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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).
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301
Facilitators and Barriers to Implementing SBIRT in Primary Care in Integrated Health Care Settings
Type: Journal Article
Year: 2014
Abstract: ABSTRACT Background: Substance abuse in the United States is a serious public health concern impacting morbidity and mortality. However, systematic screening and intervention has not been widely adopted into routine practice by health care organizations and routine screening and intervention is not currently in place for primary care at Kaiser Permanente Colorado. Therefore, a formative evaluation was conducted to explore and enhance implementation of the Substance Abuse and Mental Health Services Administration (SAMHSA) Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach in the organization. Methods: Key clinical stakeholders, including internal and family medicine physicians, primary care nurses, mental health therapists, chemical dependency clinicians, and clinic-based psychologists provided feedback. Two focus groups were also conducted with patient stakeholders; one in English and one in Spanish. Results: All clinical stakeholders promoted clinic-based psychologists to conduct brief intervention and determine referral to treatment as the optimal implementation program. Inclusion of the patient perspective also highlighted the importance of considering this perspective in implementation. Both patient groups were generally supportive of SBIRT, especially the educational value of screening questions defining healthy drinking limits, however, English-speaking patients noted privacy concerns and Spanish-speaking patients noted frequently being asked about drug or alcohol use. Organizationally, systems exist to facilitate drug and alcohol use screening, intervention, and referral to treatment. However, physician time, alignment with other priorities, and lack of consistent communication were noted potential barriers to SBIRT implementation. Conclusions: Clinicians expressed concerns about competing priorities and the need for organizational leadership involvement for successful SBIRT implementation. A unique suggestion for successful implementation is to utilize existing primary care clinic-based psychologists to conduct brief intervention and facilitate referral to treatment. Patient stakeholders supported universal screening but cultural differences in opinions and current experience were noted, indicating the importance of including this perspective when evaluating implementation potential.
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View the DOI record for Facilitators and Barriers to Implementing SBIRT in Primary Care in Integrated Health Care Settings
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View the PubMed citation for Facilitators and Barriers to Implementing SBIRT in Primary Care in Integrated Health Care Settings303
Factors enabling implementation of integrated health and social care: a systematic review
Type: Journal Article
Year: 2016
Publication Place: England
Abstract: BACKGROUND: In spite of ongoing UK Government recommendations for integrated health and social care, the implementation has been slow. While there are pockets of integration happening across England, many services remain isolated and fragmented. AIM: This review aims to critically review existing evidence to identify if there are any factors enabling successful implementation of integrated health and social care for people with long-term conditions in the community. METHOD: A review was conducted following the principles of a systematic review. Relevant data was extracted from the identified papers and the papers were quality appraised. RESULTS: A total of seven studies were included in the review. Data analysis and synthesis identified a number of themes in relation to enablers of integrated care, including co-location of teams, communication, integrated organisations, management and leadership, capacity and resources, and information technology. CONCLUSION: There is a limited amount of evidence regarding integrated health and social care teams. Although there are some consistencies within the findings, further research is needed to enhance the validity of the body of evidence available.
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View the DOI record for Factors enabling implementation of integrated health and social care: a systematic review
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View the PubMed citation for Factors enabling implementation of integrated health and social care: a systematic review305
Feasibility and preliminary outcomes from a pilot study of an integrated health-mental health promotion program in school mental health services
Type: Journal Article
Year: 2014
Publication Place: United States
Abstract: The prevalence of unmet health and mental health needs among youth has spurred the growing consensus to develop strategies that integrate services to promote overall well-being. This pilot study reports on the feasibility and outcomes of a theory-driven, family-focused, integrated health-mental health promotion program for underserved adolescents receiving school mental health services. Parent and adolescent assessments conducted prior to and following the brief, 6-session promotion program showed significant improvements in family support, youth self-efficacy, health behaviors, and mental health outcomes. Clinician reports contributed to a characterization of the feasibility, acceptability, and future recommendations for the integrated program.
