1
|
Filippi MK, Nederveld A, Williams MD, Robertson E, Doubeni C, Waxmonsky JA, Hester CM. Integrated Behavioral Health Adaptations During the COVID-19 Pandemic. J Am Board Fam Med 2024; 36:1023-1028. [PMID: 38182424 DOI: 10.3122/jabfm.2023.230125r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/28/2023] [Accepted: 07/07/2023] [Indexed: 01/07/2024] Open
Abstract
INTRODUCTION COVID-19 pandemic lockdowns threatened standard components of integrated behavioral health (IBH) such as in-person communication across care teams, screening, and assessment. Restrictions also exacerbated pre-existing challenges to behavioral health (BH) access. METHODS Semistructured interviews were completed with clinicians from family medicine residency programs on the impact of the pandemic on IBH care delivery along with adaptations employed by care teams to ameliorate disruption. RESULTS Participants (n = 41) from 14 family medicine residency programs described the rapid shift to virtual care, creating challenges for IBH delivery and increased demand for BH services. With patients and care team members at home, virtual warm handoffs and increased attention to communication were necessary. Screening and measurement were more difficult, and referrals to appropriate services were challenging due to higher demand. Tele-BH facilitated continued access to BH services but was associated with logistic challenges. Participants described adaptations to stay connected with patients and care teams and discussed the need to increase capacity for both in-person and virtual care. DISCUSSION Most practices modified their workflows to use tele-BH as COVID-19 cases increased. Participants shared key learnings for successful implementation of tele-BH that could be applied in future health care crises. CONCLUSION Practices adapted readily to challenges posed by pandemic restrictions and their ability to sustain key elements of IBH during the COVID-19 pandemic demonstrates innovation in maintaining access when in-person care is not possible, informing strategies applicable to other scenarios.
Collapse
Affiliation(s)
- Melissa K Filippi
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); University of Colorado Anschutz, Aurora, CO (AN); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW). )
| | - Andrea Nederveld
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); University of Colorado Anschutz, Aurora, CO (AN); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW)
| | - Mark D Williams
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); University of Colorado Anschutz, Aurora, CO (AN); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW)
| | - Elise Robertson
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); University of Colorado Anschutz, Aurora, CO (AN); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW)
| | - Chyke Doubeni
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); University of Colorado Anschutz, Aurora, CO (AN); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW)
| | - Jeanette A Waxmonsky
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); University of Colorado Anschutz, Aurora, CO (AN); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW)
| | - Christina M Hester
- From the American Academy of Family Physicians National Research Network, American Academy of Family Physicians, Leawood, KS (MKF, ER, CMH); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (MKF); University of Colorado Anschutz, Aurora, CO (AN); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MI (MDW); Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH (CD); Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (JAW)
| |
Collapse
|
2
|
Mosen DM, Banegas MP, Keast EM, Ertz-Berger BL. The Association Between Social Isolation and Memory Loss Among Older Adults. J Am Board Fam Med 2022; 35:1168-73. [PMID: 36564194 DOI: 10.3122/jabfm.2022.210497R2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/20/2021] [Accepted: 06/30/2022] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Social isolation among older individuals is associated with poor health outcomes. However, less is known about the association between social isolation and memory loss, specifically among Medicare enrollees in large, integrated health care systems. METHODS We conducted a cross-sectional, observational study. From a cohort of 46,240 Medicare members aged 65 years and older at Kaiser Permanente Northwest (KPNW) who completed a health questionnaire, we compared self-reported memory loss of those who reported feeling lonely or socially isolated and those who did not, adjusting for demographic factors, health conditions, and use of health services in the 12 months before the survey. RESULTS Patients who reported sometimes experiencing social isolation were more likely than those who rarely or never experienced social isolation to report memory loss in both unadjusted (odds ratio [ORsometimes]: 2.56, 95% CI= 2.42-2.70, P = 0.0076) and adjusted (ORsometimes: 2.45, 95% CI= 2.32-2.60, P = 0.0298) logistic regression models. Similarly, those who reported social isolation often or always were more likely to report memory loss than those who reported rarely or never experiencing isolation in both unadjusted (ORoften/always: 5.50, 95% CI = 5.06-5.99, P < 0.0001) and adjusted logistic regression models (ORoften/always: 5.20, 95% CI = 4.75-5.68, P < 0.0001). CONCLUSIONS The strong association between social isolation and memory loss suggests the need to develop interventions to reduce isolation and to evaluate their effects on potential future memory loss.
