TY - JOUR
KW - Cross-Sectional Studies
KW - Humans
KW - Mental Health
KW - patient outcome assessment
KW - Primary Health Care
KW - United States
KW - United States Department of Veterans Affairs
KW - Veterans Health
KW - Communication
KW - Patient Satisfaction
KW - primary care
KW - Veterans
AU - L. B. Leung
AU - D. Rose
AU - R. Guo
AU - C. E. Brayton
AU - L. V. Rubenstein
AU - S. Stockdale
A1 - 
AB - BACKGROUND: Mental health specialists and care managers facilitate comprehensive care provision within medical homes. Despite implementation challenges, mental health integration is thought to improve patient-centered primary care. OBJECTIVES: To examine the relationship between primary care patient experience and mental health integration. RESEARCH DESIGN: Cross-sectional surveys from 168 primary care clinicians (PCPs) (n = 226) matched with assigned patients' surveys (n = 1734) in one Veterans Health Administration (VA) region, fiscal years 2012-2013. Multilevel regression models examined patient experience and mental health integration, adjusting for patient and PCP characteristics. MEASURES: Patient experience outcomes were (1) experience with PCP and (2) receipt of comprehensive care, such as talked about "stress". Independent variables represented mental health integration- (1) PCP-rated communication with mental health and (2) proportion of clinic patients who saw integrated specialists. RESULTS: 50% and 43% of patients rated their PCPs 10/10 and reported receiving comprehensive care, respectively. Neither patient experience or receipt of comprehensive care was significantly associated with PCP's ratings of communication with mental health, nor with proportion of clinic patients who saw integrated specialists. Among a subsample of patients who rated their mental health as poor/fair, however, we detected an association between proportion of clinic patients who saw integrated specialists and patient experience (odds ratio = 1.05, 95% confidence interval = 1.01-1.09, p = .01). CONCLUSIONS: No association was observed between mental health integration and primary care patients' reported care experiences, but a significant association existed among patients who reported poor/fair mental health. More research is needed to understand patient experiences with regard to care model implementation.
AD - Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA. Electronic address: lleung@mednet.ucla.edu.; Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.; Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.; Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, 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.; Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
BT - Healthcare (Amsterdam, Netherlands)
C5 - Education & Workforce; Healthcare Disparities; Medical Home
CP - 4
DO - 10.1016/j.hjdsi.2021.100587
IS - 4
JF - Healthcare (Amsterdam, Netherlands)
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Mental health specialists and care managers facilitate comprehensive care provision within medical homes. Despite implementation challenges, mental health integration is thought to improve patient-centered primary care. OBJECTIVES: To examine the relationship between primary care patient experience and mental health integration. RESEARCH DESIGN: Cross-sectional surveys from 168 primary care clinicians (PCPs) (n = 226) matched with assigned patients' surveys (n = 1734) in one Veterans Health Administration (VA) region, fiscal years 2012-2013. Multilevel regression models examined patient experience and mental health integration, adjusting for patient and PCP characteristics. MEASURES: Patient experience outcomes were (1) experience with PCP and (2) receipt of comprehensive care, such as talked about "stress". Independent variables represented mental health integration- (1) PCP-rated communication with mental health and (2) proportion of clinic patients who saw integrated specialists. RESULTS: 50% and 43% of patients rated their PCPs 10/10 and reported receiving comprehensive care, respectively. Neither patient experience or receipt of comprehensive care was significantly associated with PCP's ratings of communication with mental health, nor with proportion of clinic patients who saw integrated specialists. Among a subsample of patients who rated their mental health as poor/fair, however, we detected an association between proportion of clinic patients who saw integrated specialists and patient experience (odds ratio = 1.05, 95% confidence interval = 1.01-1.09, p = .01). CONCLUSIONS: No association was observed between mental health integration and primary care patients' reported care experiences, but a significant association existed among patients who reported poor/fair mental health. More research is needed to understand patient experiences with regard to care model implementation.
PY - 2021
SN - 2213-0772; 2213-0764
SP - 100587
T1 - Mental health care integration and primary care patient experience in the Veterans Health Administration
T2 - Healthcare (Amsterdam, Netherlands)
TI - Mental health care integration and primary care patient experience in the Veterans Health Administration
U1 - Education & Workforce; Healthcare Disparities; Medical Home
U2 - 34601395
U3 - 10.1016/j.hjdsi.2021.100587
VL - 9
VO - 2213-0772; 2213-0764
Y1 - 2021
Y2 - Dec
ER -