Smith), and Center for Research Engagement (Dr Nunez-Smith), Yale School of Medicine, New Haven, Connecticut; Section of Pediatric Hospitalist Medicine, Department of Pediatrics, Yale New Haven Children's Hospital, New Haven, Connecticut (Dr Ludomirsky); and Section of General Medicine, Department of Internal Medicine, Yale New Haven Health System, New Haven, Connecticut (Ms Weiss and Dr Nunez-Smith)
| | - Amanda J. Gupta
- Connecticut Department of Public Health, Hartford, Connecticut (Dr Johnson and Mss Diallo and Soto); Global Health Justice Partnership, Yale Law School, New Haven, Connecticut (Dr Johnson); Department of Epidemiology of Microbial Diseases (Mss Hennein and Gupta, Mr Shelby, and Dr Davis), Department of Biostatistics (Dr Zhou), Pulmonary, Critical Care and Sleep Medicine Section (Drs Davis, Zhou), and Center for Methods in Implementation and Prevention Science (Dr Davis), Yale School of Public Health, New Haven, Connecticut; Yale National Clinician Scholars Program (Drs Ludomirsky and Nunez-Smith), Equity, Research, and Innovation Center (Ms Weiss and Dr Nunez-Smith), and Center for Research Engagement (Dr Nunez-Smith), Yale School of Medicine, New Haven, Connecticut; Section of Pediatric Hospitalist Medicine, Department of Pediatrics, Yale New Haven Children's Hospital, New Haven, Connecticut (Dr Ludomirsky); and Section of General Medicine, Department of Internal Medicine, Yale New Haven Health System, New Haven, Connecticut (Ms Weiss and Dr Nunez-Smith)
| | - Avital Ludomirsky
- Connecticut Department of Public Health, Hartford, Connecticut (Dr Johnson and Mss Diallo and Soto); Global Health Justice Partnership, Yale Law School, New Haven, Connecticut (Dr Johnson); Department of Epidemiology of Microbial Diseases (Mss Hennein and Gupta, Mr Shelby, and Dr Davis), Department of Biostatistics (Dr Zhou), Pulmonary, Critical Care and Sleep Medicine Section (Drs Davis, Zhou), and Center for Methods in Implementation and Prevention Science (Dr Davis), Yale School of Public Health, New Haven, Connecticut; Yale National Clinician Scholars Program (Drs Ludomirsky and Nunez-Smith), Equity, Research, and Innovation Center (Ms Weiss and Dr Nunez-Smith), and Center for Research Engagement (Dr Nunez-Smith), Yale School of Medicine, New Haven, Connecticut; Section of Pediatric Hospitalist Medicine, Department of Pediatrics, Yale New Haven Children's Hospital, New Haven, Connecticut (Dr Ludomirsky); and Section of General Medicine, Department of Internal Medicine, Yale New Haven Health System, New Haven, Connecticut (Ms Weiss and Dr Nunez-Smith)
| | - June-Marie Weiss
- Connecticut Department of Public Health, Hartford, Connecticut (Dr Johnson and Mss Diallo and Soto); Global Health Justice Partnership, Yale Law School, New Haven, Connecticut (Dr Johnson); Department of Epidemiology of Microbial Diseases (Mss Hennein and Gupta, Mr Shelby, and Dr Davis), Department of Biostatistics (Dr Zhou), Pulmonary, Critical Care and Sleep Medicine Section (Drs Davis, Zhou), and Center for Methods in Implementation and Prevention Science (Dr Davis), Yale School of Public Health, New Haven, Connecticut; Yale National Clinician Scholars Program (Drs Ludomirsky and Nunez-Smith), Equity, Research, and Innovation Center (Ms Weiss and Dr Nunez-Smith), and Center for Research Engagement (Dr Nunez-Smith), Yale School of Medicine, New Haven, Connecticut; Section of Pediatric Hospitalist Medicine, Department of Pediatrics, Yale New Haven Children's Hospital, New Haven, Connecticut (Dr Ludomirsky); and Section of General Medicine, Department of Internal Medicine, Yale New Haven Health System, New Haven, Connecticut (Ms Weiss and Dr Nunez-Smith)
| | - Marcella Nunez-Smith
- Connecticut Department of Public Health, Hartford, Connecticut (Dr Johnson and Mss Diallo and Soto); Global Health Justice Partnership, Yale Law School, New Haven, Connecticut (Dr Johnson); Department of Epidemiology of Microbial Diseases (Mss Hennein and Gupta, Mr Shelby, and Dr Davis), Department of Biostatistics (Dr Zhou), Pulmonary, Critical Care and Sleep Medicine Section (Drs Davis, Zhou), and Center for Methods in Implementation and Prevention Science (Dr Davis), Yale School of Public Health, New Haven, Connecticut; Yale National Clinician Scholars Program (Drs Ludomirsky and Nunez-Smith), Equity, Research, and Innovation Center (Ms Weiss and Dr Nunez-Smith), and Center for Research Engagement (Dr Nunez-Smith), Yale School of Medicine, New Haven, Connecticut; Section of Pediatric Hospitalist Medicine, Department of Pediatrics, Yale New Haven Children's Hospital, New Haven, Connecticut (Dr Ludomirsky); and Section of General Medicine, Department of Internal Medicine, Yale New Haven Health System, New Haven, Connecticut (Ms Weiss and Dr Nunez-Smith)
