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 Integrating Behavioral Health and Primary Care (IBH-PC) to improve patient-centered outcomes in adults with multiple chronic medical and behavioral health conditions: study protocol for a pragmatic cluster-randomized control trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Abigail M. Crocker ◽  
Rodger Kessler ◽  
Constance van Eeghen ◽  
Levi N. Bonnell ◽  
Ryan E. Breshears ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Behavioral Health ◽  
Behavioral Health Care ◽  
Health Conditions ◽  
Patient Centered ◽  
Practice Level ◽  
Behavioral Health Integration ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background Chronic diseases that drive morbidity, mortality, and health care costs are largely influenced by human behavior. Behavioral health conditions such as anxiety, depression, and substance use disorders can often be effectively managed. The majority of patients in need of behavioral health care are seen in primary care, which often has difficulty responding. Some primary care practices are providing integrated behavioral health care (IBH), where primary care and behavioral health providers work together, in one location, using a team-based approach. Research suggests there may be an association between IBH and improved patient outcomes. However, it is often difficult for practices to achieve high levels of integration. The Integrating Behavioral Health and Primary Care study responds to this need by testing the effectiveness of a comprehensive practice-level intervention designed to improve outcomes in patients with multiple chronic medical and behavioral health conditions by increasing the practice’s degree of behavioral health integration. Methods Forty-five primary care practices, with existing onsite behavioral health care, will be recruited for this study. Forty-three practices will be randomized to the intervention or usual care arm, while 2 practices will be considered “Vanguard” (pilot) practices for developing the intervention. The intervention is a 24-month supported practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community. Each practice’s degree of behavioral health integration will be measured using the Practice Integration Profile. Approximately 75 patients with both chronic medical and behavioral health conditions from each practice will be asked to complete a series of surveys to measure patient-centered outcomes. Change in practice degree of behavioral health integration and patient-centered outcomes will be compared between the two groups. Practice-level case studies will be conducted to better understand the contextual factors influencing integration. Discussion As primary care practices are encouraged to provide IBH services, evidence-based interventions to increase practice integration will be needed. This study will demonstrate the effectiveness of one such intervention in a pragmatic, real-world setting. Trial registration ClinicalTrials.gov NCT02868983. Registered on August 16, 2016.

scholarly journals Integrating Behavioral Health and Primary Care (IBH-PC) to improve patient-centered outcomes in adults with multiple chronic medical and behavioral health conditions: study protocol for a pragmatic cluster-randomized control trial

2020 ◽  
Author(s):  
Abigail M Crocker ◽  
Rodger Kessler ◽  
Constance van Eeghen ◽  
Levi N Bonnell ◽  
Ryan E Breshears ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Behavioral Health ◽  
Behavioral Health Care ◽  
Health Conditions ◽  
Patient Centered ◽  
Practice Level ◽  
Behavioral Health Integration ◽  
Care Practices ◽  
Primary Care Practices

Abstract BackgroundChronic diseases that drive morbidity, mortality, and health care costs are largely influenced by human behavior. Behavioral health conditions such as anxiety, depression, and substance use disorders can often be effectively managed. The majority of patients in need of behavioral health care are seen in primary care, which often has difficulty responding. Some primary care practices are providing integrated behavioral health care (IBH), where primary care and behavioral health providers work together, in one location, using a team-based approach. Research suggests there may be an association between IBH and improved patient outcomes. However, it is often difficult for practices to achieve high levels of integration. The Integrating Behavioral Health and Primary Care study responds to this need by testing the effectiveness of a comprehensive practice-level intervention designed to improve outcomes in patients with multiple chronic medical and behavioral health conditions by increasing the practice’s degree of behavioral health integration.Methods43 primary care practices, with existing onsite behavioral health care, will be randomized to the intervention or usual care arm. The intervention is a 24-month supported practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community. Each practice’s degree of behavioral health integration will be measured using the Practice Integration Profile. Approximately 75 patients with both chronic medical and behavioral health conditions from each practice will be asked to complete a series of surveys to measure patient-centered outcomes. Change in practice degree of behavioral health integration and patient-centered outcomes will be compared between the two groups. Practice-level case studies will be conducted to better understand the contextual factors influencing integration.DiscussionAs primary care practices are encouraged to provide IBH services, evidence-based interventions to increase practice integration will be needed. This study will demonstrate the effectiveness of one such intervention in a pragmatic, real-world setting.Trial registrationClinicalTrials.gov NCT02868983. Registered August 16, 2016. https://clinicaltrials.gov/ct2/show/NCT02868983

Improving Access to Integrated Behavioral Health in a Nurse-Led Federally Qualified Health Center

2021 ◽  
pp. 107839032199416
Author(s):  
Sarah Stalder ◽  
Aimee Techau ◽  
Jenny Hamilton ◽  
Carlo Caballero ◽  
Mary Weber ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Behavioral Health ◽  
Behavioral Health Care ◽  
Primary Care Providers ◽  
Care Team ◽  
Psychiatric Nurse ◽  
Care Providers ◽  
Team Members ◽  
Task Forces