Topic(s):
General Literature
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307
Features of the Chronic Care Model (CCM) associated with behavioral counseling and diabetes care in community primary care
Type: Journal Article
Year: 2010
Publication Place: United States
Abstract: BACKGROUND: The Chronic Care Model (CCM) was developed to improve chronic disease care, but it may also inform delivery of other types of preventive care. Using hierarchical analyses of service delivery to patients, we explored associations of CCM implementation with diabetes care and counseling for diet or weight loss and physical activity in community-based primary care offices. METHODS: Secondary analysis focused on baseline data from 25 practices (with an average of 4 physicians per practice) participating in an intervention trial targeting improved colorectal cancer screening rates. This intervention made no reference to the CCM. CCM implementation was measured through staff and clinical management surveys and was associated with patient care indicators (chart audits and patient questionnaires). RESULTS: Overall, practices had low levels of CCM implementation. However, higher levels of CCM implementation were associated with better diabetes assessment and treatment of patients (P = .009 and .015, respectively), particularly among practices open to "innovation." Physical activity counseling for obese and, particularly, overweight patients was strongly associated with CCM implementation (P = .0017), particularly among practices open to "innovation"; however, this association did not hold for overweight and obese patients with diabetes. CONCLUSIONS: Very modest levels of CCM implementation in unsupported primary care practices are associated with improved care for patients with diabetes and higher rates of behavioral counseling. Incremental incorporation of CCM components is an option, especially for community practices with stretched resources and with cultures of "innovativeness."
Topic(s):
General Literature
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309
Finding potentially new multimorbidity patterns of psychiatric and somatic diseases: exploring the use of literature-based discovery in primary care research
Type: Journal Article
Year: 2014
Publication Place: United States
Abstract: BACKGROUND: Multimorbidity, the co-occurrence of two or more chronic medical conditions within a single individual, is increasingly becoming part of daily care of general medical practice. Literature-based discovery may help to investigate the patterns of multimorbidity and to integrate medical knowledge for improving healthcare delivery for individuals with co-occurring chronic conditions. OBJECTIVE: To explore the usefulness of literature-based discovery in primary care research through the key-case of finding associations between psychiatric and somatic diseases relevant to general practice in a large biomedical literature database (Medline). METHODS: By using literature based discovery for matching disease profiles as vectors in a high-dimensional associative concept space, co-occurrences of a broad spectrum of chronic medical conditions were matched for their potential in biomedicine. An experimental setting was chosen in parallel with expert evaluations and expert meetings to assess performance and to generate targets for integrating literature-based discovery in multidisciplinary medical research of psychiatric and somatic disease associations. RESULTS: Through stepwise reductions a reference set of 21,945 disease combinations was generated, from which a set of 166 combinations between psychiatric and somatic diseases was selected and assessed by text mining and expert evaluation. CONCLUSIONS: Literature-based discovery tools generate specific patterns of associations between psychiatric and somatic diseases: one subset was appraised as promising for further research; the other subset surprised the experts, leading to intricate discussions and further eliciting of frameworks of biomedical knowledge. These frameworks enable us to specify targets for further developing and integrating literature-based discovery in multidisciplinary research of general practice, psychology and psychiatry, and epidemiology.
Topic(s):
General Literature
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310
Five-Year Mental Health Care Use by Patients Referred to Collaborative Care or to Specialized Care
Type: Journal Article
Year: 2015
Publication Place: United States
Abstract: OBJECTIVE: This study compared long-term use of mental health care by two groups of patients who had common mental disorders in the Netherlands-those treated in a collaborative care setting and those referred to off-site specialized mental health services if indicated. METHODS: The study was a retrospective analysis of use of mental health care over five years by 139 patients who participated in a cluster-randomized parent study. The parent study involved 27 general practitioners (GPs) who provided either collaborative care or usual care. In the collaborative care condition, a mental health professional worked on site at the GP's practice and was available to provide short-term treatment. In the usual-care condition, the GP referred the patient to off-site specialized mental health services if indicated; if not indicated, the GP provided usual care. The two treatment groups were compared on the number of mental health care contacts and total treatment duration, the proportion that initiated a new treatment episode after termination of the initial treatment, and time to new treatment. RESULTS: Patients in the collaborative care condition received about half the number of mental health care contacts as those in the usual-care condition, and no differences were found in the rate of initiation of new treatment episodes after initial treatment, time to new treatment, and total treatment duration. CONCLUSIONS: Referral of patients with common mental disorders to collaborative mental health care as a first intervention led to fewer contacts with a mental health care professional over the long term, compared with referral to specialized mental health care.