| | - Kristen Soto
- Connecticut Department of Public Health, Hartford, Connecticut (Dr Johnson and Mss Diallo and Soto); Global Health Justice Partnership, Yale Law School, New Haven, Connecticut (Dr Johnson); Department of Epidemiology of Microbial Diseases (Mss Hennein and Gupta, Mr Shelby, and Dr Davis), Department of Biostatistics (Dr Zhou), Pulmonary, Critical Care and Sleep Medicine Section (Drs Davis, Zhou), and Center for Methods in Implementation and Prevention Science (Dr Davis), Yale School of Public Health, New Haven, Connecticut; Yale National Clinician Scholars Program (Drs Ludomirsky and Nunez-Smith), Equity, Research, and Innovation Center (Ms Weiss and Dr Nunez-Smith), and Center for Research Engagement (Dr Nunez-Smith), Yale School of Medicine, New Haven, Connecticut; Section of Pediatric Hospitalist Medicine, Department of Pediatrics, Yale New Haven Children's Hospital, New Haven, Connecticut (Dr Ludomirsky); and Section of General Medicine, Department of Internal Medicine, Yale New Haven Health System, New Haven, Connecticut (Ms Weiss and Dr Nunez-Smith)
| | - J. Lucian Davis
- Connecticut Department of Public Health, Hartford, Connecticut (Dr Johnson and Mss Diallo and Soto); Global Health Justice Partnership, Yale Law School, New Haven, Connecticut (Dr Johnson); Department of Epidemiology of Microbial Diseases (Mss Hennein and Gupta, Mr Shelby, and Dr Davis), Department of Biostatistics (Dr Zhou), Pulmonary, Critical Care and Sleep Medicine Section (Drs Davis, Zhou), and Center for Methods in Implementation and Prevention Science (Dr Davis), Yale School of Public Health, New Haven, Connecticut; Yale National Clinician Scholars Program (Drs Ludomirsky and Nunez-Smith), Equity, Research, and Innovation Center (Ms Weiss and Dr Nunez-Smith), and Center for Research Engagement (Dr Nunez-Smith), Yale School of Medicine, New Haven, Connecticut; Section of Pediatric Hospitalist Medicine, Department of Pediatrics, Yale New Haven Children's Hospital, New Haven, Connecticut (Dr Ludomirsky); and Section of General Medicine, Department of Internal Medicine, Yale New Haven Health System, New Haven, Connecticut (Ms Weiss and Dr Nunez-Smith)
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Crasta D, Crane CA, Trabold N, Shepardson RL, Possemato K, Funderburk JS. Relationship Health and Intimate Partner Violence in Integrated Primary Care: Individual Characteristics and Preferences for Relationship Support across Risk Levels. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192113984. [PMID: 36360867 PMCID: PMC9654718 DOI: 10.3390/ijerph192113984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 05/27/2023]
Abstract
This study explores differences in characteristics and relationship treatment preferences across different levels of intimate partner violence (IPV) among Veterans Affairs (VA) primary care patients. In Fall 2019, we sent a mail-in survey assessing relationship healthcare needs to N = 299 Veterans randomly sampled from 20 northeastern VA primary care clinics (oversampling female and younger Veterans). We compared those reporting past year use or experience of physical/sexual aggression, threats/coercion, or injury (Severe IPV; 21%), to those only reporting yelling and screaming (Verbal Conflict; 51%), and denying any IPV (No IPV; 28%). Participants across groups desired 2-6 sessions of face-to-face support for couples' health and communication. No IPV participants were older and had preferred treatment in primary care. The Verbal Conflict and Severe IPV groups were both flagged by IPV screens and had similar interest in couple treatment and relationship evaluation. The Severe IPV group had higher rates of harms (e.g., depression, alcohol use disorder, relationship dissatisfaction, fear of partner) and higher interest in addressing safety outside of VA. Exploratory analyses suggested differences based on use vs. experience of Severe IPV. Findings highlight ways integrated primary care teams can differentiate services to address dissatisfaction and conflict while facilitating referrals for Severe IPV.
