Does behavioral health integration improve primary care providers' perceptions of health-care system functioning and their own knowledge?

2017 ◽  
Vol 46 ◽  
pp. 88-93 ◽  
Author(s):  
Leah Zallman ◽  
Robert Joseph ◽  
Colleen O'Brien ◽  
Emily Benedetto ◽  
Ellie Grossman ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Behavioral Health ◽  
Health Care System ◽  
Primary Care Providers ◽  
Care Providers ◽  
Behavioral Health Integration ◽  
System Functioning ◽  
Care System

scholarly journals Prevalence of Inappropriate Antibiotic Prescribing in Primary Care Clinics within a Veterans Affairs Health Care System

2018 ◽  
Vol 62 (8) ◽  
Author(s):  
Nathan R. Shively ◽  
Deanna J. Buehrle ◽  
Cornelius J. Clancy ◽  
Brooke K. Decker
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Tract Infection ◽  
Health Care System ◽  
Primary Care Providers ◽  
Acute Respiratory Tract Infection ◽  
Chronic Obstructive ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Care System

ABSTRACT Data are needed from outpatient settings to better inform antimicrobial stewardship. In this study, a random sample of outpatient antibiotic prescriptions by primary care providers (PCPs) at our health care system was reviewed and compared to consensus guidelines. Over 12 months, 3,880 acute antibiotic prescriptions were written by 76 PCPs caring for 40,734 patients (median panel, 600 patients; range, 33 to 1,547). PCPs ordered a median of 84 antibiotic prescriptions per 1,000 patients per year. Azithromycin (25.8%), amoxicillin-clavulanate (13.3%), doxycycline (12.4%), amoxicillin (11%), fluoroquinolones (11%), and trimethoprim-sulfamethoxazole (10.6%) were prescribed most commonly. Medical records corresponding to 300 prescriptions from 59 PCPs were analyzed in depth. The most common indications for these prescriptions were acute respiratory tract infection (28.3%), urinary tract infection (23%), skin and soft tissue infection (15.7%), and chronic obstructive pulmonary disease (COPD) exacerbation (6.3%). In 5.7% of cases, no reason for the prescription was listed. No antibiotic was indicated in 49.7% of cases. In 12.3% of cases, an antibiotic was indicated, but the prescribed agent was guideline discordant. In another 14% of cases, a guideline-concordant antibiotic was given for a guideline-discordant duration. Therefore, 76% of reviewed prescriptions were inappropriate. Ciprofloxacin and azithromycin were most likely to be prescribed inappropriately. A non-face-to-face encounter prompted 34% of prescriptions. The condition for which an antibiotic was prescribed was not listed in primary or secondary diagnosis codes in 54.5% of clinic visits. In conclusion, there is an enormous opportunity to reduce inappropriate outpatient antibiotic prescriptions.

scholarly journals A Pilot Assessment of Primary Care Providers’ Knowledge of Adrenal Insufficiency Diagnosis and Management

2019 ◽  
Vol 10 ◽  
pp. 215013271986216 ◽  
Author(s):  
Vinni Makin ◽  
Amy S. Nowacki ◽  
Colleen Y. Colbert
Keyword(s):  
Professional Development ◽  
Primary Care ◽  
Health Care ◽  
Needs Assessment ◽  
Adrenal Insufficiency ◽  
Health Care System ◽  
Primary Care Providers ◽  
Care Providers ◽  
Diagnosis And Management ◽  
Care System

Background and Objectives: Adrenal insufficiency (AI) is one of the most challenging diagnoses in primary care, and misdiagnosis is costly. The aim of this educational needs assessment was to assess primary care physicians’ (PCPs) knowledge of AI diagnosis and management as a preliminary step in developing a professional education module to address knowledge of practice gaps. Methods: We developed a 12-item needs assessment and pretested questionnaire items prior to use to gather validity evidence. The questionnaire contained 4 AI knowledge items, 4 needs assessment items, and 4 demographic items. It was administered to 100 PCPs across a single integrated health care system over a 6-month period. Results: Fifty-one of 100 questionnaires were returned. The majority of respondents believed their knowledge of AI diagnosis and management was “average” when compared with peers. Responses indicated that PCPs were fairly comfortable diagnosing, but not managing AI patients. There was no association between respondents’ clinical knowledge of AI and respondents’ roles as clinical instructors (ie, having trainees assigned to them). A total of 54% of respondents said they utilized online resources to enhance current knowledge of AI and 88% of respondents said they would use a new AI resource, if available. When asked to rank preferences for professional development modalities, 26/38 respondents ranked UpToDate, 21/38 respondents ranked traditional lecture, and 19/38 respondents ranked case discussion among their top 3 choices. Conclusion: Results of this needs assessment showed that PCPs within our health care system both needed and desired professional development targeting AI diagnosis and management. A faculty development session, which included a short lecture and case scenarios, was developed and delivered to PCPs at participating family health centers. Session materials are now available for use by other institutions to meet professional development needs on this important topic.