Topic(s):
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View the DOI record for Five-Year Mental Health Care Use by Patients Referred to Collaborative Care or to Specialized Care
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View the PubMed citation for Five-Year Mental Health Care Use by Patients Referred to Collaborative Care or to Specialized Care311
Five-year outcome of major depressive disorder in primary health care
Type: Journal Article
Year: 2014
Publication Place: England
Abstract: BACKGROUND: Primary health care provides treatment for most patients with depression. Despite their importance for organizing services, long-term course of depression and risk factors for poor outcome in primary care are not well known. METHOD: In the Vantaa Primary Care Depression Study, a stratified random sample of 1119 patients representing primary care patients in a Finnish city was screened for depression with the Primary Care Evaluation of Mental Disorders. SCID-I/P and SCID-II interviews were used to diagnose Axis I and II disorders. The 137 patients with DSM-IV depressive disorder were prospectively followed up at 3, 6, 18 and 60 months. Altogether, 82% of patients completed the 5-year follow-up, including 102 patients with a research diagnosis of major depressive disorder (MDD) at baseline. Duration of the index episode, recurrences, time spent in major depressive episodes (MDEs) and partial or full remission were examined with a life-chart. RESULTS: Of the MDD patients, 70% reached full remission, in a median time of 20 months. One-third had at least one recurrence. The patients spent 34% of the follow-up time in MDEs, 24% in partial remission and 42% in full remission. Baseline severity of depression and substance use co-morbidity predicted time spent in MDEs. CONCLUSIONS: This prospective, naturalistic, long-term study of a representative cohort of primary care patients with depression indicated slow or incomplete recovery and a commonly recurrent course, which need to be taken into account when developing primary care services. Severity of depressive symptoms and substance use co-morbidity should be systematically evaluated in planning treatment.
Topic(s):
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View the DOI record for Five-year outcome of major depressive disorder in primary health care
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View the PubMed citation for Five-year outcome of major depressive disorder in primary health care312
Focusing on employment in primary mental health care: A scoping review
Type: Journal Article
Year: 2018
Publication Place: Netherlands
Abstract: BACKGROUND: People with mental health issues usually access primary health care services but employment status and/or return to work is not typically an explicit focus of a general practice consultation. OBJECTIVE: This scoping review aims to investigate the broad range of interventions used in primary health care to effectively support people with mental health issues to choose, get, or keep employment. METHODS: A literature search was conducted using five electronic databases. Peer reviewed research articles published between 1996 and February 2016 were included in the review. RESULTS: Twelve studies explored work related interventions for people with mental health issues in the primary health care context. The most commonly used intervention was sickness certification, other interventions that show promise were identified but there is limited empirical evidence to show their effectiveness in relation to improving employment outcomes. General practitioners identified a range of barriers in terms of focusing on employment outcomes for patients including knowledge and confidence in understanding the impact of work on symptoms and limited access to advice or services to refer patients to. CONCLUSIONS: This review suggests that work focused interventions situated in primary health care settings appear to be a promising approach for people with mental health issues. However, various barriers impact the implementation of an employment approach, with limited comparisons between different effective interventions. In the context of increasing numbers of people presenting with mental health issues, future research should address the implementation and effectiveness of work-focused interventions based in primary health care.
Topic(s):
General Literature
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View the DOI record for Focusing on employment in primary mental health care: A scoping review
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View the PubMed citation for Focusing on employment in primary mental health care: A scoping review313
Focusing on employment in primary mental health care: A scoping review
Type: Journal Article
Year: 2018
Publication Place: Netherlands
Abstract: BACKGROUND: People with mental health issues usually access primary health care services but employment status and/or return to work is not typically an explicit focus of a general practice consultation. OBJECTIVE: This scoping review aims to investigate the broad range of interventions used in primary health care to effectively support people with mental health issues to choose, get, or keep employment. METHODS: A literature search was conducted using five electronic databases. Peer reviewed research articles published between 1996 and February 2016 were included in the review. RESULTS: Twelve studies explored work related interventions for people with mental health issues in the primary health care context. The most commonly used intervention was sickness certification, other interventions that show promise were identified but there is limited empirical evidence to show their effectiveness in relation to improving employment outcomes. General practitioners identified a range of barriers in terms of focusing on employment outcomes for patients including knowledge and confidence in understanding the impact of work on symptoms and limited access to advice or services to refer patients to. CONCLUSIONS: This review suggests that work focused interventions situated in primary health care settings appear to be a promising approach for people with mental health issues. However, various barriers impact the implementation of an employment approach, with limited comparisons between different effective interventions. In the context of increasing numbers of people presenting with mental health issues, future research should address the implementation and effectiveness of work-focused interventions based in primary health care.