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Affiliation(s)
- Dev Crasta
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY 14424, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Cory A. Crane
- College of Health Science and Technology, Rochester Institute of Technology, Rochester, NY 14623, USA
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
| | - Nicole Trabold
- College of Health Science and Technology, Rochester Institute of Technology, Rochester, NY 14623, USA
| | - Robyn L. Shepardson
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
| | - Kyle Possemato
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
| | - Jennifer S. Funderburk
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY 13210, USA
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA
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McKee M, James TG, Helm KVT, Marzolf B, Chung DH, Williams J, Zazove P. Reframing Our Health Care System for Patients With Hearing Loss. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3633-3645. [PMID: 35969852 PMCID: PMC9802570 DOI: 10.1044/2022_jslhr-22-00052] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/05/2022] [Accepted: 04/19/2022] [Indexed: 06/04/2023]
Abstract
PURPOSE Nearly 20% of U.S. Americans report a hearing loss, yet our current health care system is poorly designed and equipped to effectively care for these individuals. Individuals with hearing loss report communication breakdowns, inaccessible health information, reduced awareness and training by health care providers, and decreased satisfaction while struggling with inadequate health literacy. These all contribute to health inequities and increased health care expenditures and inefficiencies. It is time to reframe the health care system for these individuals using existing models of best practices and accessibility to mitigate inequities and improve quality of care. METHOD A review of system-, clinic-, provider-, and patient-level barriers, along with existing and suggested efforts to improve care for individuals with hearing loss, are presented. RESULTS These strategies include improving screening and identification of hearing loss, adopting universal design and inclusion principles, implementing effective communication approaches, leveraging assistive technologies and training, and diversifying a team to better care for patients with hearing loss. Patients should also be encouraged to seek social support and resources from hearing loss organizations while leveraging technologies to help facilitate communication. CONCLUSIONS The strategies described introduce actionable steps that can be made at the system, clinic, provider, and patient levels. With implementation of these steps, significant progress can be made to more proactively meet the needs of patients with hearing loss. Presentation Video: https://doi.org/10.23641/asha.21215843.
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Affiliation(s)
- Michael McKee
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Tyler G. James
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Kaila V. T. Helm
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Brianna Marzolf
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Dana H. Chung
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - John Williams
- Department of Population Health Science, University of Mississippi Medical Center, Jackson
| | - Philip Zazove
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
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Cos TA, Levkovich N, Tjoa CW, Williams SK, Larach CS. Integrated primary care behavioural health in a regional network of FQHC agencies during COVID-19. INTEGRATED HEALTHCARE JOURNAL 2022. [DOI: 10.1136/ihj-2022-000125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives(1) Examine the ability to sustain integrated primary care behavioural health (eg, colocation, communication and coordination) in 40 community health centres, during the COVID-19 pandemic and (2) review adaptations and challenges to provide integrated behavioural health via telehealth.Methods and analysisThis qualitative investigation assessed 55 behavioural health consultants (BHCs), via semistructured interviews, spanning 40 practice sites and 10 organisations, on their adjustment to telehealth delivery, modified practice workflows and challenges of maintaining integration while displaced by the pandemic. Assessment of the level of integrated care was also conducted with available semistructured toolsResultsThe results highlight rapid service adjustment, positive patient and provider satisfaction, increased but lowered ratings of remote BHC integration and collaboration with the primary care teams and reduced behavioural health screening, compared with prepandemic levels. This investigation also highlights the co-occurring importance of racial disparities and injustice in patient care. In several settings, BHCs had a significant support role for staff self-care.ConclusionThe COVID-19 pandemic, and its subsequent shelter-in-place mandates and telehealth care provision, has altered standard integrated behavioural health practice, yet harnessed the accessible, generalist and team-based spirit to meet the increasing behavioural health needs in this community.