scholarly journals Quantification of the resilience of primary care networks by stress testing the health care system

2019 ◽  
Vol 116 (48) ◽  
pp. 23930-23935 ◽  
Author(s):  
Donald Ruggiero Lo Sardo ◽  
Stefan Thurner ◽  
Johannes Sorger ◽  
Georg Duftschmid ◽  
Gottfried Endel ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care System ◽  
Large Scale ◽  
Health Care Systems ◽  
Primary Care Providers ◽  
Care Providers ◽  
Physician Density ◽  
Care Systems ◽  
Care System

There are practically no quantitative tools for understanding how much stress a health care system can absorb before it loses its ability to provide care. We propose to measure the resilience of health care systems with respect to changes in the density of primary care providers. We develop a computational model on a 1-to-1 scale for a countrywide primary care sector based on patient-sharing networks. Nodes represent all primary care providers in a country; links indicate patient flows between them. The removal of providers could cause a cascade of patient displacements, as patients have to find alternative providers. The model is calibrated with nationwide data from Austria that includes almost all primary care contacts over 2 y. We assign 2 properties to every provider: the “CareRank” measures the average number of displacements caused by a provider’s removal (systemic risk) as well as the fraction of patients a provider can absorb when others default (systemic benefit). Below a critical number of providers, large-scale cascades of patient displacements occur, and no more providers can be found in a given region. We quantify regional resilience as the maximum fraction of providers that can be removed before cascading events prevent coverage for all patients within a district. We find considerable regional heterogeneity in the critical transition point from resilient to nonresilient behavior. We demonstrate that health care resilience cannot be quantified by physician density alone but must take into account how networked systems respond and restructure in response to shocks. The approach can identify systemically relevant providers.

Primary Care Behavioral Health Integration for Anxiety Management in a Safety-Net Health Care System

2020 ◽  
Vol 31 (2) ◽  
pp. 569-581 ◽  
Author(s):  
Ranjani K. Paradise ◽  
Karen E. Finnegan ◽  
Blessing Dube ◽  
Leah Zallman ◽  
Emily Benedetto ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Behavioral Health ◽  
Health Care System ◽  
Safety Net ◽  
Anxiety Management ◽  
Primary Care Behavioral Health ◽  
Behavioral Health Integration ◽  
Care System

A novel continuum-based framework for translating behavioral health integration to primary care settings

2020 ◽  
Vol 10 (3) ◽  
pp. 580-589 ◽  
Author(s):  
Matthew L Goldman ◽  
Ekaterina Smali ◽  
Talia Richkin ◽  
Harold A Pincus ◽  
Henry Chung
Keyword(s):  
Primary Care ◽  
Behavioral Health ◽  
Technical Assistance ◽  
New York State ◽  
Behavioral Health Care ◽  
Primary Care Providers ◽  
Care Providers ◽  
Behavioral Health Integration ◽  
Care Practices ◽  
Primary Care Practices

Abstract Although evidence-based behavioral health integration models have been demonstrated to work well when implemented properly, primary care practices need practical guidance on the steps they can take to build behavioral health integration capacities. This is especially true for practice settings with fewer resources. This study is a pilot field test of a framework continuum composed of core components of behavioral health integration that can be used to translate the implementation of behavioral health into diverse clinical settings guided by a practice's priorities and available resources. This framework, in combination with technical assistance by the study team, was piloted in 11 small primary care sites (defined as ≤5 primary care providers) throughout New York State. Surveys were collected at baseline, 6 months, and 12 months. Informal check-in calls and site visits using qualitative semistructured individual and group interviews were conducted with 10 of the 11 sites. A mixed-methods approach was used to incorporate the survey data and qualitative thematic analysis. All practices advanced at least one level of behavioral health integration along various components of the framework. These advances included implementing depression screening, standardizing workflows for positive screens, integrating patient tracking tools for follow-up behavioral health visits, incorporating warm hand-offs to on-site or off-site behavioral health providers, and formalized external referrals using collaborative agreements. Practices reported they had overall positive experiences using the framework and offered feedback for how to improve future iterations. The framework continuum, in combination with technical assistance, was shown to be useful for primary care practices to advance integrated behavioral health care based on their priorities and resource availability. The results combined with feedback from the practices have yielded a revised “Framework 2.0” that includes a new organization as well as the addition of a “Sustainability” domain.

