Psychiatric Nurse Practitioners as Leaders in Behavioral Health Integration

Primary Care Organizational Support for Nurse Practitioner Practice and Emotional Health Care Delivery

OBJECTIVES

Nurse practitioners (NPs) are key to delivery of primary care services. However, poor organizational support for independent NP practice, such as lack of access to clinic resources, may lead to prioritizing patient physical health over emotional health. We investigated the relationship between organizational support for independent NP practice and emotional health care delivery.

METHODS

This was a secondary analysis of cross-sectional survey data collected from 397 NPs in 2017. We measured organizational support for independent NP practice using the independent practice and support subscale of the NP Primary Care Organizational Climate Questionnaire. Emotional health care delivery was measured by asking NPs how frequently they addressed emotional concerns of patients. We utilized multilevel mixed effects linear regression models, adjusting for NP and practice covariates.

RESULTS

Controlling for NP age, gender, marital status, race, and ethnicity, along with practice setting and size, as the independent practice and support score increased, NPs reported addressing emotional concerns of patients more frequently (beta = 0.34, 95% confidence interval = 0.02-0.66, P = 0.04). This indicates that as organizations provided more support for independent NP practice, NPs were able to more frequently address emotional concerns of patients.

CONCLUSIONS

Organizational support for independent NP practice is associated with addressing emotional concerns of patients. To support NP practice, primary care organizations should ensure that NPs manage patients independently and have access to ancillary staff and support for care management.

The Future of the Psychiatric Mental Health Nursing Workforce: Using Our Skill Set to Address Incongruities in Mental Health Care Delivery

The USA is dealing with well-documented issues around mental health and its treatment. The Psychiatric Mental Health (PMH) workforce is growing and practicing in a variety of roles within the mental health system. How will PMH nurses address instances when the structure of services does not meet the mental health needs of the population? In this piece, I argue that to some degree the future of the PMH workforce will be determined by how well we use our capacity and capabilities to address incongruities in service structure and population needs. Five areas of concern with mental health services are outlined; they all involve factors that can be addressed with innovative approaches and optimum utilization of the PMH workforce. Included are suggestions on how PMH nurses might direct efforts toward these service issues, particularly by using their skill set and presence in the mental health system. Strategies include forging a tighter connection between the work of advanced practice and registered nurses in delivering care. Broadly, these efforts should be directed at building models of patient-centered care that address the needs of populations, reducing disparities, and demonstrating how engagement is a critical lever of effective inpatient and community-based care.

Enhancing GP care of mental health disorders post-COVID-19: a scoping review of interventions and outcomes

OBJECTIVES

Considerable literature has examined the COVID-19 pandemic's negative mental health sequelae. It is recognised that most people experiencing mental health problems present to primary care and the development of interventions to support GPs in the care of patients with mental health problems is a priority. This review examines interventions to enhance GP care of mental health disorders, with a view to reviewing how mental health needs might be addressed in the post-COVID-19 era.

METHODS

Five electronic databases (PubMed, PsycINFO, Cochrane Library, Google Scholar and WHO 'Global Research on COVID-19') were searched from May - July 2021 for papers published in English following Arksey and O'Malley's six-stage scoping review process.

RESULTS

The initial search identified 148 articles and a total of 29 were included in the review. These studies adopted a range of methodologies, most commonly randomised control trials, qualitative interviews and surveys. Results from included studies were divided into themes: Interventions to improve identification of mental health disorders, Interventions to support GPs, Therapeutic interventions, Telemedicine Interventions and Barriers and Facilitators to Intervention Implementation. Outcome measures reported included the Seven-item Generalised Anxiety Disorder Scale (GAD-7), the Nine-item Patient Health Questionnaire (PHQ-9) and the 'The Patient Global Impression of Change Scale'.

CONCLUSION

With increasing recognition of the mental health sequelae of COVID-19, there is a lack of large scale trials researching the acceptability or effectiveness of general practice interventions. Furthermore there is a lack of research regarding possible biological interventions (psychiatric medications) for mental health problems arising from the pandemic.

Advancement of research on nurse practitioners: Setting a research agenda

BACKGROUND

Primary care delivered by nurse practitioners (NPs) helps to meet the United States' growing demand for care and improves patient outcomes. Yet, barriers impede NP practice. Knowledge of these barriers is limited, hindering opportunities to eliminate them.

PURPOSE

We convened a 1.5-day conference to develop a research agenda to advance evidence on the primary care NP workforce.

METHODS

Thirty experts gathered in New York City for a conference in 2022. The conference included plenary sessions, small group discussions, and a prioritization process to identify areas for future research and research questions.

DISCUSSION

The research agenda includes top-ranked research questions within five categories: (a) policy regulations and implications for care, quality, and access; (b) systems affecting NP practice; (c) health equity and the NP workforce; (d) NP education and workforce dynamics, and (e) international perspectives.

CONCLUSION

The agenda can advance evidence on the NP workforce to guide policy and practice.

The effectiveness of nurse practitioner care for patients with mental health conditions in primary care settings: A systematic review

BACKGROUND

The nurse practitioner (NP) workforce is key to meeting the demand for mental health services in primary care settings.

PURPOSE

The purpose of this study is to synthesize the evidence focused on the effectiveness of NP care for patients with mental health conditions in primary care settings, particularly focused on primary care NPs and psychiatric mental health NPs and patients with anxiety, depression, and substance use disorders.

METHODS

Studies published since 2014 in the United States studying NP care of patients with anxiety, depression, or substance use disorders in primary care settings were included.

FINDINGS

Seventeen studies were included. Four high-quality studies showed that NP evidence-based care and prescribing were comparable to that of physicians. Seven low-quality studies suggest that NP-led collaborative care is associated with reduced symptoms.

DISCUSSION

More high-quality evidence is needed to determine the effectiveness of NP care for patients with mental health conditions in primary care settings.

Social workers in integrated care beyond primary care: a scoping review

Social workers are key members of integrated care (IC) teams, yet there is limited research on the presence and roles of social workers on IC teams. Research literature from 2014 to 2021 was identified using the following search engines: Academic Search Complete, PsycINFO, CINAHL Plus, SocINDEX and MEDLINE. An exploratory search was conducted in January 2021 and an updated search was conducted in August 2021. This search resulted in 802 references, 50 of which met criteria for full-text review. Nine articles were identified through supplemental searching. 20 articles were included in the final review. Of the 20 studies included, most were randomized control trials (45%; n = 9). Studies varied across settings including specialty care (40%; n = 8), community-based practices (35%; n = 7), and primary care (25%; n = 5). Social workers engaged in a variety of roles including behavioral interventions, care coordination, and intake assessment. Social workers are engaged in IC in a variety of roles across healthcare settings. Findings suggest that patients' mental health outcomes improve in IC settings which include social workers. Future research is needed to isolate the impact that social workers have in IC. Social workers are key members of integrated care teams, yet there is a need to explore their roles on these teams. Using a methodological approach, research literature from 2014 to 2021 was explored to establish the roles, responsibilities, and settings of social workers on integrated care teams. Of the 20 articles included in the review, social workers held various roles including intake assessment, care coordination, and behavioral interventions, such as psychotherapy or cognitive behavioral therapy. Findings suggest that social workers are on integrated care teams in a variety of roles across various healthcare settings and that patients' mental health outcomes improve in integrated care settings that include social workers.