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Opioids & SU
The Literature Collection contains over 11,000 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).
1453 Results
282
Community Health Workers Bring Cost Savings to Patient-Centered Medical Homes
Type: Journal Article
Year: 2018
Publication Place: Netherlands
Abstract: The Patient-Centered Medical Home (PCMH) model demonstrated that processes of care can be improved while unnecessary care, such as preventable emergency department utilization, can be reduced through better care coordination. A complementary model, the Integrated Primary Care and Community Support (I-PaCS) model, which integrates community health workers (CHWs) into primary care settings, functions beyond improved coordination of primary medical care to include management of the social determinants of health. However, the PCMH model puts downward pressure on the panel sizes of primary care providers, increasing the average fixed costs of care at the practice level. While the I-PaCS model layers an additional cost of the CHWs into the primary care cost structure, that additional costs is relatively small. The purpose of this study is to simulate the effects of the PCMH and I-PaCS models over a 3-year period to account for program initiation to maturity. The costs and cost offsets of the model were estimated at the clinic practice level. The studies which find the largest cost savings are for high-risk, paneled patients and therefore do not represent the effects of the PCMH model on moderate-utilizing patients or practice-level effects. We modeled a 12.6% decrease in the inpatient hospital, outpatient hospital and emergency department costs of high and moderate risk patients. The PCMH is expected to realize a 1.7% annual savings by year three while the I-PaCS program is expected to a 7.1% savings in the third year. The two models are complementary, the I-PaCS program enhancing the cost reduction capability of the PCMH.
Topic(s):
Financing & Sustainability
See topic collection
, Medical Home
See topic collection
Reference Links: 
View the DOI record for Community Health Workers Bring Cost Savings to Patient-Centered Medical Homes
View DOI Record
View the PubMed citation for Community Health Workers Bring Cost Savings to Patient-Centered Medical Homes283
Community Health Workers Bring Cost Savings to Patient-Centered Medical Homes
Type: Journal Article
Year: 2018
Publication Place: Netherlands
Abstract: The Patient-Centered Medical Home (PCMH) model demonstrated that processes of care can be improved while unnecessary care, such as preventable emergency department utilization, can be reduced through better care coordination. A complementary model, the Integrated Primary Care and Community Support (I-PaCS) model, which integrates community health workers (CHWs) into primary care settings, functions beyond improved coordination of primary medical care to include management of the social determinants of health. However, the PCMH model puts downward pressure on the panel sizes of primary care providers, increasing the average fixed costs of care at the practice level. While the I-PaCS model layers an additional cost of the CHWs into the primary care cost structure, that additional costs is relatively small. The purpose of this study is to simulate the effects of the PCMH and I-PaCS models over a 3-year period to account for program initiation to maturity. The costs and cost offsets of the model were estimated at the clinic practice level. The studies which find the largest cost savings are for high-risk, paneled patients and therefore do not represent the effects of the PCMH model on moderate-utilizing patients or practice-level effects. We modeled a 12.6% decrease in the inpatient hospital, outpatient hospital and emergency department costs of high and moderate risk patients. The PCMH is expected to realize a 1.7% annual savings by year three while the I-PaCS program is expected to a 7.1% savings in the third year. The two models are complementary, the I-PaCS program enhancing the cost reduction capability of the PCMH.
Topic(s):
Financing & Sustainability
See topic collection
, Medical Home
See topic collection
Reference Links:
View the DOI record for Community Health Workers Bring Cost Savings to Patient-Centered Medical Homes
View DOI Record
View the PubMed citation for Community Health Workers Bring Cost Savings to Patient-Centered Medical Homes286
Comparing patients' and other stakeholders' preferences for outcomes of integrated care for multimorbidity: a discrete choice experiment in eight European countries
Type: Journal Article
Year: 2020
Topic(s):
Education & Workforce
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, Financing & Sustainability
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, Healthcare Disparities
See topic collection
287
Comparing telemedicine to in-person buprenorphine treatment in U.S. veterans with opioid use disorder
Type: Journal Article
Year: 2022
Abstract:
BACKGROUND: Telemedicine-delivered buprenorphine (tele-buprenorphine) can potentially increase access to buprenorphine for patients with opioid use disorder (OUD), especially during the COVID-19 pandemic, but we know little about use in clinical care. METHODS: This study was a retrospective national cohort study of veterans diagnosed with opioid use disorder (OUD) receiving buprenorphine treatment from the Veterans Health Administration (VHA) in fiscal years 2012-2019. The study examined trends in use of tele-buprenorphine and compared demographic and clinical characteristics in patients who received tele-buprenorphine versus those who received in-person treatment only. RESULTS: Utilization of tele-buprenorphine increased from 2.29% of buprenorphine patients in FY2012 (n = 187) to 7.96% (n = 1352) in FY2019 in VHA veterans nationally. Compared to patients receiving only in-person care, tele-buprenorphine patients were less likely to be male (AOR = 0.85, 95% CI: 0.73-0.98) or Black (AOR = 0.54, 95% CI: 0.45-0.65). Tele-buprenorphine patients were more likely to be treated in community-based outpatient clinics rather than large medical centers (AOR = 2.91, 95% CI: 2.67-3.17) and to live in rural areas (AOR = 2.12, 95% CI:1.92-2.35). The median days supplied of buprenorphine treatment was 722 (interquartile range: 322-1459) among the tele-buprenorphine patients compared to 295 (interquartile range: 67-854) among patients who received treatment in-person. CONCLUSIONS: Use of telemedicine to deliver buprenorphine treatment in VHA increased 3.5-fold between 2012 and 2019, though overall use remained low prior to COVID-19. Tele-buprenorphine is a promising modality especially when treatment access is limited. However, we must continue to understand how practitioners and patient are using telemedicine and how these patients' outcomes compare to those using in-person care.