Collapse
|
3
|
Duque-Molina C, Borrayo-Sánche G, Avilés-Hernández R, Herrera-Reyna P. [PRIISMA Project: Transformation into a more preventive, resilient, comprehensive, innovative, sustainable, modern and accessible IMSS]. Rev Med Inst Mex Seguro Soc 2022; 60:S54-S64. [PMID: 36795956 PMCID: PMC10627496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/05/2022] [Indexed: 02/18/2023]
Abstract
Two years after the onset of the COVID-19 pandemic, the Mexican Institute for Social Security (IMSS, according to its initials in Spanish) rethought new projects focused on the new needs of the population and social security organizations and institutions. The Institute, as a cornerstone in the search for the wellbeing of Mexicans, aligned with the National Development Plan and the Strategic Health for Wellbeing Program, sought to direct its transformation towards a preventive, resilient, comprehensive, innovative, sustainable, modern and accessible IMSS. For this reason, the Medical Services Director designed the PRIISMA Project, as the one that over the next three years could make possible to innovate and improve its medical care processes, starting with the recovery of medical services and identifying those groups of beneficiaries who experience the most vulnerable circumstances. The PRIISMA project consisted of five sub-projects: 1. Vulnerable groups; 2. Efficient and effective care; 3. Prevent IMSS plus; 4 IMSS University and 5. Recovery of medical services. The strategies of each project seek to improve medical care for all IMSS beneficiaries and users with a human rights perspective and by priority groups; the goal is reducing the gaps in access to health care, leaving no one behind and leaving no one out; and to surpass the goals for medical services provided before the pandemic. This document provides an overview of strategies and progress of the PRIISMA sub-projects achieved during 2022.
Collapse
Affiliation(s)
- Célida Duque-Molina
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Gabriela Borrayo-Sánche
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas, Coordinación de Innovación en Salud. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Ricardo Avilés-Hernández
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas, Unidad de Planeación e Innovación en Salud. Ciudad de México, México Instituto Mexicano del Seguro SocialMéxico
| | - Paulina Herrera-Reyna
- Instituto Mexicano del Seguro Social, Dirección de Prestaciones Médicas, Coordinación de Innovación en Salud. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| |
Collapse
|
4
|
Mosen DM, Banegas MP, Keast EM, Ertz-Berger BL. The Association Between Social Isolation and Memory Loss Among Older Adults. J Am Board Fam Med 2022:jabfm.2022.AP.210497. [PMID: 36113995 DOI: 10.3122/jabfm.2022.ap.210497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/20/2021] [Accepted: 06/30/2022] [Indexed: 03/21/2023] Open
Abstract
INTRODUCTION Social isolation among older individuals is associated with poor health outcomes. However, less is known about the association between social isolation and memory loss, specifically among Medicare enrollees in large, integrated health care systems. METHODS We conducted a cross-sectional, observational study. From a cohort of 46,240 Medicare members aged 65 years and older at Kaiser Permanente Northwest (KPNW) who completed a health questionnaire, we compared self-reported memory loss of those who reported feeling lonely or socially isolated and those who did not, adjusting for demographic factors, health conditions, and use of health services in the 12 months before the survey. RESULTS Patients who reported sometimes experiencing social isolation were more likely than those who rarely or never experienced social isolation to report memory loss in both unadjusted (odds ratio [ORsometimes]: 2.56, 95% CI= 2.42-2.70, P = 0.0076) and adjusted (ORsometimes: 2.45, 95% CI= 2.32-2.60, P = .0298) logistic regression models. Similarly, those who reported social isolation often or always were more likely to report memory loss than those who reported rarely or never experiencing isolation in both unadjusted (ORoften/always: 5.50, 95% CI = 5.06-5.99, P < .0001) and adjusted logistic regression models (ORoften/always: 5.20, 95% CI = 4.75-5.68, P < .0001). CONCLUSIONS The strong association between social isolation and memory loss suggest the need to develop interventions to reduce isolation and to evaluate their effects on potential future memory loss.