BACKGROUND: The specific aims of this project were to create a fully integrated, nurse-led model of a psychiatric nurse practitioner and behavioral health care team within primary care to facilitate (1) patients receiving an appropriate level of care and (2) care team members performing at the top of their scope of practice. METHOD: The guiding model for process implementation was Rapid Cycle Quality Improvement. Three task forces were established to develop interventions in the areas of Roles and Responsibilities, Training and Implementation, and the electronic health record. INTERVENTION: The four interventions that emerged from these task forces were (1) the establishment of patient tiers based on diagnosis, medications, and risk assessment; (2) the creation of process maps to engage care team members; (3) just-in-time education regarding psychiatric medication management for primary care providers; and (4) use of a registry to track patients. RESULTS: The process measures of referrals to the psychiatric care team and psychiatric assessment intakes performed as expected. Both measures were higher at the onset of the project and lower 1 year later. The outcome indicator, number of case reviews, increased dramatically over time. CONCLUSIONS: For psychiatric nurse practitioners, this quality improvement effort provides evidence that a consultative role can be effective in supporting primary care providers. Through providing education, establishing patient tiers, and establishing an effective workflow, more patients may have access to psychiatric services.

scholarly journals Beyond BMI: a feasibility study implementing NutriSTEP in primary care practices using electronic medical records (EMRs)

2020 ◽  
Vol 40 (1) ◽  
pp. 1-10
Author(s):  
Lesley Andrade ◽  
Kathy Moran ◽  
Susan J. Snelling ◽  
Darshaka Malaviarachchi ◽  
Joanne Beyers ◽  
...  
Keyword(s):  
Primary Care ◽  
Eating Habits ◽  
Qualitative Interviews ◽  
Primary Care Providers ◽  
Early Years ◽  
Successful Implementation ◽  
Care Providers ◽  
Nutrition Risk ◽  
Care Practices ◽  
Primary Care Practices

Introduction Primary care providers have a role to play in supporting the development of healthy eating habits, particularly in a child’s early years. This study examined the feasibility of implementing the NutriSTEP® screen—a 17-item nutrition risk screening tool validated for use with both toddler and preschooler populations—integrated with an electronic medical record (EMR) in primary care practices in Ontario, Canada, to inform primary care decision-making and public health surveillance. Methods Five primary care practices implemented the NutriSTEP screen as a standardized form into their EMRs. To understand practitioners’ experiences with delivery and assess factors associated with successful implementation, we conducted semi-structured qualitative interviews with primary care providers who were most knowledgeable about NutriSTEP implementation at their site. We assessed the quality of the extracted patient EMR data by determining the number of fully completed NutriSTEP screens and documented growth measurements of children. Results Primary care practices implemented the NutriSTEP screen as part of a variety of routine clinical contacts; specific data collection processes varied by site. Valid NutriSTEP screen data were captured in the EMRs of 80% of primary care practices. Approximately 90% of records had valid NutriSTEP screen completions and 70% of records had both valid NutriSTEP screen completions and valid growth measurements. Conclusion Integration of NutriSTEP as a standardized EMR form is feasible in primary care practices, although implementation varied in our study. The application of EMR-integrated NutriSTEP screening as part of a comprehensive childhood healthy weights surveillance system warrants further exploration.

scholarly journals Approaches to Behavioral Health Integration at High Performing Primary Care Practices

2018 ◽  
Vol 31 (5) ◽  
pp. 691-701 ◽  
Author(s):  
Paula R. Blasi ◽  
DeAnn Cromp ◽  
Sarah McDonald ◽  
Clarissa Hsu ◽  
Katie Coleman ◽  
...  
Keyword(s):  
Primary Care ◽  
Behavioral Health ◽  
High Performing ◽  
Behavioral Health Integration ◽  
Care Practices ◽  
Primary Care Practices

scholarly journals Adult Asthma Diagnosis: Physician Reported Challenges in Alberta-Based Primary Care Practices

2020 ◽  
Vol 6 ◽  
pp. 237796082092598
Author(s):  
H. Sharpe ◽  
F. C. Claveria-Gonzalez ◽  
W. Davidson ◽  
A. D. Befus ◽  
J. P. Leung ◽  
...  
Keyword(s):  
Primary Care ◽  
Pulmonary Function ◽  
Primary Care Providers ◽  
Pulmonary Function Testing ◽  
Objective Measurement ◽  
Care Providers ◽  
Asthma Diagnosis ◽  
Care Practices ◽  
Primary Care Practices ◽  
Function Testing