scholarly journals Primary health care policy and vision for community pharmacy and pharmacists in Indonesia

2020 ◽  
Vol 18 (3) ◽  
pp. 2085
Author(s):  
Andi Hermansyah ◽  
Luh Wulandari ◽  
Susi A. Kristina ◽  
Sherly Meilianti
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Community Pharmacy ◽  
Health Care Policy ◽  
Primary Care Providers ◽  
Good Evidence ◽  
Care Practice ◽  
Health Coverage ◽  
Care Providers ◽  
Care System

The practice of community pharmacy in low and middle-income countries, including in Indonesia, is often described as in the state of infancy with several intractable barriers that have been substantially and continuously hampering the practice. Such description might be valid in highlighting how pharmacy is practiced and the conditions within and beyond community pharmacy organizations. Therefore, it is not surprising that the concept of integrating community pharmacy into the primary care system may not be considered in the contemporary discourse despite the fact that community pharmacy has been operating within communities for years. However, in the case of Indonesia, we argue that changes in the health care system within the past decade particularly with the introduction of the universal health coverage (UHC) in 2014, may have significantly amplified the role of pharmacists. There is good evidence which highlights the contribution of pharmacist as a substantial health care element in primary care practice. The initiative for employing pharmacist, identified in this article as primary care pharmacist, in the setting of community health center [puskesmas] and the introduction of affiliated or contracted community pharmacy under the UHC have enabled pharmacist to work together with other primary care providers. Moreover, government agenda under the “Smart Use of Medicines” program [Gema Cermat] recognizes pharmacists as the agent of change for improving the rational use of medicines in the community. Community pharmacy is developing, albeit slowly, and is able to grasp a novel position to deliver pharmacy-related primary care services to the general public through new services, for example drug monitoring and home care. Nevertheless, integrating community pharmacy into primary care is relatively a new notion in the Indonesian setting, and is a challenging process given the presence of barriers in the macro, meso- and micro-level of practice.

scholarly journals POST-COVID-19HEALTHCARE:TRANSITIONTOANEW NORMAL

2021 ◽  
Vol 8 (1) ◽  
pp. 1
Author(s):  
Safia Rehman
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Social Media ◽  
Healthcare System ◽  
Health Care System ◽  
World Health ◽  
Care Process ◽  
Care Providers ◽  
Short Period ◽  
Care System