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Martin MP, Bridges AJ, Cos T. Measuring Productivity in Primary Care Behavioral Health: A Delphi Study. J Clin Psychol Med Settings 2022; 29:616-623. [PMID: 34420120 DOI: 10.1007/s10880-021-09814-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
High productivity by behavioral health consultants (BHC) is a defining aspect of the primary care behavioral health (PCBH) model to maximize access to care and is often measured by patient volume. Studies of productivity in health care settings suggest a single productivity target may not be optimal. We used a Delphi method to obtain expert consensus on an operational definition of high productivity by BHCs in the PCBH model. Clinicians, managers, and researchers in PCBH were recruited to participate in a multi-round survey using a modified Delphi technique and develop consensus on PCBH productivity metrics. Ten participants completed all three survey rounds and rated 28 metrics. After three rounds, two direct metrics (average number of billable BHC visits each day; number of patients seen per day) received at least 80% consensus as "Essential", two received at least 50%, and five received less than 50%. One influencer (level of integration at the practice) received at least 80% consensus as "Very Much" influential, 19 received at least 50%, and eight items received less than 50%. Several themes arose from participant comments. PCBH productivity can be interpreted as being high volume. Numerous practice factors influence how productive a BHC may be. Future studies should determine the feasibility of our metrics in clinical practice, establish productivity expectations based on patient needs and clinic resources, and identify patient-, clinician-, or practice-level moderators of productivity.
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Affiliation(s)
- Matthew P Martin
- College of Health Solutions, Arizona State University, 550 N. 3rd St Phoenix, Phoenix, AZ, 85004, USA.
| | - Ana J Bridges
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - Travis Cos
- Health Federation of Philadelphia, Philadelphia, PA, USA
- Department of Psychology, La Salle University, Philadelphia, PA, USA
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Primary Care Behavioral Health Integration and Care Utilization: Implications for Patient Outcome and Healthcare Resource Use. J Gen Intern Med 2022; 37:2691-2697. [PMID: 35132550 PMCID: PMC9411292 DOI: 10.1007/s11606-021-07372-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 12/17/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Behavioral health (BH) integration in primary care (PC) can potentially improve outcomes and reduce cost of care. While different models of integration exist, evidence from real-world examples is needed to demonstrate the effectiveness and value of integration. This study aimed to evaluate the outcomes of six PC practice sites located in Western New York that implemented a primary care behavioral health (PCBH) integration model. OBJECTIVE To assess the impact of PCBH on all-cause healthcare utilization rates. DESIGN A retrospective observational study based on historical multi-payer health insurance claims data. Claims data were aggregated on a per-member-per-month basis to compare utilization rates among the patients in the PC practice sites that had implemented PCBH to those in the sites that had not yet done so. PARTICIPANTS The sample included 6768 unique adult health plan members between October 2015 and June 2017 with at least one BH diagnosis code who were attributed to one of the six newly integrated PC practice sites. INTERVENTIONS Under the PCBH integration model, BH specialists were embedded in PC practice sites to treat a wide range of BH conditions. MAIN MEASURES Rates of all-cause ED visits and hospital admissions, along with rates of PC provider and BH provider visits. KEY RESULTS PCBH implementation was associated with reductions in the rates of outpatient ED visits (14.2%; p < 0.001) and PC provider visits (12.0%; p < 0.001), as well as with an increased rate of BH provider visits (7.5%; p = 0.018). CONCLUSIONS PCBH integration appears to alter the treatment patterns among patients with BH conditions by shifting patient visits away from ED and PC providers toward BH providers who specialize in treatment of such patients.