Introduction An estimated 8.1% of Canadians adults have asthma. While there are challenges associated with the use of objective measurement of lung function in the diagnosis of asthma, we are uncertain of the barriers that impact the use of objective measures, and have limited understanding of the challenges experienced by primary care providers in diagnosis of asthma. The objectives of this quality improvement initiative were to identify primary care providers’ methods of diagnosing asthma and to identify challenges with diagnosis. Methods An online survey was disseminated using a snowball methodology. Setting Primary care practices in Alberta, Canada. Participants A total of 84 primary care providers completed the survey. Main Outcome Measures Participants were asked their ideal and sufficient methods for diagnosing asthma and to identify challenges in their practice related to asthma diagnosis. Results They identified full pulmonary function testing (54%), pre- and postbronchodilator spirometry (54%), complete history and physical (42%), peak flow measurement overtime (26%), pulmonary consult (26%), and trial of asthma medication(s) (23%), as ideal methods of diagnosing asthma. The most significant barriers to diagnosis included episodic care–care provided typically during times of worsening symptoms without ongoing preventative/maintenance care (55%), patient follow-up (44%), conflict between clinical impression and pulmonary function results (43%), patient already on asthma medications (43%), and interpreting spirometry/pulmonary function results (39%). Conclusion The results of this survey indicate that the majority of primary care providers would choose full pulmonary function testing or pre- and postbronchodilator spirometry as the ideal methods of diagnosing asthma. However, barriers related to the nature of asthma care, patient factors, and challenges with diagnostic testing create challenges. This study also highlights that primary care providers have adapted to challenges in leveraging objective measurement and may rely upon other methods for diagnosis such as trials of medications.

scholarly journals Integrating childhood obesity resources into the patient-centered medical home: Provider perspectives in the United States

2018 ◽  
Vol 23 (1) ◽  
pp. 63-78 ◽  
Author(s):  
Samareh G Hill ◽  
Thao-Ly T Phan ◽  
George A Datto ◽  
Jobayer Hossain ◽  
Lloyd N Werk ◽  
...  
Keyword(s):  
Primary Care ◽  
Childhood Obesity ◽  
Primary Care Providers ◽  
System Level ◽  
Pediatric Primary Care ◽  
Care Providers ◽  
Obesity Management ◽  
Ancillary Staff ◽  
Care Practices ◽  
Primary Care Practices

Pediatric primary care providers play a critical role in managing obesity yet often lack the resources and support systems to provide effective care to children with obesity. The objective of this study was to identify system-level barriers to managing obesity and resources desired to better managing obesity from the perspective of pediatric primary care providers. A 64-item survey was electronically administered to 159 primary care providers from 26 practices within a large pediatric primary care network. Bivariate analyses were performed to compare survey responses based on provider and practice characteristics. Also factor analysis was conducted to determine key constructs that effect pediatric interventions for obesity. Survey response rate was 69% ( n = 109), with the majority of respondents being female (77%), physicians (67%), and without prior training in obesity management (74%). Time constraints during well visits (86%) and lack of ancillary staff (82%) were the most frequently reported barriers to obesity management. Information on community resources (99%), an on-site dietitian (96%), and patient educational materials (94%) were most frequently identified as potentially helpful for management of obesity in the primary care setting. Providers who desired more ancillary staff were significantly more likely to practice in clinics with a higher percentage of obese, Medicaid, and Hispanic patients. Integrating ancillary lifestyle expert support into primary care practices and connecting primary care practices to community organizations may be a successful strategy for assisting primary care providers with managing childhood obesity, especially among vulnerable populations.

Impact of the New York State Prescription Drug Monitoring Program (IStop) on chronic pain management by primary care providers

2021 ◽  
Vol 17 (1) ◽  
pp. 39-54
Author(s):  
Josiah D. Strawser, MD ◽  
Lauren Block, MD, MPH
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Risk Reduction ◽  
New York State ◽  
Monitoring Program ◽  
Primary Care Providers ◽  
Care Providers ◽  
Reduction Strategies ◽  
Risk Reduction Strategies

Objective: To explore the impact of the New York State Prescription Drug Monitoring Program (IStop) on the self-reported management of patients with chronic pain by primary care providers.Design: Mixed-methods study with survey collection and semistructured interviews.Setting: Multiple academic hospitals in New York.Participants: One hundred and thirty-six primary care providers (residents, fellows, attendings, and nurse practitioners) for survey collection, and eight primary care clinicians (residents, attending, and pharmacist) for interviews. Interventions: Introduction of IStop.Main outcome measure(s): Change in usage of four risk reduction strategies (pain contracts, urine tests, monthly visits, and co-management) as reported by primary care providers for patients with chronic pain.Results: After the introduction of IStop, 25 percent (32/128) of providers increased usage of monthly visits, 28 percent (36/128) of providers increased usage of pain management co-management with other healthcare providers, and 46 percent (60/129) of providers increased usage of at least one of four risk reduction strategies. Residents indicated much higher rates of change in risk reduction strategies due to IStop usage; increasing in the use of monthly visits (32 vs. 13 percent, p = 0.02) and co-management (36 vs. 13 percent, p = 0.01) occurred at a much higher rate in residents than attending physicians. Interview themes revealed an emphasis on finding opioid alternatives when possible, the need for frequent patient visits in effective pain management, and the importance of communication between the patient and provider to protect the relationship in chronic pain management.Conclusions: After the introduction of IStop, primary care providers have increased usage of risk reduction strategies in the care of chronic pain patients.

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