The COVID-19 pandemic has challenged the health care system to face extraordinary circumstances. These challenges bring forth a new era with a certain high point like the transition to the fusion of in person and digital health practice framework. Post COVID-19 there is a lot of sludge in health care, inthe form of administrative processes and requirements that slow down the core activities of providing care. COVID-19 crisis is used as an opportunity to reduce administrative burdens which most of the times made a primary care physician feel demoralized and burned out'. The focus of healthcare has shifted from hospitals to homes using telemedicine technologies which enabled virtual visits and remote care delivery. COVID-19 signified the telemedicine to be an essential component of healthcare delivery. It proved to an effective and safe way of treatment and avoiding nosocomial infections’. Previously, telemedicine was not considered to be a normal consultation method, nowadays it’s part of the normal lives of the patients as well as health care providers. The other big advantage of this great tool is that one can consult doctors even from very remote areas, which is impossible to consult physically. Different technological advancement like Artificial Intelligence-based diagnostics, cloud-based storage of medical records and integration of information in and outside hospitals were explored and adopted in the COVID-19 pandemic. Data is the key to advance research and refine health care process and outcomes for the COVID-19 patients. The digitalization of the health care system can provide significant benefit’. The phenomenon of digitalization of healthcare system is especially benefited for the developing world, because, in the resource-limited environment, a lot of cost and resources can be saved by opting paperless systems. When people were locked down, social media was pivotal in creating awareness and educating people in a short period*. There was a lot of stuff regarding COVID-19 pandemic on social media and most interestingly it was portrayedin a way that one could not be able to neglect the content. Consequently, intentionally or unintentionally many of the users opted some of the measures for prevention of the deadlyinfection. The pandemic has shown us that countries with the more robust public health system, primary care services and a healthier population perform well in the fight against the pandemic. Safeguard of voluntary and community organization is essential’. At the same time the countries with fewer resources and with limited measures for controlling massive disasters, in the form of this pandemic, got exposed. This is an alarming situation for global organizations like the World Health Organization and other health-related global leaders to work together for making sure that health resources be equally provided to all the countries across the globe. The COVID-19 pandemic educated the underdeveloped countries regarding infection control measures like Biosafety and Biosecurity. Health official shifted their resources in maintaining hygienic measures to patients, doctors and support staff. Overall, this led to great impact in revolutionizing patient care and improving quality standards. The deficiency of trained staff in Intensive Care Unit and Accident & Emergency is also highlighted in this pandemic. Hence the focus should be on enabling the existing resources to acquire skill in these specialties. The people started making the right food choice, adapting to healthy physical exercise and ensuring therapies to relieve stress and anxiety’. The pandemic brings changes to the healthcare system, whichis not entirely new, these were introduced by technologists earlier; the system is going back to normal that is stronger, smarter and healthier. Hospitals should ensure that their infrastructure is sufficiently ready to cope with the advent of digitalization.

Integrated Health Care

2017 ◽  
Author(s):  
Jason Cheng ◽  
Jeanie Tse
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Mental Illness ◽  
Physical Health ◽  
Behavioral Health ◽  
Primary Care Providers ◽  
Health Conditions ◽  
Health Staff ◽  
Care Providers ◽  
Care Experience

People with serious mental illness often receive inadequate care for physical health conditions. This chapter illustrates ways in which psychiatrists can play a key role in managing the physical health of an individual by communicating with primary care providers, educating behavioral health staff about disease management, and expanding the scope of practice to include screening for and managing metabolic conditions. This role is particularly important for the numerous individuals with mental illness who are not well engaged with primary care. For these people, therapeutic approaches such as motivational enhancement and trauma-informed care can support self-management of physical health conditions. Co-location and integration of primary care and behavioral health services can address barriers to accessing care. Although integration poses certain challenges, it has the potential to achieve the triple aim of improving the health care experience, improving population health, and reducing health care costs.

Collaborative Care: Integrating Behavioral Health Into the Primary Care Setting

2021 ◽  
pp. 107839032110416
Author(s):  
Virginia Reising ◽  
Lauren Diegel-Vacek ◽  
Lisa Dadabo MSW ◽  
Susan Corbridge
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Behavioral Health ◽  
Nurse Practitioners ◽  
Collaborative Care ◽  
Primary Care Providers ◽  
Care Team ◽  
Screening Tools ◽  
Care Providers ◽  
Family Nurse Practitioners

INTRODUCTION Integrated behavioral health is a model of health care that aims to meet the complex health care needs of patients in primary care settings. Collaborative Care (CC) is an evidence-based model incorporating an interdisciplinary team to improve outcomes for behavioral health disorders commonly seen by primary care providers. OBJECTIVE CC was implemented in a nurse-managed health center in a medically underserved community of Chicago with a team of family nurse practitioners, psychiatric mental health nurse practitioners, and a licensed clinical social worker. METHOD Integration of the CC model required restructuring of the patient visit, the care team, and financial operations. Weekly team meetings were held for interdisciplinary case consultation and training for the primary care team by the psychiatric nurse practitioner. The model includes suggested goals of reducing patient scores of validated depression (Patient Health Questionnaire–9) and anxiety (Generalized Anxiety Disorder–7) screening tools to a score less than 5 points or to less than 50% of original score. RESULTS During the initial year of implementation, 166 patients received care under the CC model, with 64 patients currently receiving active care. In this cohort, 22% reached suggested goals for depression and 47% for anxiety. CONCLUSIONS CC has benefits for both patients and providers. Patients receive holistic treatment of both mental and physical health needs and access to psychiatric services for medication initiation and behavioral health modalities when necessary. We observed that the CC model improved collaboration with behavioral health specialists and the competence and confidence of family nurse practitioners.

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