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Cooper Z, Reitmeier M, Bethel SR. Health professionals' attitudes on integrated care and social work practice. SOCIAL WORK IN HEALTH CARE 2022; 61:369-386. [PMID: 35899873 DOI: 10.1080/00981389.2022.2104984] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/15/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
Research regarding the intersection of social work and integrated care has recently increased. Although research specific to the role and engagement of social workers in integrated care is promising, research regarding attitudes toward social workers on integrated behavioral health (IBH) teams remains scant. This study provides perspective regarding healthcare professionals' attitudes toward the role of social workers on IBH teams. A survey was constructed and distributed to health professionals (n = 104) from medicine, nursing, pharmacy, and social work. Mixed methods were used to evaluate survey findings. Results suggest attitudes toward social workers on IBH teams are generally favorable.
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Affiliation(s)
- Zachary Cooper
- University of Georgia School of Social Work, Athens, Georgia, USA
| | - Melissa Reitmeier
- University of South Carolina College of Social Work, Columbia, South Carolina, USA
| | - Samuel R Bethel
- University of South Carolina College of Social Work, Columbia, South Carolina, USA
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Plys E, Levy CR, Brenner LA, Vranceanu AM. Let’s Integrate! The Case for Bringing Behavioral Health to Nursing Home–Based Post-Acute and Subacute Care. J Am Med Dir Assoc 2022; 23:1461-1467.e7. [DOI: 10.1016/j.jamda.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022]
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Fisher K, Weissinger G, O'Rorke R, Edwards E, Diamond G. Consumers With Serious Mental Illness Perspectives on Care Integration: Preparation for Integration. J Am Psychiatr Nurses Assoc 2022; 28:193-202. [PMID: 35546134 DOI: 10.1177/10783903221091974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Those with serious mental illness (SMI) experience poor health outcomes which may be addressed by the integration of mental health and primary care services. This integration could be enhanced by the inclusion of consumers in the planning process. AIMS This study sought to bring the voice of the consumer with SMI to assist with the integration of primary care and mental health services. METHODS Working with a community advisory board in the City of Philadelphia, we carried out a sequential explanatory mixed-methods study. The team conducted 12 focus groups (n=149) and surveys (n = 137) of consumers with SMI about their experiences of the health care system and perspectives on integrated health. Data from surveys and focus groups were analyzed and integrated. RESULTS Three relevant themes emerged: primary care experiences; health care stigma; and social determinants as barriers to health. Generally, individuals with SMI supported the integration of care, with careful consideration given to social determinants of health, patient privacy, and respect between providers and patients. CONCLUSIONS Integration may reduce health disparities experienced by individuals with SMI, but the process must be informed by intended consumers. Policymakers and administrators will need to address barriers to care, healthcare stigma, and social determinants of health. Nurses are well placed to inform and lead healthcare integration and overcome the siloing of mental and physical healthcare systems.
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Affiliation(s)
- Kathleen Fisher
- Kathleen Fisher, PhD, CRNP, Drexel University, Philadelphia, PA, USA
| | - Guy Weissinger
- Guy Weissinger, PhD, RN, Villanova University, Villanova, PA, USA
| | - Rosemary O'Rorke
- Rosemary O'Rorke, MEd, The Philadelphia Coalition, Philadelphia, PA, USA
| | - Erica Edwards
- Erica Edwards, MSW, The Consortium, Philadelphia, PA, USA
| | - Guy Diamond
- Guy Diamond, PhD, Drexel University, Philadelphia, PA, USA
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Assessing the Use of Data Systems to Estimate Return-on-Investment of Behavioral Healthcare Interventions: Opportunities and Barriers. J Behav Health Serv Res 2022; 50:80-94. [PMID: 35415803 DOI: 10.1007/s11414-022-09794-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
Abstract
To improve access to and quality of affordable behavioral healthcare, there is a need for more research to identify which interventions can generate long-term, societal return-on-investment (ROI). Barriers to ROI studies in the behavioral health sector were explored by conducting semi-structured interviews with individuals from key stakeholder groups at state and national behavioral health-related organizations. Limited operating budgets, state-based payer systems, the lack of financial support, privacy laws, and other unique experiences of behavioral health providers and patients were identified as important factors that affect the collection and utilization of data. To comprehensively assess ROI of interventions, it is necessary to improve standardization and data infrastructure across multiple health and non-health systems and clarify or address legal, regulatory, and commercial conflicts.