Collapse
Affiliation(s)
- David M Mosen
- From Kaiser Permanente Center for Health Research, Portland (DMM, MPB, EMK); Northwest Permanente, Continuum of Care Department, Portland, OR (BLE-B)
| | - Matthew P Banegas
- From Kaiser Permanente Center for Health Research, Portland (DMM, MPB, EMK); Northwest Permanente, Continuum of Care Department, Portland, OR (BLE-B)
| | - Erin M Keast
- From Kaiser Permanente Center for Health Research, Portland (DMM, MPB, EMK); Northwest Permanente, Continuum of Care Department, Portland, OR (BLE-B)
| | - Briar L Ertz-Berger
- From Kaiser Permanente Center for Health Research, Portland (DMM, MPB, EMK); Northwest Permanente, Continuum of Care Department, Portland, OR (BLE-B)
| |
Collapse
|
5
|
Hias J, Hellemans L, Laenen A, Walgraeve K, Liesenborghs A, De Geest S, Luyten J, Spriet I, Flamaing J, Van der Linden L, Tournoy J. The effect of a trAnSitional Pharmacist Intervention in geRiatric inpatients on hospital visits after dischargE (ASPIRE): Protocol for a randomized controlled trial. Contemp Clin Trials 2022; 119:106853. [PMID: 35842106 DOI: 10.1016/j.cct.2022.106853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Unplanned rehospitalizations occur frequently in older patients. Drug-related problems constitute a major and largely preventable cause with inappropriate prescribing being a substantial culprit. Solutions are needed to reduce this risk by targeting pharmacotherapy both during and after hospital stay. Therefore, we aim to perform a randomized controlled trial in geriatric inpatients to investigate the impact of a multifaceted clinical pharmacy intervention on health-related outcomes. METHODS/DESIGN The study concerns a monocenter, non-blinded, randomized controlled trial that will take place at the acute geriatric wards of a large academic hospital. Patients being in a palliative stage with active therapy withdrawal or patients discharged to another ward within the same hospital or another hospital are excluded. In total, 828 patients will be randomized (1:1) to the usual care or intervention group. The multifaceted clinical pharmacy intervention comprises medication reconciliation at admission and discharge, medication review, patient/caregiver education, intensified communication with primary care providers and post-discharge follow-up, which also includes a telepharmacology service. The primary endpoint is defined as the time to an all-cause, unplanned hospital revisit within six months after discharge. Other health-related outcomes such as drug-related readmissions, quality of life and number of potentially inappropriate medications will be analyzed as secondary endpoints. Patient inclusion started in February 2021. DISCUSSION This study will provide useful insights regarding the impact of clinical pharmacy interventions on geriatric wards with the goal to optimize health-related outcomes such as hospital revisits. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04617340.
