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The Literature Collection contains over 10,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
Use the Search feature below to find references for your terms across the entire Literature Collection, or limit your searches by Authors, Keywords, or Titles and by Year, Type, or Topic. View your search results as displayed, or use the options to: Show more references per page; Sort references by Title or Date; and Refine your search criteria. Expand an individual reference to View Details. Full-text access to the literature may be available through a link to PubMed, a DOI, or a URL. References may also be exported for use in bibliographic software (e.g., EndNote, RefWorks, Zotero).
1012 Results
221
Coordinating care across diseases, settings, and clinicians: A key role for the generalist in practice
Type: Journal Article
Year: 2005
Publication Place: United States
Abstract: Coordinated care is a defining principle of primary care, but it is becoming increasingly difficult to provide as the health care delivery system in the United States becomes more complex. To guide recommendations for research and practice, the evidence about implementation of coordinated care and its benefits must be considered. On the basis of review of the published literature this article makes recommendations concerning needs for a better-developed evidence base to substantiate the value of care coordination, generalist practices to be the hub of care coordination for most patients, improved communication among clinicians, a team approach to achieve coordination, integration of patients and families as partners, and incorporation of medical informatics. Although coordination of care is central to generalist practice, it requires far more effort than physicians alone can deliver. To make policy recommendations, further work is needed to identify essential elements of care coordination and prove its effectiveness at improving health outcomes.
Topic(s):
Education & Workforce
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, HIT & Telehealth
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, Healthcare Policy
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Reference Links: View the PubMed citation for Coordinating care across diseases, settings, and clinicians: A key role for the generalist in practice
222
Coordination of health behavior counseling in primary care
Type: Journal Article
Year: 2011
Publication Place: United States
Abstract: PURPOSE: We wanted to examine how coordinated care is implemented in primary care practices to address patients' health behavior change needs. METHODS: Site visit notes, documents, interviews, and online implementation diaries were collected from July 2005 to September 2007 from practice-based research networks (PBRNs) participating in Prescription for Health: Promoting Healthy Behaviors in Primary Care Research Networks (P4H). An iterative group process was used to conduct a cross-case comparative analysis of 9 interventions. Published patient outcomes reports from P4H interventions were referenced to provide information on intervention effectiveness. RESULTS: In-practice health risk assessment (HRA) and brief counseling, coupled with referral and outreach to a valued and known counseling resource, emerged as the best way to consistently coordinate and encourage follow-through for health behavior counseling. Findings from published P4H outcomes suggest that this approach led to improvement in health behaviors. Automated prompts and decision support tools for HRA, brief counseling and referral, training in brief counseling strategies, and co-location of referral with outreach facilitated implementation. Interventions that attempted to minimize practice or clinician burden through telephone and Web-based counseling systems or by expanding the medical assistant role in coordination of health behavior counseling experienced difficulties in implementation and require more study to determine how to optimize integration in practices. CONCLUSIONS: Easy-to-use system-level solutions that have point-of-delivery reminders and decision support facilitate coordination of health behavior counseling for primary care patients. Infrastructure is needed if broader integration of health behavior counseling is to be achieved in primary care.
Topic(s):
HIT & Telehealth
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, Education & Workforce
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Reference Links: View the PubMed citation for Coordination of health behavior counseling in primary care
223
Copy/paste documentation of lifestyle counseling and glycemic control in patients with diabetes: true to form?
Type: Journal Article
Year: 2011
Publication Place: United States
Topic(s):
HIT & Telehealth
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Reference Links:
View the DOI record for Copy/paste documentation of lifestyle counseling and glycemic control in patients with diabetes: true to form?