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Spirituality in Primary Care Settings: Addressing the Whole Person through Christian Mindfulness. RELIGIONS 2022. [DOI: 10.3390/rel13040346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Spirituality is integral to the provision of high-quality health and mental healthcare. Despite this, there is limited research on how to assess and address spiritual determinants of health within primary care settings. Many individuals initiate care within primary care settings, and several will only receive care from their primary care provider. The high prevalence of individuals receiving care within primary care settings coupled with the positive impact spirituality has on health and mental health reveal the need to care for spiritual needs within primary care settings. Integrated care is a model of treatment that addresses the fragmentation of healthcare by assessing and addressing the psychosocial determinants of health within primary care settings. The structure of integrated care models is designed to treat the biological and psychosocial determinants of health and, as a result, provide suitable context for assessing and addressing spirituality in primary care settings. The purpose of this paper is to (1) summarize the efforts to integrate spirituality within primary care (whole person care models), (2) summarize the integrated care efforts to promote psychosocial integration, (3) highlight Christian mindfulness as a potential form of intervention to address spirituality within integrated care models, and (4) operationalize the delivery of Christian mindfulness within a fully integrated care model. The conclusions from the conceptual review include both practice innovation for the assessment and intervention of spirituality in integrated care as well as potential direction for future research to study Christian mindfulness within integrated care settings.
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Sheldrick RC, Bair-Merritt MH, Durham MP, Rosenberg J, Tamene M, Bonacci C, Daftary G, Tang MH, Sengupta N, Morris A, Feinberg E. Integrating Pediatric Universal Behavioral Health Care at Federally Qualified Health Centers. Pediatrics 2022; 149:185679. [PMID: 35347338 DOI: 10.1542/peds.2021-051822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Research supports integrated pediatric behavioral health (BH), but evidence gaps remain in ensuring equitable care for children of all ages. In response, an interdisciplinary team codeveloped a stepped care model that expands BH services at 3 federally qualified health centers (FQHCs). METHODS FQHCs reported monthly electronic medical record data regarding detection of BH issues, receipt of services, and psychotropic medications. Study staff reviewed charts of children with attention-deficit/hyperactivity disorder (ADHD) before and after implementation. RESULTS Across 47 437 well-child visits, >80% included a complete BH screen, significantly higher than the state's long-term average (67.5%; P < .001). Primary care providers identified >30% of children as having BH issues. Of these, 11.2% of children <5 years, 53.8% of 5-12 years, and 74.6% >12 years were referred for care. Children seen by BH staff on the day of referral (ie, "warm hand-off") were more likely to complete an additional BH visit than children seen later (hazard ratio = 1.37; P < .0001). There was no change in the proportion of children prescribed psychotropic medications, but polypharmacy declined (from 9.5% to 5.7%; P < .001). After implementation, diagnostic rates for ADHD more than doubled compared with baseline, follow-up with a clinician within 30 days of diagnosis increased (62.9% before vs 78.3% after; P = .03) and prescriptions for psychotropic medication decreased (61.4% before vs 43.9% after; P = .03). CONCLUSIONS Adding to a growing literature, results demonstrate that integrated BH care can improve services for children of all ages in FQHCs that predominantly serve marginalized populations.
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Affiliation(s)
| | | | - Michelle P Durham
- Psychiatry, Boston University School of Medicine, Boston, Massachusetts.,Psychiatry, Boston Medical Center, Boston, Massachusetts
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Buchanan GJR, Piehler T, Berge J, Hansen A, Stephens KA. Integrated Behavioral Health Implementation Patterns in Primary Care Using the Cross-Model Framework: A Latent Class Analysis. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:312-325. [PMID: 34529202 PMCID: PMC8854330 DOI: 10.1007/s10488-021-01165-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 12/20/2022]
Abstract
Primary care has increasingly adopted integrated behavioral health (IBH) practices to enhance overall care. The IBH Cross-Model Framework clarifies the core processes and structures of IBH, but little is known about how practices vary in the implementation of these processes and structures. This study aimed to describe clusters of clinics using the IBH Cross-Model Framework for a large sample of primary care clinics, as well as contextual variables associated with differences in implementation. Primary care clinics (N = 102) in Minnesota reported their level of implementation across 18 different components of IBH via the site self-assessment (SSA). The components were mapped to all five principles and four of the nine structures of the IBH Cross-Model Framework. latent class analysis was used to identify unique clusters of IBH components from the SSA across the IBH Cross-Model Framework's processes and structures. Latent classes were then regressed onto context variables. A four-class model was determined to be the best fit: Low IBH (39.6%), Structural IBH (7.9%), Partial IBH (29.4%), and Strong IBH (23.1%). Partial IBH clinics were more urban than the other three classes, lower in SES risk than Structural IBH clinics, and located in smaller organizations than Strong IBH clinics. There were no differences between classes in race/ethnicity of the clinic area or practice size. Four groups of IBH implementation were identified representing unique profiles of integration. These clusters may represent patterns of community-based implementation of IBH that indicate easier and more challenging aspects of IBH implementation.
