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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).
171 Results
81
Integrated care: treatment initiation following positive depression screens
Type: Journal Article
Year: 2013
Publication Place: United States
Abstract: BACKGROUND: Primary Care-Mental Health Integration (PC-MHI) may improve mental health services access and continuity of care. OBJECTIVE: To assess whether receipt of integrated PC-MHI services on the date of an initial positive depression screen influences receipt of depression treatment among primary care (PC) patients in the Veterans Health Administration. DESIGN: Retrospective cohort study. SUBJECTS: Thirty-six thousand, two hundred and sixty-three PC patients with positive depression screens between October 1, 2009 and September 30, 2010. MAIN MEASURES: Subjects were assessed for depression diagnosis and initiation of antidepressants or psychotherapy on the screening day, within 12 weeks, and within 6 months. Among individuals with PC encounters on the screening day, setting of services received that day was categorized as PC only, PC-MHI, or Specialty Mental Health (SMH). Using multivariable generalized estimating equations (GEE) logistic regression, we assessed likelihood of treatment initiation, adjusting for demographic and clinical measures, including depression screening score. KEY RESULTS: Patients who received same-day PC-MHI services were more likely to initiate psychotherapy (OR: 8.16; 95 % CI: 6.54-10.17) and antidepressant medications (OR: 2.33, 95 % CI: 2.10-2.58) within 12 weeks than were those who received only PC services on the screening day. CONCLUSIONS: Receipt of same-day PC-MHI may facilitate timely receipt of depression treatment.
Topic(s):
Key & Foundational
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, Measures
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Reference Links: 
View the DOI record for Integrated care: treatment initiation following positive depression screens
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View the PubMed citation for Integrated care: treatment initiation following positive depression screens86
Integrated primary care: an inclusive three-world view through process metrics and empirical discrimination
Type: Journal Article
Year: 2009
Publication Place: United States
Abstract: Integrating behavioral health services within the primary care setting drives higher levels of collaborative care, and is proving to be an essential part of the solution for our struggling American healthcare system. However, justification for implementing and sustaining integrated and collaborative care has shown to be a formidable task. In an attempt to move beyond conflicting terminology found in the literature, we delineate terms and suggest a standardized nomenclature. Further, we maintain that addressing the three principal worlds of healthcare (clinical, operational, financial) is requisite in making sense of the spectrum of available implementations and ultimately transitioning collaborative care into the mainstream. Using a model that deconstructs process metrics into factors/barriers and generalizes behavioral health provider roles into major categories provides a framework to empirically discriminate between implementations across specific settings. This approach offers practical guidelines for care sites implementing integrated and collaborative care and defines a research framework to produce the evidence required for the aforementioned clinical, operational and financial worlds of this important movement.
Topic(s):
Financing & Sustainability
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, Key & Foundational
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Reference Links:
View the DOI record for Integrated primary care: an inclusive three-world view through process metrics and empirical discrimination
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View the PubMed citation for Integrated primary care: an inclusive three-world view through process metrics and empirical discrimination88
Integrating a behavioral health specialist into your practice
Type: Journal Article
Year: 2011
Publication Place: United States
Topic(s):
Key & Foundational
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Reference Links: View the PubMed citation for Integrating a behavioral health specialist into your practice
93
Integrating mental health and primary care
Type: Journal Article
Year: 2007
Publication Place: United States
Abstract: Mental health and primary care delivery systems have evolved to operate differently. For example, attention to multiple medical issues, health maintenance, and structured diagnostic procedures are standard elements of primary care rarely incorporated into mental health care. A multidisciplinary treatment approach, group care, and case management are common features of mental health treatment settings only rarely used in primary care practices. Advances in treatments for mental health disorders and increased knowledge of the integral link between mental health and physical health encourage mental health disorder treatment in primary care settings, which reach the most patients. Effective integration of mental health care into primary care requires systematic and pragmatic change that builds on the strengths of both mental health and primary care.
Topic(s):
Key & Foundational
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97
Integrating treatment for mental and physical disorders and substance misuse in Indigenous primary care settings
Type: Journal Article
Year: 2011
Publication Place: England
Abstract: OBJECTIVE: Australian Indigenous peoples in remote and rural settings continue to have limited access to treatment for mental illness. Comorbid disorders complicate presentations in primary care where Indigenous youths and perinatal women are at particular risk. Despite this high comorbidity there are few examples of successful models of integrated treatment. This paper outlines these challenges and provides recommendations for practice that derive from recent developments in the Northern Territory. CONCLUSIONS: There is a strong need to develop evidence for the effectiveness of integrated and culturally informed individual and service level interventions. We describe the Best practice in Early intervention Assessment and Treatment of depression and substance misuse study which seeks to address this need.
