Collaborative Care: Integrating Behavioral Health Into the Primary Care Setting

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.

Increasing Vitamin B12 Screening Among Patients With Type 2 Diabetes on Long-Term Metformin Therapy

The setting for this project was a free clinic that serves an underserved and underprivileged community in the southeastern United States. The patient population is 80% Hispanic and 20% African American and Caucasian. The clinic also serves the community by doubling as a food bank and clothing center. Clinician staffing at the clinic included three physicians, two family nurse practitioners (FNPs), one physician assistant (PA), and a mixture of nurse practitioner (NP) and PA students. The students rotated through the clinic for one semester or multiple semesters as they progressed through their graduate program’s plan of study.

Increasing Vitamin B12 Screening Among Patients With Type 2 Diabetes on Long-Term Metformin Therapy

The setting for this project was a free clinic that serves an underserved and underprivileged community in the southeastern United States. The patient population is 80% Hispanic and 20% African American and Caucasian. The clinic also serves the community by doubling as a food bank and clothing center. Clinician staffing at the clinic included three physicians, two family nurse practitioners (FNPs), one physician assistant (PA), and a mixture of nurse practitioner (NP) and PA students. The students rotated through the clinic for one semester or multiple semesters as they progressed through their graduate program’s plan of study.

Digital Tool to Help Stop Newborn Phototherapy: A Prospective Study

The present study evaluated end-user experience for effectiveness, efficiency, and satisfaction of a mobile application (app) to estimate the risk of rebound hyperbilirubinemia within 72 hours after initial phototherapy ends for infants at 35 weeks’ gestation or longer and age younger than 14 days. This prospective parallel study was performed at one medical center. The 26 participants are neonatology and pediatric and family physicians, neonatal and family nurse practitioners, and family practice residents, who were asked to estimate the risk of rebound hyperbilirubinemia when phototherapy is stopped for a fictional newborn. Participants in Group 1 (no app) were compared with Group 2 (with app). Satisfaction measured from 1 (0%) to 7 (100%). Group 1 had fewer correct answers than Group 2 (38.5% vs. 84.6%; P = .04). The mean satisfaction score for Group 1 was 2, lower than the score for Group 2, 6.6 (P < .001). This provider-developed app is effective and receives high end-user satisfaction.

Professional competences in family nurse practitioners in North-Western Poland*

Introduction: Professional nursing is increasingly often understood as accompanying and assisting people during health, disease and limited fitness. It is also shaping their self-care capabilities. The complexity of these tasks puts great responsibility on nurses, since they are those health care professionals who are in direct contact with patients’ families and communities. Nurses’ functions are exceptional because they involve the management and organization of holistic care in work with patients and their families (nursing and educational activities, cooperation with other members of a therapeutic team).The purpose of this study was to analyze their level of knowledge concerning their tasks and professional competences in family nurse practitioners employed in primary health care centers.Materials and methods: The research were carried out from February 2014 to the end of October 2015 in entities providing nursing services in primary health care in north-western Poland. For the analysis 643 questionnaire surveys were accepted.Results: Family nurse practitioners in north-western Poland show a satisfactory level of knowledge in the field of professional competence. Nurses have especially high levels of knowledge concerning patients’ access to nursing services, information provided by primary care physicians as part of cooperation in the care of a patient, the nursing process method, and care of elderly and chronically ill individuals. The nurses had gaps in their knowledge of selected nursing services, such as bladder irrigation, transport, and rectal procedures. Alarmingly low levels of knowledge were observed with regard to professional competence in the care of patients with mental diseases.