Collapse
Affiliation(s)
- Julie Hias
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
| | - Laura Hellemans
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Department of Public Health and Primary care, KU Leuven, Leuven, Belgium; Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | | | | | - Sabina De Geest
- Department of Public Health and Primary care, KU Leuven, Leuven, Belgium; Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
| | - Jeroen Luyten
- Department of Public Health and Primary care, KU Leuven, Leuven, Belgium; Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Public Health and Primary care, KU Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Lorenz Van der Linden
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Jos Tournoy
- Department of Public Health and Primary care, KU Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
6
|
Gruß I, Varga A, Brooks N, Gold R, Banegas MP. Patient Interest in Receiving Assistance with Self-Reported Social Risks. J Am Board Fam Med 2021; 34:914-24. [PMID: 34535517 DOI: 10.3122/jabfm.2021.05.210069] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES This study evaluated how often patients who reported social risk factors requested assistance with these risks in an integrated health system. METHODS We examined how self-reports of risk related to stated desire for help with that risk reported during social risk screenings at Kaiser Permanente Northwest (KPNW). We examined how patient characteristics were associated with desire for help with each social risk domain using logistic regression. RESULTS Approximately 24% (n = 7,807) of the 32,865 KPNW members aged ≥ 18 years who were screened between June 1, 2017, and December 31, 2019, reported at least 1 social risk. More than half of patients who reported a risk were risk/help concordant (i.e., they also wanted help with that risk). The highest concordance (81.7%) was observed among patients reporting medical financial hardship. Several demographic, health, and other factors were associated with concordance across domains. CONCLUSIONS Patients do not request assistance for all reported social needs. Our findings could help shape future work examining patients' reasons for not accepting assistance and developing interventions to help patients with high social risk more effectively.
Collapse
|
7
|
David SP, Dunnenberger HM, Ali R, Matsil A, Lemke AA, Singh L, Zimmer A, Hulick PJ. Implementing Primary Care Mediated Population Genetic Screening Within an Integrated Health System. J Am Board Fam Med 2021; 34:861-5. [PMID: 34312282 DOI: 10.3122/jabfm.2021.04.200381] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 07/24/2020] [Accepted: 09/29/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Genetic screenings can have a large impact on enabling personalized preventive care. However, this can be limited by the primary use of medical history-based screenings in determining care. The purpose of this study was to understand the impact of DNA10K, a population-based genetic screening program mediated by primary care physicians within an integrated health system to emphasize its contribution to preventive healthcare. METHODS Construction of the patient experience as part of DNA10K shaped the context for PCP engagement within the program. A cross-sectional analysis of patient consents, orders, tests, and results of nearly 10,000 patients within the primary care specialties of family medicine, internal medicine or obstetrics/gynecology between April 1, 2019 and January 22, 2020 was conducted. RESULTS Across all specialties, a median number of 7.5 cancer and cardiovascular disease variants per PCP was found. The average age of the study population was 49.6 years. Over 8% of these patients had at least one actionable genetic risk variant and almost 2% of patients had at least one CDC Tier 1 variant. The median numbers of patients per PCP with either hereditary breast and ovarian cancer, Lynch Syndrome, or Familial Hypercholesterolemia was 1 (Interquartile Range 0-2). DISCUSSION The analysis of test results and the engagement of an integrated healthcare system in the implementation of a genetic screening program suggests that it can have a large impact on population health outcomes and minimal referral burden to PCPs if identified risks can lead to preventive care.
Collapse
|
8
|
Puac-Polanco V, Leung LB, Bossarte RM, Bryant C, Keusch JN, Liu H, Ziobrowski HN, Pigeon WR, Oslin DW, Post EP, Kessler RC. Treatment Differences in Primary and Specialty Settings in Veterans with Major Depression. J Am Board Fam Med 2021; 34:268-90. [PMID: 33832996 DOI: 10.3122/jabfm.2021.02.200475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The Veterans Health Administration (VHA) supports the nation's largest primary care-mental health integration (PC-MHI) collaborative care model to increase treatment of mild to moderate common mental disorders in primary care (PC) and refer more severe-complex cases to specialty mental health (SMH) settings. It is unclear how this treatment assignment works in practice. METHODS Patients (n = 2610) who sought incident episode VHA treatment for depression completed a baseline self-report questionnaire about depression severity-complexity. Administrative data were used to determine settings and types of treatment during the next 30 days. RESULTS Thirty-four percent (34.2%) of depressed patients received treatment in PC settings, 65.8% in SMH settings. PC patients had less severe and fewer comorbid depressive episodes. Patients with lowest severity and/or complexity were most likely to receive PC antidepressant medication treatment; those with highest severity and/or complexity were most likely to receive combined treatment in SMH settings. Assignment of patients across settings and types of treatment was stronger than found in previous civilian studies but less pronounced than expected (cross-validated AUC = 0.50-0.68). DISCUSSION By expanding access to evidence-based treatments, VHA's PC-MHI increases consistency of treatment assignment. Reasons for assignment being less pronounced than expected and implications for treatment response will require continued study.
