Behavioural health consultants in integrated primary care teams: a model for future care

BackgroundLoss to follow-up is an under-recognised problem in primary care. Continuity with a primary care provider improves morbidity and mortality in the Veterans Health Administration. We sought to reduce the percentage of patients lost to follow-up at the Northeast Ohio Veterans Affairs Healthcare System from October 2017 to March 2019.MethodsThe Panel Retention Tool (PRT) was developed and tested with primary care teams using multiple Plan, Do, Study and Act cycles to identify and schedule lost to follow-up patients. Baseline data on loss to follow-up, defined as the percentage of panelled patients not seen in primary care in the past year, was collected over 6 months during tool development. Outcomes were tracked from implementation through spread and sustainment (12 months) across 14 primary care clinics.ResultsOf the 96 170 panelled patients at the beginning of the study period, 2715 (2.8%) were found to be inactive and removed from provider panels, improving panel reliability. Among the remaining, 1856 (1.9%) patients without scheduled follow-up were scheduled for future care, and 1239 (1.3%) without recent prior care completed encounters during the study period. The percentage of patients lost to follow-up decreased from 10.1% (lower control limit (LCL) 9.8%–upper control limit (UCL) 10.4%) at baseline to 6.4% (LCL 6.2%–UCL 6.7%) postintervention and patients without planned future care decreased from 21.7% (LCL 21.3%–UCL 22.1%) to 17.1% (LCL 16.7%–UCL 17.5%).ConclusionsThe PRT allowed primary care teams in an integrated health system to identify and schedule lost to follow-up patients. Ease of use, adaptability and encouraging outcomes facilitated spread. This has the potential to contribute to more appropriate utilisation of healthcare resources and improved access to primary care.

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Team-Based Integrated Primary Care

10.1093/med/9780190276201.003.0004 ◽

2017 ◽

Author(s):

Tziporah Rosenberg ◽

Colleen T. Fogarty ◽

Michael R Privitera ◽

Susan H. McDaniel

Keyword(s):

Primary Care ◽

Care Delivery ◽

Integrated Primary Care ◽

Primary Care Teams ◽

Major Reform ◽

Access To Primary Care ◽

Health Care Delivery Systems ◽

The University

With the advent of major reform in health care delivery systems, team-based approaches to primary care are becoming standard, inviting expansion of the role of the psychiatrist as part of those teams. Teams of interdisciplinary professionals expand access to primary care and the connection to specialty care for those who need the most support. This chapter describes the typical roles in integrated primary care teams, including those filled by a psychiatrist. The authors discuss the differences between traditional mental health and primary care cultures and adapting to the needs of primary care through transdisciplinary collaboration. An overview of the potential levels of collaboration is provided. The authors describe their own long-term experience with integrated primary care in the Department of Family Medicine at the University of Rochester. The chapter concludes with a discussion about the future of psychiatric care within primary care teams as well as population management for those with comorbid illness.

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Integrated Primary Care Teams (IPCT) pilot project in Quebec: a protocol paper

BMJ Open ◽

10.1136/bmjopen-2015-010559 ◽

2015 ◽

Vol 5 (12) ◽

pp. e010559 ◽

Cited By ~ 4

Author(s):

Damien Contandriopoulos ◽

Arnaud Duhoux ◽

Bernard Roy ◽

Maxime Amar ◽

Jean-Pierre Bonin ◽

...

Keyword(s):

Primary Care ◽

Pilot Project ◽

Integrated Primary Care ◽

Primary Care Teams

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Designing health information technology tools for behavioural health clinicians integrated within US-based primary care teams

BMJ Health & Care Informatics ◽

10.14236/jhi.v25i3.998 ◽

2018 ◽

Vol 25 (3) ◽

pp. 148-168 ◽

Cited By ~ 2

Author(s):

Tanisha Tate Woodson ◽

Rose Gunn ◽

Khaya D. Clark ◽

Bijal A. Balasubramanian ◽

Katelyn K. Jetelina ◽

...

Keyword(s):

Primary Care ◽

Information Technology ◽

Integrated Care ◽

Health Information Technology ◽

Health Information ◽

Information Needs ◽

Care Delivery ◽

Care Practice ◽

Behavioural Health ◽

Primary Care Teams

BackgroundElectronic health records (EHRs) are a key tool for primary care practice. However, the EHR functionality is not keeping pace with the evolving informational and decision-support needs of behavioural health clinicians (BHCs) working on integrated teams.ObjectiveDescribe the workflows and tasks of integrated BHCs working with adult patients identify their health information technology (health IT) needs and develop EHR tools to address them.MethodA mixed-methods, comparative case study of six community health centres (CHCs) in Oregon, each with at least one BHC integrated into their primary care team. We observed clinical work and conducted interviews to understand workflows and clinical tasks, aiming to identify how effectively current EHRs supported integrated care delivery, including transitions, documentation, information sharing and decision-making. We analysed these data and employed a user-centred design process to develop EHR tools addressing the identified needs.ResultsBHCs used the primary care EHR for documentation and communication with other team members, but the EHR lacked the functionality to fully support integrated care. Needs include the ability to: (1) automate and track paper-based screening; (2) document behavioural health history; (3) access patient social and medical history relevant to behavioural health issues and (4) rapidly document and track progress on goals. To meet these needs, we engaged users and developed a set of EHR tools called the Behavioural Health e-Suite (BH e-Suite).ConclusionUS-based integrated primary care teams, and particularly BHCs working with adult populations, have unique information needs, workflows and tasks. These needs can be met and supported by the EHR with a moderate level of modification.

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