Topic(s):
General Literature
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View the DOI record for Focusing on employment in primary mental health care: A scoping review
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View the PubMed citation for Focusing on employment in primary mental health care: A scoping review314
Foreword. Psychiatric diagnosis and management in primary care
Type: Journal Article
Year: 2014
Publication Place: United States
Topic(s):
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View the DOI record for Foreword. Psychiatric diagnosis and management in primary care
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View the PubMed citation for Foreword. Psychiatric diagnosis and management in primary care315
Frequency of generalized anxiety disorder in Chinese primary care
Type: Journal Article
Year: 2010
Publication Place: United States
Abstract: OBJECTIVE: This study aimed to assess the frequency of generalized anxiety disorder (GAD) among primary care patients in China. We also determined the rate of comorbid major depression (MD) in patients with GAD and explored the differences in sociodemographic and health-related characteristics between patients with and without GAD. METHOD: We invited consecutive outpatients who presented to 4 primary care facilities in Shanghai, China to fill out a survey composed of a screening questionnaire based on the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) for GAD (GAD-7), the Zung Self-Rating Depression Scale (SDS), and various sociodemographic and health-related variables. The 4 primary care facilities covered urban and suburban areas of the city. Patients completed the survey in the reception area as they waited for their medical appointment. RESULTS: The frequency of GAD in Chinese primary care was 4.1% (3.9% for males and 4.3% for females). This estimate was based on 127 positive results among a total of 3073 surveys collected. Of the patients who screened positive for GAD, 72.4% also screened positive for MD. Patients with GAD were more likely to report chronic medical conditions and to attend a university-affiliated primary care clinic. CONCLUSION: Our results showed that the frequency of GAD was significantly high in Chinese primary care patients. Compared with the GAD prevalence in Chinese general population from previously published studies, our findings suggest a link between GAD and health-seeking behaviors. Generalized anxiety disorder was also strongly correlated with MD. Integration of a routine GAD screening regime merits serious consideration to screen, diagnose, and treat patients with GAD in the primary care setting.
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View the DOI record for Frequency of generalized anxiety disorder in Chinese primary care
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View the PubMed citation for Frequency of generalized anxiety disorder in Chinese primary care318
From mental disorder to shared understanding: a non-categorical approach to support individuals with distress in primary care
Type: Journal Article
Year: 2019
Publication Place: England
Topic(s):
General Literature
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319
Functional outcomes of multi-condition collaborative care and successful ageing: results of randomised trial
Type: Journal Article
Year: 2011
Publication Place: England
Abstract: OBJECTIVE: To evaluate the effectiveness of integrated care for chronic physical diseases and depression in reducing disability and improving quality of life. DESIGN: A randomised controlled trial of multi-condition collaborative care for depression and poorly controlled diabetes and/or risk factors for coronary heart disease compared with usual care among middle aged and elderly people SETTING: Fourteen primary care clinics in Seattle, Washington. PARTICIPANTS: Patients with diabetes or coronary heart disease, or both, and blood pressure above 140/90 mm Hg, low density lipoprotein concentration >3.37 mmol/L, or glycated haemoglobin 8.5% or higher, and PHQ-9 depression scores of >/= 10. INTERVENTION: A 12 month intervention to improve depression, glycaemic control, blood pressure, and lipid control by integrating a "treat to target" programme for diabetes and risk factors for coronary heart disease with collaborative care for depression. The intervention combined self management support, monitoring of disease control, and pharmacotherapy to control depression, hyperglycaemia, hypertension, and hyperlipidaemia. MAIN OUTCOME MEASURES: Social role disability (Sheehan disability scale), global quality of life rating, and World Health Organization disability assessment schedule (WHODAS-2) scales to measure disabilities in activities of daily living (mobility, self care, household maintenance). RESULTS: Of 214 patients enrolled (106 intervention and 108 usual care), disability and quality of life measures were obtained for 97 intervention patients at six months (92%) and 92 at 12 months (87%), and for 96 usual care patients at six months (89%) and 92 at 12 months (85%). Improvements from baseline on the Sheehan disability scale (-0.9, 95% confidence interval -1.5 to -0.2; P = 0.006) and global quality of life rating (0.7, 0.2 to 1.2; P = 0.005) were significantly greater at six and 12 months in patients in the intervention group. There was a trend toward greater improvement in disabilities in activities of daily living (-1.5, -3.3 to 0.4; P = 0.10). CONCLUSIONS: Integrated care that covers chronic physical disease and comorbid depression can reduce social role disability and enhance global quality of life. Trial registration Clinical Trials NCT00468676.
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View the DOI record for Functional outcomes of multi-condition collaborative care and successful ageing: results of randomised trial
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View the PubMed citation for Functional outcomes of multi-condition collaborative care and successful ageing: results of randomised trial