Collapse
|
9
|
Westfall JM, Liaw W, Griswold K, Stange K, Green LA, Phillips R, Bazemore A, Jaén CR, Hughes LS, DeVoe J, Gullett H, Puffer JC, Gotler RS. Uniting Public Health and Primary Care for Healthy Communities in the COVID-19 Era and Beyond. J Am Board Fam Med 2021; 34:S203-9. [PMID: 33622839 DOI: 10.3122/jabfm.2021.S1.200458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/08/2022] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic has laid bare the dis-integrated health care system in the United States. Decades of inattention and dwindling support for public health, coupled with declining access to primary care medical services have left many vulnerable communities without adequate COVID-19 response and recovery capacity. "Health is a Community Affair" is a 1966 effort to build and deploy local communities of solution that align public health, primary care, and community organizations to identify health care problem sheds, and activate local asset sheds. After decades of independent effort, the COVID-19 pandemic offers an opportunity to reunite and align the shared goals of public health and primary care. Imagine how different things might look if we had widely implemented the recommendations from the 1966 report? The ideas and concepts laid out in "Health is a Community Affair" still offer a COVID-19 response and recovery approach. By bringing public health and primary care together in community now, a future that includes a shared vision and combined effort may emerge.
Collapse
|
10
|
Maxey HL, Norwood CW, Weaver DL. Primary Care Physician Roles in Health Centers with Oral Health Care Units. J Am Board Fam Med 2017; 30:491-504. [PMID: 28720630 DOI: 10.3122/jabfm.2017.04.170106] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/05/2017] [Accepted: 04/09/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Integrating oral health care and primary care is a priority for improving population health. Primary care physicians (PCP) are filling expanded roles within oral health care to secure strong overall health for their patients. METHODS This comparative case study examines the roles of PCPs at 5 federally qualified health centers that have integrated oral health care and primary care. Administrative data were obtained directly from the Health Resources and Services Administration. Key informant interviews were performed with administrators and clinical care team members at each of the health centers. Data were reviewed by 2 experts in oral health to identify emerging roles for physicians. RESULTS PPCPs' roles in health centers' integration models vary, but 3 distinct roles emerged: (1) the physician as a champion, (2) the physician as a collaborator, and (3) the physician as a member of an interprofessional team. In addition, providing physicians with the necessary training to identify oral health issues was critical to preparing physicians to take on expanded roles in integrated health care delivery models. CONCLUSIONS Regardless of the roles that they play, family physicians can contribute a great deal to the success of integration models.
Collapse
|
11
|
Balasubramanian BA, Cohen DJ, Jetelina KK, Dickinson LM, Davis M, Gunn R, Gowen K, deGruy FV 3rd, Miller BF, Green LA. Outcomes of Integrated Behavioral Health with Primary Care. J Am Board Fam Med 2017; 30:130-9. [PMID: 28379819 DOI: 10.3122/jabfm.2017.02.160234] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 01/04/2017] [Accepted: 01/09/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Integrating behavioral health and primary care is beneficial to patients and health systems. However, for integration to be widely adopted, studies demonstrating its benefits in community practices are needed. The objective of this study was to evaluate effect of integrated care, adapted to local contexts, on depression severity and patients' experience of care. METHODS This study used a convergent mixed-methods design, merging findings from a quasi-experimental study with patient interviews conducted as part of Advancing Care Together, a community demonstration project that created an innovation incubator for practices implementing evidence-based integration strategies. The study included 475 patients with a 9-item Patient Health Questionnaire (PHQ-9) score ≥10 at baseline, from 5 practices. RESULTS Statistically significant reductions in mean PHQ-9 scores were observed in all practices, ranging from 2.72 to 6.46 points. Clinically, 50% of patients had a ≥5-point reduction in PHQ-9 score and 32% had a ≥50% reduction. This finding was corroborated by patient interviews that demonstrated positive experiences with behavioral health clinicians and acquiring new skills to cope with adverse situations at work and home. CONCLUSIONS Integrating behavioral health and primary care, when adapted to fit into community practices, reduced depression severity and enhanced patients' experience of care. Integration is a worthwhile investment; clinical leaders, policymakers, and payers should support integration in their communities.
