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.

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.

Care Coordination and the Expansion of Nursing Scopes of Practice

2014 ◽  
Vol 42 (1) ◽  
pp. 93-103 ◽  
Author(s):  
Y. Tony Yang ◽  
Mark R. Meiners
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
Access To Health Care ◽  
Primary Care Providers ◽  
Cost Curve ◽  
Care Providers ◽  
Access To Health ◽  
Recent Developments

Recent developments in the health care industry have precipitated a new wave of interest in expanding the scope of practice for nursing. This is because the Patient Protection and Affordable Care Act (ACA), broadly designed to increase access to health insurance, will inevitably result in increased demand for primary care providers. And with compensation for primary care physicians already lagging far behind that of specialists, the role of nurse practitioners is once again receiving increased attention as a viable means by which to ease the pressure for access to health care.But the economics of this trade-off are controversial. On one hand, it sets primary care physicians at odds with specialists; namely, if the ultimate goal is to “bend the cost curve downward,” should specialist compensation be reduced in order to increase spending on primary care?

Screening for Risk in a Primary Care Setting

2019 ◽  
pp. 435-458
Author(s):  
Lynne C. Huffman ◽  
Joan Baran
Keyword(s):  
Primary Care ◽  
Young Children ◽  
Behavioral Health ◽  
Primary Care Providers ◽  
Health Problems ◽  
Preschool Age ◽  
Screening Tools ◽  
Care Providers ◽  
Validity Data ◽  
Primary Care Pediatricians

Behavioral issues in children can emerge as early as infancy and be clearly apparent by toddlerhood and preschool age. Though pediatricians see infants and young children for up to a dozen well-child visits during the first two years of life, such problems are often not appreciated or identified, and consensus is lacking on a reliable and valid way to determine quickly whether a concern is significant enough to warrant a referral for further assessment/intervention. Given the pediatrics developmental surveillance and anticipatory guidance models, these visits provide an important opportunity for both prevention and early intervention efforts in the behavioral health domains. A few screening tools that reliably identify behavioral health problems in young children can help pediatricians begin the conversation, substantiate parental concerns, validate clinical impressions, inform immediate care, facilitate appropriate referrals, and, ultimately, potentially change the trajectory of a child’s life. Follow-up after screening is essential to increase likelihood of linkage to care. This chapter describes the primary health care context and examines the role of primary care pediatricians in caring for young children with behavioral health problems. Next, it gives a brief overview of the problems typically seen in this age range. Then, screening tools available to primary care pediatricians are reviewed, noting the reliability and validity data for each tool. Summary recommendations for useful screening strategies are given and the limits of what is available to primary care providers are addressed.

“There Are so Many Nuances . . . ”: Health Care Providers’ Perspectives of Pain Communication With Hmong Patients in Primary Care Settings

2020 ◽  
pp. 104365962095943
Author(s):  
Maichou Lor ◽  
David Rabago ◽  
Miroslav Backonja
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Content Analysis ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Limited English Proficiency ◽  
Qualitative Content Analysis ◽  
Primary Care Providers ◽  
Care Providers ◽  
Pain Communication

Introduction While researchers have studied Hmong patients with limited English proficiency in pain communication, no research has examined primary care providers’ (PCPs’) interpretation of Hmong pain communication. This study examines PCPs’ pain communication experience with Hmong patients. Method A qualitative content analysis was conducted with PCPs. Interviews were audio recorded, transcribed, and analyzed using conventional content analysis. Results Fifteen PCPs—including seven physicians, one osteopathic physician, four nurse practitioners, and three physician assistants—participated. PCPs’ interpretations of pain communication with Hmong patients were characterized by three themes: (a) the providers experienced pain communication problems related to language, (b) the providers perceived the Hmong to have different beliefs about pain, and (c) the providers used different strategies to improve communication. Discussion The findings suggest that challenges are present in achieving effective pain communication between Hmong patients and their PCPs. Ineffective pain communication hinders the delivery of culturally congruent health care for Hmong patients.