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Affiliation(s)
| | - Timothy Piehler
- Department of Family Social Science, University of Minnesota, Minneapolis, MN, USA
| | - Jerica Berge
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Audrey Hansen
- Institute for Clinical Systems Improvement, Bloomington, MN, USA
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Rene R, Cherson M, Rannazzisi A, Felter J, Silverio A, Cunningham AT. Transitioning from In-Person to Telemedicine Within Primary Care Behavioral Health During COVID-19. Popul Health Manag 2022; 25:455-461. [PMID: 35196130 DOI: 10.1089/pop.2021.0292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The COVID-19 pandemic created significant mental stressors among patients, which had the potential to impede access to primary care behavioral health (PCBH) services through rapid unplanned shifts to telehealth. The authors utilized retrospective administrative data and patient surveys to assess the feasibility, acceptability, and clinical outcomes of Jefferson Health PCBH pre- and post-COVID pandemic onset (Cohort 1 in person-only visits and Cohort 2 telemedicine-only visits). Using a retrospective cohort comparison study, outcomes included number of patients receiving PCBH in both cohorts, frequency of visits, no-show and cancellation rates, change in mean PHQ-9 and GAD-7 scores for patients, changes in the levels of depression and anxiety severity using established severity levels, and patient satisfaction with telehealth (Cohort 2 only). Patients in Cohort 2 were significantly more likely to have an anxiety diagnosis, had a smaller average number of visits, and were more likely to have a cancelled appointment. Both cohorts had statistically significant improvements in PHQ-9 and GAD-7 scores. In regression analyses, treatment cohort was not a significant predictor of final PHQ-9 or GAD-7 score. More members of Cohort 2 reported severe anxiety at both initial and final measurements. Nearly all Cohort 2 patients agreed or strongly agreed that telehealth made it easier for them to obtain care, that the platform was easy to use, and the visit was effective. Overall, PCBH telehealth services post-COVID-19 onset were feasible, acceptable to patients, and yielded similar clinical improvements to in-person behavioral health visits conducted before the pandemic.
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Affiliation(s)
- Rachelle Rene
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Comprehensive Primary Care Plus, Population Health, Jefferson Health
| | - Mollie Cherson
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Comprehensive Primary Care Plus, Population Health, Jefferson Health
| | - Angelo Rannazzisi
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Comprehensive Primary Care Plus, Population Health, Jefferson Health
| | - Jeanne Felter
- Department of Counseling and Behavioral Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexis Silverio
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amy T Cunningham
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Alessi EJ, Caldwell B, Zazzarino AS, Greenfield B, Findley PA. 'You just really have to assert yourself:' social work, nursing, and rehabilitation counseling student experiences of providing integrated behavioral health services before and after the immediate start of COVID-19. BMC Health Serv Res 2022; 22:88. [PMID: 35042482 PMCID: PMC8765676 DOI: 10.1186/s12913-022-07465-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/24/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Educators who train healthcare students to provide behavioral health services in primary care settings frequently encounter challenges as they work to ensure that students acquire the knowledge and skills to effectively function on interprofessional practice teams. This has become increasingly important during COVID-19, as interprofessional collaborative practice is needed more than ever to address the interrelated health, mental health, and social structural issues linked to the pandemic. METHODS We used qualitative focus groups to understand the experiences of 6 interprofessional teams (comprised of graduate social work, nursing, and rehabilitation counseling students; n = 19) providing behavioral health services in primary care settings before and after the immediate start of COVID-19. To triangulate data and enrich findings, one focus group with students' faculty supervisors was also conducted; n = 5). Data were analyzed using thematic analysis. RESULTS Four themes highlighted student participants' need to assert themselves at the beginning of their educational experience, to communicate and learn from one another to develop positive team dynamics, to contend with role confusion and missed opportunities for collaboration, and to manage the emotional impact of COVID-19 on learning. CONCLUSION Findings indicate that educators should work with clinical faculty and agency supervisors to orient students to ensure they have role clarity within the agency. Graduate students providing behavioral health services should also learn to work collaboratively within their scopes of practice to serve patients virtually, especially in preparation for public health emergencies.
