Uninsured Children With Psychosocial Problems: Primary Care Management

PEDIATRICS ◽  
2000 ◽  
Vol 106 (Supplement_3) ◽  
pp. 930-936 ◽  
Author(s):  
Thomas K. McInerny ◽  
Peter G. Szilagyi ◽  
George E. Childs ◽  
Richard C. Wasserman ◽  
Kelly J. Kelleher
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Professionals ◽  
Mental Health Problems ◽  
Psychosocial Problems ◽  
The United States ◽  
Behavior Study ◽  
Care Practices ◽  
Uninsured Children ◽  
Primary Care Practices

Objective. Nearly 14% of children in the United States are uninsured. We compared the prevalence of psychosocial problems and mental health services received by insured and uninsured children in primary care practices. Methods. The Child Behavior Study was a cohort study conducted by Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network. Four hundred one primary care clinicians enrolled an average sample of 55 consecutive children (4–15 years old) per clinician. Results. Of the 13 401 visits to clinicians with 3 or more uninsured patients, 12 518 were by insured children (93.4%) and 883 were by uninsured children (6.6%). A higher percentage of adolescents, Hispanic children, those with unmarried parents, and those with less educated parents were uninsured. According to clinicians, uninsured children and insured children had similar rates of psychosocial problems (19%) and severe psychosocial problems (2%). For children with a clinician-identified psychosocial problem, we found no differences in clinician-reported counseling, medication use, or referral to mental health professionals. Conclusions. Among children served in primary care practices, uninsured children have similar prevalence of clinician-identified psychosocial and mental health problems compared with insured children. Within their practices, clinicians managed uninsured children much the same way as insured children.psychosocial problems, uninsured children, pediatrics, family medicine, primary care.

scholarly journals Clinical effectiveness and cost effectiveness of individual mental health workers colocated within primary care practices: a systematic literature review

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042052
Author(s):  
Jean-Baptiste Woods ◽  
Geva Greenfield ◽  
Azeem Majeed ◽  
Benedict Hayhoe
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Cost Effectiveness ◽  
Health Worker ◽  
Health Workers ◽  
Risk Of Bias ◽  
Mental Health Workers ◽  
Mental Health Worker ◽  
Care Practices ◽  
Primary Care Practices

ObjectivesMental health disorders contribute significantly to the global burden of disease and lead to extensive strain on health systems. The integration of mental health workers into primary care has been proposed as one possible solution, but evidence of clinical and cost effectiveness of this approach is unclear. We reviewed the clinical and cost effectiveness of mental health workers colocated within primary care practices.DesignSystematic literature review.Data sourcesWe searched the Medline, Embase, PsycINFO, Healthcare Management Information Consortium (HMIC) and Global Health databases.Eligibility criteriaAll quantitative studies published before July 2019 were eligible for the review; participants of any age and gender were included. Studies did not need to report a certain outcome measure or comparator in order to be eligible.Data extraction and synthesisData were extracted using a standardised table; however, pooled analysis proved unfeasible. Studies were assessed for risk of bias using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool and the Cochrane collaboration’s tool for assessing risk of bias in randomised trials.ResultsFifteen studies from four countries were included. Mental health worker integration was associated with mental health benefits to varied populations, including minority groups and those with comorbid chronic diseases. Furthermore, the interventions were correlated with high patient satisfaction and increases in specialist mental health referrals among minority populations. However, there was insufficient evidence to suggest clinical outcomes were significantly different from usual general practitioner care.ConclusionsWhile there appear to be some benefits associated with mental health worker integration in primary care practices, we found insufficient evidence to conclude that an onsite primary care mental health worker is significantly more clinically or cost effective when compared with usual general practitioner care. There should therefore be an increased emphasis on generating new evidence from clinical trials to better understand the benefits and effectiveness of mental health workers colocated within primary care practices.