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.

scholarly journals Perspectives on Providing And Receiving Preventive Health Care From Primary Care Providers and Their Patients With Mental Illnesses

2018 ◽  
Vol 32 (8) ◽  
pp. 1730-1739 ◽  
Author(s):  
Scott P. Stumbo ◽  
Bobbi Jo H. Yarborough ◽  
Micah T. Yarborough ◽  
Carla A. Green
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Population ◽  
Behavioral Health ◽  
Preventive Care ◽  
Preventive Health Care ◽  
Primary Care Providers ◽  
Safety Net ◽  
Mental Illnesses ◽  
Care Providers

Purpose: Individuals with mental illnesses have higher morbidity rates and reduced life expectancy compared to the general population. Understanding how patients and providers perceive the need for prevention, as well as the barriers and beliefs that may contribute to insufficient care, are important for improving service delivery tailored to this population. Design: Cross-sectional; mixed methods. Setting: An integrated health system and a network of federally qualified health centers and safety net clinics. Participants: Interviews (n = 30) and surveys (n = 249) with primary care providers. Interviews (n = 158) and surveys (n = 160) with patients diagnosed with schizophrenia, bipolar, anxiety, or major depressive disorders. Measures: Semi-structured interviews and surveys. Analysis: Thematic analysis for qualitative data; frequencies for quantitative data. Results: More than half (n = 131, 53%) of clinicians believed patients with mental illnesses care less about preventive care than the general population, yet 88% (n = 139) of patients reported interest in improving health. Most providers (n = 216, 88%) lacked confidence that patients with mental illnesses would follow preventive recommendations; 82% (n = 129) of patients reported they would try to change lifestyles if their doctor recommended. Clinicians explained that their perception of patients’ chaotic lives and lack of interest in preventive care contributed to their fatalistic attitudes on care delivery to this population. Clinicians and patients agreed on substantial need for additional support for behavior changes. Clinicians reported providing informational support by keeping messages simple; patients reported a desire for more detailed information on reasons to complete preventive care. Patients also detailed the need for assistive and tangible support to manage behavioral health changes. Conclusions: Our results suggest a few clinical changes could help patients complete preventive care recommendations and improve health behaviors: improving clinician–patient collaboration on realistic goal setting, increasing visit time or utilizing behavioral health consultants that bridge primary and specialty mental health care, and increasing educational and tangible patient support services.

754 Insomnia and Depression Symptoms in Primary Care Patients Referred for Mental Health Care

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A294-A294
Author(s):  
Ivan Vargas ◽  
Alexandria Muench ◽  
Mark Seewald ◽  
Cecilia Livesey ◽  
Matthew Press ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Primary Care Providers ◽  
Depression Symptoms ◽  
Care Providers ◽  
Mild Depression ◽  
Significant Depression ◽  
Clinically Significant

Abstract Introduction Past epidemiological research indicates that insomnia and depression are both highly prevalent and tend to co-occur in the general population. The present study further assesses this association by estimating: (1) the concurrence rates of insomnia and depression in outpatients referred by their primary care providers for mental health care; and (2) whether the association between depression and insomnia varies by insomnia subtype (initial, middle, and late). Methods Data were collected from 3,174 patients (mean age=42.7; 74% women; 50% Black) who were referred to the integrated care program for assessment of mental health symptoms (2018–2020). All patients completed an Insomnia Severity Index (ISI) and a Patient Health Questionnaire (PHQ-9) during their evaluations. Total scores for the ISI and PHQ-9 were computed. These scores were used to categorize patients into diagnostic groups for insomnia (no-insomnia [ISI < 8], subthreshold-insomnia [ISI 8–14], and clinically-significant-insomnia [ISI>14]) and depression (no-depression [PHQ-914]). Items 1–3 of the ISI were also used to assess the association between depression and subtypes of insomnia. Results Rates of insomnia were as follows: 34.6% for subthreshold-insomnia, 35.5% for clinically-significant insomnia, and 28.9% for mild-depression and 26.9% for clinically-significant-depression. 92% of patients with clinically significant depression reported at least subthreshold levels of insomnia. While the majority of patients with clinical depression reported having insomnia, the proportion of patients that endorsed these symptoms were comparable across insomnia subtypes (percent by subtype: initial insomnia 63%; middle insomnia 61%; late insomnia 59%). Conclusion According to these data, the proportion of outpatients referred for mental health evaluations that endorse treatable levels of insomnia is very high (approximately 70%). This naturally gives rise to at least two questions: how will such symptomatology be addressed (within primary or specialty care) and what affect might targeted treatment for insomnia have on health were it a focus of treatment in general? Support (if any) Vargas: K23HL141581; Perlis: K24AG055602

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