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View the PubMed citation for Copy/paste documentation of lifestyle counseling and glycemic control in patients with diabetes: true to form?225
Cost effectiveness of text messages to reduce methamphetamine use and HIV sexual risk behaviors among men who have sex with men
Type: Journal Article
Year: 2019
Topic(s):
Education & Workforce
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, Financing & Sustainability
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, Healthcare Disparities
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, HIT & Telehealth
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, Measures
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, Opioids & Substance Use
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226
Cost-effectiveness analysis of a rural telemedicine collaborative care intervention for depression
Type: Journal Article
Year: 2010
Publication Place: United States
Abstract: CONTEXT: Collaborative care interventions for depression in primary care settings are clinically beneficial and cost-effective. Most prior studies were conducted in urban settings. OBJECTIVE: To examine the cost-effectiveness of a rural telemedicine-based collaborative care depression intervention. DESIGN: Randomized controlled trial of intervention vs usual care. SETTING: Seven small (serving 1000 to 5000 veterans) Veterans Health Administration community-based outpatient clinics serving rural catchment areas in 3 mid-South states. Each site had interactive televideo dedicated to mental health but no psychiatrist or psychologist on site. Patients Among 18 306 primary care patients who were screened, 1260 (6.9%) screened positive for depression; 395 met eligibility criteria and were enrolled from April 2003 to September 2004. Of those enrolled, 360 (91.1%) completed a 6-month follow-up and 335 (84.8%) completed a 12-month follow-up. Intervention A stepped-care model for depression treatment was used by an off-site depression care team to make treatment recommendations via electronic medical record. The team included a nurse depression care manager, clinical pharmacist, and psychiatrist. The depression care manager communicated with patients via telephone and was supported by computerized decision support software. MAIN OUTCOME MEASURES: The base case cost analysis included outpatient, pharmacy, and intervention expenditures. The effectiveness outcomes were depression-free days and quality-adjusted life years (QALYs) calculated using the 12-Item Short Form Health Survey standard gamble conversion formula. RESULTS: The incremental depression-free days outcome was not significant (P = .10); therefore, further cost-effectiveness analyses were not done. The incremental QALY outcome was significant (P = .04) and the mean base case incremental cost-effectiveness ratio was $85 634/QALY. Results adding inpatient costs were $111 999/QALY to $132 175/QALY. CONCLUSIONS: In rural settings, a telemedicine-based collaborative care intervention for depression is effective and expensive. The mean base case result was $85 634/QALY, which is greater than cost per QALY ratios reported for other, mostly urban, depression collaborative care interventions.
Topic(s):
Financing & Sustainability
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, HIT & Telehealth
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, Healthcare Policy
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Reference Links:
View the DOI record for Cost-effectiveness analysis of a rural telemedicine collaborative care intervention for depression
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View the PubMed citation for Cost-effectiveness analysis of a rural telemedicine collaborative care intervention for depression227
Cost-effectiveness of computerised cognitive-behavioural therapy for anxiety and depression in primary care: Randomised controlled trial
Type: Journal Article
Year: 2004
Publication Place: England
Abstract: BACKGROUND: Cognitive-behavioural therapy (CBT) is effective for treating anxiety and depression in primary care, but there is a shortage of therapists. Computer-delivered treatment may be a viable alternative. AIMS: To assess the cost-effectiveness of computer-delivered CBT. METHOD: A sample of people with depression or anxiety were randomised to usual care (n=128) or computer-delivered CBT (n=146). Costs were available for 123 and 138 participants, respectively. Costs and depression scores were combined using the net benefit approach. RESULTS: Service costs were 40 British pounds (90% CI - 28 British pounds to 148 British pounds) higher over 8 months for computer-delivered CBT. Lost-employment costs were 407 British pounds (90% CI 196 British pounds to 586 British pounds) less for this group. Valuing a 1-unit improvement on the Beck Depression Inventory at 40 British pounds, there is an 81% chance that computer-delivered CBT is cost-effective, and it revealed a highly competitive cost per quality-adjusted life year. CONCLUSIONS: Computer-delivered CBT has a high probability of being cost-effective, even if a modest value is placed on unit improvements in depression.
Topic(s):
Financing & Sustainability
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, HIT & Telehealth
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228
Cost-effectiveness of computerized cognitive-behavioural therapy for the treatment of depression in primary care: findings from the Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy (REEACT) trial
Type: Journal Article
Year: 2017
Publication Place: England
Abstract: BACKGROUND: Computerized cognitive-behavioural therapy (cCBT) forms a core component of stepped psychological care for depression. Existing evidence for cCBT has been informed by developer-led trials. This is the first study based on a large independent pragmatic trial to assess the cost-effectiveness of cCBT as an adjunct to usual general practitioner (GP) care compared with usual GP care alone and to establish the differential cost-effectiveness of a free-to-use cCBT programme (MoodGYM) in comparison with a commercial programme (Beating the Blues) in primary care. METHOD: Costs were estimated from a healthcare perspective and outcomes measured using quality-adjusted life years (QALYs) over 2 years. The incremental cost-effectiveness of each cCBT programme was compared with usual GP care. Uncertainty was estimated using probabilistic sensitivity analysis and scenario analyses were performed to assess the robustness of results. RESULTS: Neither cCBT programme was found to be cost-effective compared with usual GP care alone. At a pound20 000 per QALY threshold, usual GP care alone had the highest probability of being cost-effective (0.55) followed by MoodGYM (0.42) and Beating the Blues (0.04). Usual GP care alone was also the cost-effective intervention in the majority of scenario analyses. However, the magnitude of the differences in costs and QALYs between all groups appeared minor (and non-significant). CONCLUSIONS: Technically supported cCBT programmes do not appear any more cost-effective than usual GP care alone. No cost-effective advantage of the commercially developed cCBT programme was evident compared with the free-to-use cCBT programme. Current UK practice recommendations for cCBT may need to be reconsidered in the light of the results.