Challenging care work: General practitioners’ perspectives on caring for young adults with complex psychosocial problems

2019 ◽  
pp. 136345931987410
Author(s):  
Julie Høgsgaard Andersen ◽  
Tine Tjørnhøj-Thomsen ◽  
Susanne Reventlow ◽  
Annette Sofie Davidsen
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Young Adults ◽  
General Practitioners ◽  
Mental Health Problems ◽  
Psychosocial Problems ◽  
Health Problems ◽  
Care Work ◽  
Psychiatric Nurses ◽  
Provision Of Care

The international literature shows that primary care is well placed to address mental health problems in young people, but that primary care professionals experience a range of challenges in this regard. In Denmark, young adults who have complex psychosocial problems, and who are not in education or work, cause political and academic concern. They are also in regular contact with their general practitioners, the Danish municipalities and psychiatric services. However, little is known about general practitioners’ perspectives on caring for this vulnerable group of patients. In this article, we investigate how general practitioners’ care work is shaped by the bureaucratic management of care in a complex infrastructure network comprising the general practitioners, psychiatry, the municipalities and the young adults. The analysis is based on interviews and focus groups with general practitioners, psychiatric nurses and social workers. We employ Tronto’s concept of care and the concept of boundary work as a theoretical framework. We argue that general practitioners strive to provide care, but they are challenged by the following: contested diagnostic interpretations and the bureaucratic significance of diagnoses for the provision of care from psychiatry and the municipalities, systemic issues with handling intertwined social and mental health problems, and the young adults’ difficulties with accessing and receiving available care.

scholarly journals VitalSign6: A Primary Care First (PCP-First) Model for Universal Screening and Measurement-Based Care for Depression

2019 ◽  
Vol 12 (2) ◽  
pp. 71 ◽  
Author(s):  
Madhukar Trivedi ◽  
Manish Jha ◽  
Farra Kahalnik ◽  
Ronny Pipes ◽  
Sara Levinson ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Universal Screening ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Similar Treatment ◽  
Measurement Based Care

Major depressive disorder affects one in five adults in the United States. While practice guidelines recommend universal screening for depression in primary care settings, clinical outcomes suffer in the absence of optimal models to manage those who screen positive for depression. The current practice of employing additional mental health professionals perpetuates the assumption that primary care providers (PCP) cannot effectively manage depression, which is not feasible, due to the added costs and shortage of mental health professionals. We have extended our previous work, which demonstrated similar treatment outcomes for depression in primary care and psychiatric settings, using measurement-based care (MBC) by developing a model, called Primary Care First (PCP-First), that empowers PCPs to effectively manage depression in their patients. This model incorporates health information technology tools, through an electronic health records (EHR) integrated web-application and facilitates the following five components: (1) Screening (2) diagnosis (3) treatment selection (4) treatment implementation and (5) treatment revision. We have implemented this model as part of a quality improvement project, called VitalSign6, and will measure its success using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. In this report, we provide the background and rationale of the PCP-First model and the operationalization of VitalSign6 project.

scholarly journals Understanding primary care-oncology relationships within a changing healthcare environment

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Jennifer Tsui ◽  
Jenna Howard ◽  
Denalee O’Malley ◽  
William L. Miller ◽  
Shawna V. Hudson ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Care Transitions ◽  
Formal System ◽  
The United States ◽  
Comparative Case Study ◽  
Health Care Environment ◽  
Optimal Care ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background Management of care transitions from primary care into and out of oncology is critical for optimal care of cancer patients and cancer survivors. There is limited understanding of existing primary care-oncology relationships within the context of the changing health care environment. Methods Through a comparative case study of 14 innovative primary care practices throughout the United States (U.S.), we examined relationships between primary care and oncology settings to identify attributes contributing to strengthened relationships in diverse settings. Field researchers observed practices for 10–12 days, recording fieldnotes and conducting interviews. We created a reduced dataset of all text related to primary care-oncology relationships, and collaboratively identified patterns to characterize these relationships through an inductive “immersion/crystallization” analysis process. Results Nine of the 14 practices discussed having either formal or informal primary care-oncology relationships. Nearly all formal primary care-oncology relationships were embedded within healthcare systems. The majority of private, independent practices had more informal relationships between individual primary care physicians and specific oncologists. Practices with formal relationships noted health system infrastructure that facilitates transfer of patient information and timely referrals. Practices with informal relationships described shared commitment, trust, and rapport with specific oncologists. Regardless of relationship type, challenges reported by primary care settings included lack of clarity about roles and responsibilities during cancer treatment and beyond. Conclusions With the rapid transformation of U.S. healthcare towards system ownership of primary care practices, efforts are needed to integrate strengths of informal primary care-oncology relationships in addition to formal system driven relationships.