Topic(s):
Financing & Sustainability
See topic collection
, Healthcare Disparities
See topic collection
, HIT & Telehealth
See topic collection
, Opioids & Substance Use
See topic collection
Reference Links:
View the DOI record for Comparing telemedicine to in-person buprenorphine treatment in U.S. veterans with opioid use disorder
View DOI Record
View the PubMed citation for Comparing telemedicine to in-person buprenorphine treatment in U.S. veterans with opioid use disorder291
Complexity in partnerships: A qualitative examination of collaborative depression care in primary care clinics and community-based organisations in California, United States
Type: Journal Article
Year: 2020
Publication Place: England
Abstract: Partnering across health clinics and community organisations, while worthwhile for improving health and well-being, is challenging and time consuming. Even partnerships that have essential elements for success in place face inevitable challenges. To better understand how cross-organisational partnerships work in practice, this paper examines collaborations between six primary care clinics and community-based organisations in the United States that were part of an initiative to address late-life depression using an enhanced collaborative care model (Archstone Foundation Care Partners Project). As part of an evaluation of the Care Partners Project, 54 key informant interviews and 10 focus groups were conducted from 2015 to 2017. Additionally, more than 80 project-related documents were reviewed. Qualitative thematic analysis was used to code the transcripts and identify prominent themes in the data. Examining clinic and community organisation partnerships in practice highlighted their inherent complexity. The partnerships were fluid and constantly evolving, shaped by a multiplicity of perspectives and values, and vulnerable to unpredictability. Care Partners sites negotiated the complexity of their partnerships drawing upon three main strategies: adaptation (allowing for flexibility and rapid change); integration (providing opportunities for multi-level partnerships within and across organisations) and cultivation (fostering a commitment to the partnership and its value). These strategies provided opportunities for Care Partners collaborators to work with the inherent complexity of partnering. Intentionally acknowledging and embracing such complexity rather than trying to reduce or avoid it, may allow clinic and community collaborators to strengthen and sustain their partnerships.
Topic(s):
Financing & Sustainability
See topic collection
292
Complexity in partnerships: A qualitative examination of collaborative depression care in primary care clinics and community-based organisations in California, United States
Type: Journal Article
Year: 2020
Publication Place: England
Abstract: Partnering across health clinics and community organisations, while worthwhile for improving health and well-being, is challenging and time consuming. Even partnerships that have essential elements for success in place face inevitable challenges. To better understand how cross-organisational partnerships work in practice, this paper examines collaborations between six primary care clinics and community-based organisations in the United States that were part of an initiative to address late-life depression using an enhanced collaborative care model (Archstone Foundation Care Partners Project). As part of an evaluation of the Care Partners Project, 54 key informant interviews and 10 focus groups were conducted from 2015 to 2017. Additionally, more than 80 project-related documents were reviewed. Qualitative thematic analysis was used to code the transcripts and identify prominent themes in the data. Examining clinic and community organisation partnerships in practice highlighted their inherent complexity. The partnerships were fluid and constantly evolving, shaped by a multiplicity of perspectives and values, and vulnerable to unpredictability. Care Partners sites negotiated the complexity of their partnerships drawing upon three main strategies: adaptation (allowing for flexibility and rapid change); integration (providing opportunities for multi-level partnerships within and across organisations) and cultivation (fostering a commitment to the partnership and its value). These strategies provided opportunities for Care Partners collaborators to work with the inherent complexity of partnering. Intentionally acknowledging and embracing such complexity rather than trying to reduce or avoid it, may allow clinic and community collaborators to strengthen and sustain their partnerships.