Topic(s):
Financing & Sustainability
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, HIT & Telehealth
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229
Cost-effectiveness of electronic- and clinician-delivered screening, brief intervention and referral to treatment for women in reproductive health centers
Type: Journal Article
Year: 2019
Topic(s):
Opioids & Substance Use
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, Financing & Sustainability
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, Healthcare Disparities
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, HIT & Telehealth
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230
Cost-Effectiveness of On-Site Versus Off-Site Collaborative Care for Depression in Rural FQHCs
Type: Journal Article
Year: 2015
Abstract: Objective: Collaborative care for depression in primary care settings is effective and cost-effective. However, there is minimal evidence to support the choice of on-site versus off-site models. This study examined the cost-effectiveness of on-site practice-based collaborative care (PBCC) versus off-site telemedicine-based collaborative care (TBCC) for depression in federally qualified health centers (FQHCs). Methods: In a multisite, randomized, pragmatic comparative cost-effectiveness trial, 19,285 patients were screened for depression, 2,863 (14.8%) screened positive, and 364 were enrolled. Telephone interview data were collected at baseline and at six, 12, and 18 months. Base case analysis used Arkansas FQHC health care costs, and secondary analysis used national cost estimates. Effectiveness measures were depression-free days and quality-adjusted life years (QALYs) derived from depression-free days, the 12-Item Short-Form Survey, and the Quality of Well-Being (QWB) Scale. Nonparametric bootstrap with replacement methods were used to generate an empirical joint distribution of incremental costs and QALYs and acceptability curves. Results: The TBCC intervention resulted in more depression-free days and QALYs but at a greater cost than the PBCC intervention. The disease-specific (depression-free day) and generic (QALY) incremental cost-effectiveness ratios (ICERs) were below their respective ICER thresholds for implementation, suggesting that the TBCC intervention was more cost effective than the PBCC intervention. Conclusions: These results support the cost-effectiveness of TBCC in medically underserved primary care settings. Information about whether to insource (make) or outsource (buy) depression care management is important, given the current interest in patient-centered medical homes, value-based purchasing, and bundled payments for depression care.
Topic(s):
Financing & Sustainability
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, Healthcare Disparities
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, HIT & Telehealth
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Reference Links:
View the DOI record for Cost-Effectiveness of On-Site Versus Off-Site Collaborative Care for Depression in Rural FQHCs
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View the PubMed citation for Cost-Effectiveness of On-Site Versus Off-Site Collaborative Care for Depression in Rural FQHCs231
Counselling behaviour and content in a pharmaceutical care service in Swedish community pharmacies
Type: Journal Article
Year: 2010
Publication Place: Netherlands
Abstract: OBJECTIVE: To characterise the counselling behaviour of practitioners providing a pharmaceutical care (PC) service in community pharmacy, and to describe the content of the consultations. SETTING: Community pharmacies in Sweden. METHODS: Non-participant observations, including audio recording, of five practitioners in five different pharmacies counselling 16 patients, were analysed qualitatively using an iterative, stepwise, interpretivist approach. MAIN OUTCOME MEASURE: Descriptions of counselling behaviour and content of consultations. RESULTS: The counselling behaviour was characterised by attempts to understand the patients' narratives by listening and asking questions and a willingness to help. The computer often had an important role in consultations, being used for documentation and as a supportive tool for identification of drug-drug interactions. The practitioners often took command in the initial phase of the consultation, and omitted to determine the patients' most urgent drug-related needs. However, counselling behaviour that identified and focused on the patient's needs, giving the computer little attention during the consultation was also observed. Practitioners provided vague descriptions of the purpose and outline of the service. Consultations included a wide variety of issues, which potentially could help patients' achieve optimal outcomes of medical treatment. CONCLUSION: The practitioners provided important advice and different forms of support to patients. Focus on the computer screen limited their abilities to practise patient centred care.