Home-Based Primary Care Practices in the United States: Current State and Quality Improvement Approaches

2015 ◽  
Vol 63 (5) ◽  
pp. 963-969 ◽  
Author(s):  
Bruce Leff ◽  
Christine M. Weston ◽  
Sarah Garrigues ◽  
Kanan Patel ◽  
Christine Ritchie ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Quality Improvement ◽  
The United States ◽  
Current State ◽  
Home Based Primary Care ◽  
Home Based ◽  
Care Practices ◽  
Primary Care Practices

Nurse Practitioner Autonomy and Complexity of Care in Rural Primary Care

2020 ◽  
pp. 107755872094591
Author(s):  
Hannah T. Neprash ◽  
Laura Barrie Smith ◽  
Bethany Sheridan ◽  
Ira Moscovice ◽  
Shailendra Prasad ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Urban Areas ◽  
The United States ◽  
Rural Primary Care ◽  
Rural And Urban ◽  
Clinical Autonomy ◽  
Care Practices ◽  
Primary Care Practices

The growing ranks of nurse practitioners (NPs) in rural areas of the United States have the potential to help alleviate existing primary care shortages. This study uses a nationwide source of claims- and EHR-data from 2017 to construct measures of NP clinical autonomy and complexity of care. Comparisons between rural and urban primary care practices reveal greater clinical autonomy for rural NPs, who were more likely to have an independent patient panel, to practice with less physician supervision, and to prescribe Schedule II controlled substances. In contrast, rural and urban NPs provided care of similar complexity. These findings provide the first claims- and EHR-based evidence for the commonly held perception that NPs practice more autonomously in rural areas than in urban areas.

Enhancing the Safe and Effective Management of Chronic Pain in Accountable Care Organization Primary Care Practices in Kentucky

2016 ◽  
Vol 32 (2) ◽  
pp. 178-185 ◽  
Author(s):  
Selam Wubu ◽  
Laura Lee Hall ◽  
Paula Straub ◽  
Matthew J. Bair ◽  
Jill A. Marsteller ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Primary Care Physicians ◽  
The United States ◽  
Care Organization ◽  
Chronic Pain Management ◽  
Accountable Care ◽  
Care Practices ◽  
Primary Care Practices

Chronic pain is a prevalent chronic condition with significant burden and economic impact in the United States. Chronic pain is particularly abundant in primary care, with an estimated 52% of chronic pain patients obtaining care from primary care physicians (PCPs). However, PCPs often lack adequate training and have limited time and resources to effectively manage chronic pain. Chronic pain management is complex in nature because of high co-occurrence of psychiatric disorders and other medical comorbidities in patients. This article describes a quality improvement initiative conducted by the American College of Physicians (ACP), in collaboration with the Kentucky ACP Chapter, and the Center for Health Services and Outcomes Research at the Johns Hopkins Bloomberg School of Public Health, to enhance chronic pain management in 8 primary care practices participating in Accountable Care Organizations in Kentucky, with a goal of enhancing the screening, diagnosis, and treatment of patients with chronic pain.

Disaster and Terrorism: Cognitive-Behavioral Interventions

2004 ◽  
Vol 19 (1) ◽  
pp. 54-63 ◽  
Author(s):  
Robyn D. Walser ◽  
Josef I. Ruzek ◽  
Amy E. Naugle ◽  
Christine Padesky ◽  
Diana M. Ronell ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Behavioral Interventions ◽  
Mental Health Problems ◽  
Current Knowledge ◽  
Behavioral Therapy ◽  
Medical Personnel ◽  
The United States ◽  
Cognitive Behavioral ◽  
Mental Health Effects

AbstractThe mental health effects of disaster and terrorism have moved to the forefront in the recent past following the events of 11 September 2001 in the United States. Although there has been a protracted history by mental health researchers and practitioners to study, understand, prevent, and treat mental health problems arising as a result of disasters and terrorism, there still is much to learn about the effects and treatment of trauma. Continued communication among disaster workers, first-response medical personnel, and mental health professionals is part of this process. This paper outlines current knowledge regarding the psychological effects of trauma and best cognitive-behavioral practices used to treat trauma reactions. More specifically, the information presented is a summary of Cognitive-Behavioral Therapy (CBT) interventions that are relevant for responding to and dealing with the aftermath of disasters.

scholarly journals Variations in Mental Health Diagnosis and Prescribing Across Pediatric Primary Care Practices

PEDIATRICS ◽  
2016 ◽  
Vol 137 (5) ◽  
pp. e20152974-e20152974 ◽  
Author(s):  
S. L. Mayne ◽  
M. E. Ross ◽  
L. Song ◽  
B. McCarn ◽  
J. Steffes ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Pediatric Primary Care ◽  
Mental Health Diagnosis ◽  
Care Practices ◽  
Primary Care Practices ◽  
Health Diagnosis
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