TY - JOUR
KW - Veterans
KW - Care management
KW - collaborative care
KW - health informatics
KW - Health Information Technology
KW - Mental Health
KW - primary care
AU - L. B. Leung
AU - A. S. Young
AU - L. Heyworth
AU - D. Rose
AU - S. Stockdale
AU - A. L. Graaff
AU - T. R. Dresselhaus
AU - L. V. Rubenstein
A1 - 
AB - BACKGROUND: To improve mental health care access, the Veterans Health Administration (VA) implemented Primary Care-Mental Health Integration (PC-MHI) in clinics nationally. Primary care clinical leader satisfaction can inform model implementation and may be facilitated by collaborative care managers and technology supporting cross-specialty collaboration. OBJECTIVE: (1) To determine primary care clinical leaders' overall satisfaction with care from embedded mental health providers for a range of conditions and (2) to examine the association between overall satisfaction and two program features (care managers, technology). DESIGN: Cross-sectional organizational survey in one VA region (Southern California, Arizona, and New Mexico), 2018. PARTICIPANTS: Sixty-nine physicians or other designated clinical leaders in each VA primary care clinic (94% response rate). MAIN MEASURES: We assessed primary care clinical leader satisfaction with embedded mental health care on four groups of conditions: target, non-target mental health, behavioral health, suicide risk management. They additionally responded about the availability of mental health care managers and the sufficiency of information technology (telemental health, e-consult, instant messaging). We examined relationships between satisfaction and the two program features using χ(2) tests and multivariable regressions. KEY RESULTS: Most primary care clinical leaders were "very satisfied" with care for targeted anxiety (71%) and depression (69%), but not for other common conditions (37% alcohol misuse, 19% pain). Care manager availability was significantly associated with "very satisfied" responses for depression (p = .02) and anxiety care by embedded mental health providers (p = .02). Highly rated sufficiency of communication technology (only 19%) was associated with "very satisfied" responses to suicide risk management (p = .002). CONCLUSIONS: Care from embedded mental health providers for depression and anxiety was highly satisfactory, which may guide improvement among less satisfactory conditions (alcohol misuse, pain). Observed associations between overall satisfaction and collaborative care features may inform clinics on how to optimize staffing and technology based on priority conditions.
AD - Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. lleung@mednet.ucla.edu.; Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA. lleung@mednet.ucla.edu.; Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.; VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA.; Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.; RAND Corporation, Santa Monica, CA, USA.; Office of Connected Care/Telehealth, Department of Veterans Affairs Central Office, Washington, DC, USA.; Department of Medicine, UCSD School of Medicine, San Diego, CA, USA.; Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.; Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.; VISN 22 (VA Desert Pacific Healthcare Network) Primary Care Coordinator, Gilbert, AZ, USA.; Department of Medicine, UCSD School of Medicine, San Diego, CA, USA.; Primary Care Service, VA San Diego Healthcare System, San Diego, CA, USA.; Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.; RAND Corporation, Santa Monica, CA, USA.; Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
BT - Journal of general internal medicine
C5 - Education & Workforce; Healthcare Disparities; HIT & Telehealth
CP - 12
DO - 10.1007/s11606-020-05660-1
IS - 12
JF - Journal of general internal medicine
LA - eng
M1 - Journal Article
N2 - BACKGROUND: To improve mental health care access, the Veterans Health Administration (VA) implemented Primary Care-Mental Health Integration (PC-MHI) in clinics nationally. Primary care clinical leader satisfaction can inform model implementation and may be facilitated by collaborative care managers and technology supporting cross-specialty collaboration. OBJECTIVE: (1) To determine primary care clinical leaders' overall satisfaction with care from embedded mental health providers for a range of conditions and (2) to examine the association between overall satisfaction and two program features (care managers, technology). DESIGN: Cross-sectional organizational survey in one VA region (Southern California, Arizona, and New Mexico), 2018. PARTICIPANTS: Sixty-nine physicians or other designated clinical leaders in each VA primary care clinic (94% response rate). MAIN MEASURES: We assessed primary care clinical leader satisfaction with embedded mental health care on four groups of conditions: target, non-target mental health, behavioral health, suicide risk management. They additionally responded about the availability of mental health care managers and the sufficiency of information technology (telemental health, e-consult, instant messaging). We examined relationships between satisfaction and the two program features using χ(2) tests and multivariable regressions. KEY RESULTS: Most primary care clinical leaders were "very satisfied" with care for targeted anxiety (71%) and depression (69%), but not for other common conditions (37% alcohol misuse, 19% pain). Care manager availability was significantly associated with "very satisfied" responses for depression (p = .02) and anxiety care by embedded mental health providers (p = .02). Highly rated sufficiency of communication technology (only 19%) was associated with "very satisfied" responses to suicide risk management (p = .002). CONCLUSIONS: Care from embedded mental health providers for depression and anxiety was highly satisfactory, which may guide improvement among less satisfactory conditions (alcohol misuse, pain). Observed associations between overall satisfaction and collaborative care features may inform clinics on how to optimize staffing and technology based on priority conditions.
PY - 2020
SN - 1525-1497; 0884-8734; 0884-8734
SP - 3458
EP - 3464
EP - 
T1 - Do Collaborative Care Managers and Technology Enhance Primary Care Satisfaction with Care from Embedded Mental Health Providers?
T2 - Journal of general internal medicine
TI - Do Collaborative Care Managers and Technology Enhance Primary Care Satisfaction with Care from Embedded Mental Health Providers?
U1 - Education & Workforce; Healthcare Disparities; HIT & Telehealth
U2 - 32556874
U3 - 10.1007/s11606-020-05660-1
VL - 35
VO - 1525-1497; 0884-8734; 0884-8734
Y1 - 2020
Y2 - Dec
ER -