Topic(s):
HIT & Telehealth
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Reference Links:
View the DOI record for Counselling behaviour and content in a pharmaceutical care service in Swedish community pharmacies
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View the PubMed citation for Counselling behaviour and content in a pharmaceutical care service in Swedish community pharmacies233
COVID-19 Adaptations in the Care of Patients with Opioid Use Disorder: a Survey of California Primary Care Clinics
Type: Journal Article
Year: 2021
Abstract:
BACKGROUND: With the onset of the COVID-19 crisis, many federal agencies relaxed policies regulating opioid use disorder treatment. The impact of these changes has been minimally documented. The abrupt nature of these shifts provides a naturalistic opportunity to examine adaptations for opioid use disorder treatment in primary care. OBJECTIVE: To examine change in medical and behavioral health appointment frequency, visit type, and management of patients with opioid use disorder in response to COVID-19. DESIGN: A 14-item survey queried primary care practices that were enrolled in a medications for opioid use disorder statewide expansion project. Survey content focused on changes in service delivery because of COVID-19. The survey was open for 18 days. PARTICIPANTS: We surveyed 338 clinicians from 57 primary care clinics located in California, including federally qualified health centers and look-alikes. A representative from all 57 clinics (100%) and 118 staff (34.8% of all staff clinicians) participated in the survey. MAIN MEASURES: The survey consisted of seven dimensions of practice: medical visits, behavioral health visits, medication management, urine drug screenings, workflow, perceived patient demand, and staff experience. KEY RESULTS: A total of 52 of 57 (91.2%) primary care clinics reported practice adaptations in response to COVID-19 regulatory changes. Many clinics indicated that both medical (40.4%) and behavioral health visits (53.8%) were now exclusively virtual. Two-thirds (65.4%) of clinics reported increased duration of buprenorphine prescriptions and reduced urine drug screenings (67.3%). The majority (56.1%) of clinics experienced an increase in patient demand for behavioral health services. Over half (56.2%) of clinics described having an easier or unchanged experience retaining patients in care. CONCLUSIONS: Many adaptations in the primary care approach to patients with opioid use disorder may be temporary reactions to COVID-19. Further evaluation of the impact of these adaptations on patient outcomes is needed to determine whether changes should be maintained post-COVID-19.
Topic(s):
Education & Workforce
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, Healthcare Policy
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, HIT & Telehealth
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, Opioids & Substance Use
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Reference Links:
View the DOI record for COVID-19 Adaptations in the Care of Patients with Opioid Use Disorder: a Survey of California Primary Care Clinics
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View the PubMed citation for COVID-19 Adaptations in the Care of Patients with Opioid Use Disorder: a Survey of California Primary Care Clinics235
COVID-19 and opioid use disorder: Expanding treatment access in rural settings
Type: Journal Article
Year: 2021
Publication Place: United States
Topic(s):
Healthcare Disparities
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, HIT & Telehealth
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, Opioids & Substance Use
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Reference Links:
View the DOI record for COVID-19 and opioid use disorder: Expanding treatment access in rural settings
View DOI Record
View the PubMed citation for COVID-19 and opioid use disorder: Expanding treatment access in rural settings237
COVID-19 and treating incarcerated populations for opioid use disorder
Type: Journal Article
Year: 2021
Topic(s):
Education & Workforce
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, Healthcare Disparities
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, HIT & Telehealth
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, Opioids & Substance Use
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Reference Links:
View the DOI record for COVID-19 and treating incarcerated populations for opioid use disorder
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View the PubMed citation for COVID-19 and treating incarcerated populations for opioid use disorder240
COVID-19-related treatment service disruptions among people with single- and polysubstance use concerns
Type: Journal Article
Year: 2020
Topic(s):
Healthcare Disparities
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, HIT & Telehealth
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, Opioids & Substance Use
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Reference Links:
View the DOI record for COVID-19-related treatment service disruptions among people with single- and polysubstance use concerns
View DOI Record
View the PubMed citation for COVID-19-related treatment service disruptions among people with single- and polysubstance use concerns