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Affiliation(s)
- Edward J Alessi
- School of Social Work, Rutgers, The State University of New Jersey, 390 George Street, FL 6 - Room 607A, New Brunswick, NJ, 08901, USA.
| | - Barbara Caldwell
- School of Nursing, Division of Advanced Nursing Practice, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Anthony S Zazzarino
- School of Health Professions, Rutgers, The State University of New Jersey, Scotch Plains, NJ, USA
| | - Brett Greenfield
- School of Social Work, Rutgers, The State University of New Jersey, 390 George Street, FL 6 - Room 607A, New Brunswick, NJ, 08901, USA
| | - Patricia A Findley
- School of Social Work, Rutgers, The State University of New Jersey, 390 George Street, FL 6 - Room 607A, New Brunswick, NJ, 08901, USA
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Kenton N, Bouranis N, Cox EJ, Jacobson L, Wright BJ. Evaluation of Shared Experiences Among Patients and Providers Following Behavioral Health Integration in Primary Care. J Patient Exp 2021; 8:23743735211063296. [PMID: 34926800 PMCID: PMC8679016 DOI: 10.1177/23743735211063296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Behavioral health integration (BHI) changes the paradigm of primary care delivery by integrating behavioral healthcare into primary care. Thus, BHI likely alters the shared experiences of both patients and providers in an interrelated manner; however, their experiences are usually evaluated separately. The purpose of this study was to analyze these shared experiences together within patient-provider pairs in integrated clinics. First, patient interviews were conducted using semi-structured interview guides and transcripts were analyzed for major themes of patient experience. Next, providers named in patient interviews were interviewed around these same themes. Thematic analysis was performed on 18 transcripts (11 patients, 7 providers). Common themes included BHI experience, pain management, feeling heard by providers, and health care experiences. Areas of alignment included positive perception of BHI, an absence of long-term care, and a desire to share decision-making. Pain management was a persistent area of conflict, and the differing experiences were consistent with a change in the psychodynamic patient-provider model. This conflict highlights a gap in BHI and a need for provider education about psychodynamic relationship models.
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Affiliation(s)
- Natalie Kenton
- Center for Outcomes Research and Education, Providence St. Joseph Health, Portland, OR, USA
| | - Nicole Bouranis
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Emily J Cox
- Providence Medical Research Center, Providence Health Care, Spokane, WA, USA
| | | | - Bill J Wright
- Health Innovation Research, Providence Research Network, Portland, OR, USA
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Hiefner AR, Villareal A. A Multidisciplinary, Family-Oriented Approach to Caring for Parents After Miscarriage: The Integrated Behavioral Health Model of Care. Front Public Health 2021; 9:725762. [PMID: 34917568 PMCID: PMC8669268 DOI: 10.3389/fpubh.2021.725762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
Abstract
Miscarriage is increasingly gaining recognition, both in scientific literature and media outlets, as a loss that has significant and lasting effects on parents, though often disenfranchised and overlooked by both personal support networks and healthcare providers. For both men and women, miscarriage can usher in intense grief, despair, and difficulty coping, and for women in particular, there is evidence of increased prevalence of depression, anxiety, and post-traumatic stress. Additionally, miscarriage can contribute to decreased relationship satisfaction and increased risk of separation, all while stigma and disenfranchisement create a sense of isolation. Despite this increased need for support, research indicates that many parents experience their healthcare providers as dismissive of the significance of the loss and as primarily focusing only on the physical elements of care. Research exploring the barriers to providers engaging in more biopsychosocial-oriented care has identified time constraints, lack of resources, lack of training in addressing loss, and compassion fatigue as key areas for intervention. This paper will review the biopsychosocial elements of miscarriage and discuss a multidisciplinary, family-oriented approach that can be implemented in healthcare settings to ensure a high quality and holistic level of care for individuals, couples, and families experiencing pregnancy loss.
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Affiliation(s)
- Angela R Hiefner
- Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Astrud Villareal
- Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
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