Collapse
|
12
|
Hovenga E, Grain H. Connecting PHRs and EHRs for a Sustainable National Health System. Stud Health Technol Inform 2017; 245:1228. [PMID: 29295315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An EHR for integrated care (IEHR) is defined by the International Organization for Standardization (ISO) [1]: "…a repository of information regarding the health status of a subject of care, in computer processable form, stored and transmitted securely, and accessible by multiple authorised users, having a standardized or commonly agreed logical information model that is independent of EHR systems and whose primary purpose is the support of continuing, efficient and quality integrated health care. It contains information which is retrospective, concurrent and prospective." We need to differentiate between EMR/EHR and the lifelong PHR in terms of type of data storage, sharing and use [2-3].
Collapse
Affiliation(s)
- Evelyn Hovenga
- eHealth Education Pty Ltd, East Melbourne, Victoria, Australia
| | - Heather Grain
- eHealth Education Pty Ltd, East Melbourne, Victoria, Australia
| |
Collapse
|
13
|
Burfeind G, Seymour D, Sillau SH, Zittleman L, Westfall JM. Provider perspectives on integrating primary and behavioral health: a report from the High Plains Research Network. J Am Board Fam Med 2014; 27:375-82. [PMID: 24808116 DOI: 10.3122/jabfm.2014.03.130152] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Integrated primary care, a health care delivery model that combines medical and behavioral health services, provides better patient access to care at a lower cost, with better outcomes compared with usual nonintegrated care models. The perspectives of primary care providers (PCPs) and behavioral health care providers (BHPs) toward integration are especially valuable because their input and endorsement are key to successful and sustained integration. However, there is little research assessing or comparing PCP and BHP perspectives on integration, especially in rural areas. The objective of this study was to identify rural PCP and BHP perspectives on integration. METHODS Written and electronic surveys were distributed to PCPs and BHPs in the High Plains Research Network in rural eastern Colorado. Items included perspectives on improving behavioral health care, barriers to integration, and confidence in the ability to integrate primary and behavioral care. RESULTS Surveys were completed by 88 PCPs (60%), and 49 BHPs (63%), for an overall response rate of 61%. PCPs were significantly more likely than BHPs to prefer improving referral methods (odds ratio [OR], 2.2; P = .03) and significantly less likely to prefer colocation (OR, 0.2; P < .0001), warm hand-offs (OR, 0.3; P < .01), improved behavioral health training for PCPs (OR, 0.4; P < .01), and shared visits (OR, 0.4; P =.03) as ways to improve health care. Lack of sufficient methods of payment for behavioral health care services was the most commonly selected barrier to integration by both groups. PCPs were significantly more likely than BHPs to select recruitment (OR, 3.8; P < .001) and retention (OR, 2.7; P < .01) of behavioral health care staff as a major barrier. BHPs were slightly more optimistic than PCPs about the achievability of integration. CONCLUSIONS Important differences of perspective exist between rural PCPs and BHPs regarding the best ways to improve behavioral health care, barriers to integration, and the achievability of integration. These differences may have important implications for rural communities and health care systems considering a transition to an integrated primary care model.
Collapse
|