Topic(s):
Financing & Sustainability
See topic collection
296
Consultation psychiatry in the medical home and accountable care organizations: Achieving the triple aim
Type: Journal Article
Year: 2011
Publication Place: United States
Topic(s):
Financing & Sustainability
See topic collection
, Medical Home
See topic collection
Reference Links:
View the DOI record for Consultation psychiatry in the medical home and accountable care organizations: Achieving the triple aim
View DOI Record
View the PubMed citation for Consultation psychiatry in the medical home and accountable care organizations: Achieving the triple aim297
Consumers' Valuation of Primary Care-Based Treatment Options for Mental and Substance Use Disorders
Type: Journal Article
Year: 2015
Publication Place: United States
Abstract: Most individuals with substance use disorders and with mental disorders do not receive treatment. If treatment options were more attractive, treatment rates might increase. The advantages of novel approaches, including primary care-based treatment and collaborative care in a primary care setting, have been documented. However, less is known about consumers' valuation of these options. The authors assessed monetary valuation of these treatment types compared with usual care in a specialty treatment setting. Contingent valuation methods were used in a Web-based randomized vignette experiment that involved 2,146 individuals who screened positive for a drug or alcohol use disorder or a mental disorder. Participants valued a primary care-based treatment visit over usual care in a specialty treatment setting by $9.00 and a collaborative care visit over usual care in a specialty treatment setting by $5.85.
Topic(s):
Financing & Sustainability
See topic collection
Reference Links:
View the DOI record for Consumers' Valuation of Primary Care-Based Treatment Options for Mental and Substance Use Disorders
View DOI Record
View the PubMed citation for Consumers' Valuation of Primary Care-Based Treatment Options for Mental and Substance Use Disorders298
Continuity of care and health care costs among persons with severe mental illness
Type: Journal Article
Year: 2005
Publication Place: United States
Abstract: OBJECTIVES: Although the association between continuity of care and health outcomes among persons with severe mental illness is beginning to be elucidated, the association between continuity and costs has remained virtually unexplored. The purpose of this study was to examine the relationship of continuity of care and health care costs in a sample of 437 adults with severe mental illness in three health regions of Alberta, Canada. METHODS: Service use events and costs were tracked through self-reported and administrative data. Associations between continuity and costs were examined by using analysis of variance and regression analysis. RESULTS: Mean+/-SD total, hospital, and community cost over the 17-month study period were $24,070+/-$25,643, $12,505+/-$20,991, and $2,848+/-$4,420, respectively. The difference in means across levels of observer-rated continuity was not statistically significant for total cost, but improved continuity was associated with both lower hospital cost and higher community cost. Total cost was significantly lower for patients with a higher self-rated quality of life as indicated on the EQ-5D visual analogue scale, although associations did not hold up in the regression analysis. Patients with higher functioning as rated by the Multnomah Community Abilities Scale had significantly lower total and community costs. CONCLUSIONS: The study showed a relationship between continuity of care and both hospital and community costs. The data also indicate that a relationship exists between cost and level of patient functioning. It will be necessary to conduct further studies using experimental designs to examine the impact of shifting resources from hospitals to the community, particularly for high-need patients, on continuity of care and subsequent outcomes.
Topic(s):
Financing & Sustainability
See topic collection
Reference Links:
View the DOI record for Continuity of care and health care costs among persons with severe mental illness
View DOI Record
View the PubMed citation for Continuity of care and health care costs among persons with severe mental illness300
Controlled trial of a collaborative primary care team model for patients with diabetes and depression: rationale and design for a comprehensive evaluation
Type: Journal Article
Year: 2012
Publication Place: England
Abstract: BACKGROUND: When depression accompanies diabetes, it complicates treatment, portends worse outcomes and increases health care costs. A collaborative care case-management model, previously tested in an urban managed care organization in the US, achieved significant reduction of depressive symptoms, improved diabetes disease control and patient-reported outcomes, and saved money. While impressive, these findings need to be replicated and extended to other healthcare settings. Our objective is to comprehensively evaluate a collaborative care model for comorbid depression and type 2 diabetes within a Canadian primary care setting. METHODS/DESIGN: We initiated the TeamCare model in four Primary Care Networks in Northern Alberta. The intervention involves a nurse care manager guiding patient-centered care with family physicians and consultant physician specialists to monitor progress and develop tailored care plans. Patients eligible for the intervention will be identified using the Patient Health Questionnaire-9 as a screen for depressive symptoms. Care managers will then guide patients through three phases: 1) improving depressive symptoms, 2) improving blood glucose, blood pressure and cholesterol, and 3) improving lifestyle behaviors. We will employ the RE-AIM framework for a comprehensive and mixed-methods approach to our evaluation. Effectiveness will be assessed using a controlled "on-off" trial design, whereby eligible patients would be alternately enrolled in the TeamCare intervention or usual care on a monthly basis. All patients will be assessed at baseline, 6 and 12 months. Our primary analyses will be based on changes in two outcomes: depressive symptoms, and a multivariable, scaled marginal model for the combined outcome of global disease control (i.e., A1c, systolic blood pressure, LDL cholesterol). Our planned enrolment of 168 patients will provide greater than 80% power to observe clinically important improvements in all measured outcomes. Direct costing of all intervention components and measurement of all health care utilization using linked administrative databases will be used to determine the cost-effectiveness of the intervention relative to usual care. DISCUSSION: Our comprehensive evaluation will generate evidence to reliability, effectiveness and sustainability of this collaborative care model for patients with chronic diseases and depression. TRIALS REGISTRATION: Clinicaltrials.gov Identifier: NCT01328639.
Topic(s):
Financing & Sustainability
See topic collection