Topic(s):
Healthcare Disparities
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, Key & Foundational
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View the DOI record for Integrating treatment for mental and physical disorders and substance misuse in Indigenous primary care settings
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View the PubMed citation for Integrating treatment for mental and physical disorders and substance misuse in Indigenous primary care settings98
Integration of mental health/substance abuse and primary care
Type: Journal Article
Year: 2008
Publication Place: United States
Abstract: OBJECTIVES: To describe models of integrated care used in the United States, assess how integration of mental health services into primary care settings or primary health care into specialty outpatient settings impacts patient outcomes and describe barriers to sustainable programs, use of health information technology (IT), and reimbursement structures of integrated care programs within the United States. DATA SOURCES: MEDLINE, CINAHL, Cochrane databases, and PsychINFO databases, the internet, and expert consultants for relevant trials and other literature that does not traditionally appear in peer reviewed journals. REVIEW METHODS: Randomized controlled trials and high quality quasi-experimental design studies were reviewed for integrated care model design components. For trials of mental health services in primary care settings, levels of integration codes were constructed and assigned for provider integration, integrated processes of care, and their interaction. Forest plots of patient symptom severity, treatment response, and remission were constructed to examine associations between level of integration and outcomes. RESULTS: Integrated care programs have been tested for depression, anxiety, at-risk alcohol, and ADHD in primary care settings and for alcohol disorders and persons with severe mental illness in specialty care settings. Although most interventions in either setting are effective, there is no discernible effect of integration level, processes of care, or combination, on patient outcomes for mental health services in primary care settings. Organizational and financial barriers persist to successfully implement sustainable integrated care programs. Health IT remains a mostly undocumented but promising tool. No reimbursement system has been subjected to experiment; no evidence exists as to which reimbursement system may most effectively support integrated care. Case studies will add to our understanding of their implementation and sustainability. CONCLUSIONS: In general, integrated care achieved positive outcomes. However, it is not possible to distinguish the effects of increased attention to mental health problems from the effects of specific strategies, evidenced by the lack of correlation between measures of integration or a systematic approach to care processes and the various outcomes. Efforts to implement integrated care will have to address financial barriers. There is a reasonably strong body of evidence to encourage integrated care, at least for depression. Encouragement can include removing obstacles, creating incentives, or mandating integrated care. Encouragement will likely differ between fee-for-service care and managed care. However, without evidence for a clearly superior model, there is legitimate reason to worry about premature orthodoxy.
Topic(s):
Financing & Sustainability
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, Key & Foundational
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Reference Links: View the PubMed citation for Integration of mental health/substance abuse and primary care
99
Introduction. Integrated case management
Type: Journal Article
Year: 2011
Publication Place: United States
Topic(s):
Key & Foundational
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Reference Links:
View the DOI record for Introduction. Integrated case management
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View the PubMed citation for Introduction. Integrated case management100
Lessons from case studies of integrating mental health into primary health care in South Africa and Uganda
Type: Journal Article
Year: 2011
Publication Place: England
Abstract: BACKGROUND: While decentralized and integrated primary mental healthcare forms the core of mental health policies in many low- and middle-income countries (LMICs), implementation remains a challenge. The aim of this study was to understand how the use of a common implementation framework could assist in the integration of mental health into primary healthcare in Ugandan and South African district demonstration sites. The foci and form of the services developed differed across the country sites depending on the service gaps and resources available. South Africa focused on reducing the service gap for common mental disorders and Uganda, for severe mental disorders. METHOD: A qualitative post-intervention process evaluation using focus group and individual interviews with key stakeholders was undertaken in both sites. The emergent data was analyzed using framework analysis. RESULTS: Sensitization of district management authorities and the establishment of community collaborative multi-sectoral forums assisted in improving political will to strengthen mental health services in both countries. Task shifting using community health workers emerged as a promising strategy for improving access to services and help seeking behaviour in both countries. However, in Uganda, limited application of task shifting to identification and referral, as well as limited availability of psychotropic medication and specialist mental health personnel, resulted in a referral bottleneck. To varying degrees, community-based self-help groups showed potential for empowering service users and carers to become more self sufficient and less dependent on overstretched healthcare systems. They also showed potential for promoting social inclusion and addressing stigma, discrimination and human rights abuses of people with mental disorders in both country sites. CONCLUSIONS: A common implementation framework incorporating a community collaborative multi-sectoral, task shifting and self-help approach to integrating mental health into primary healthcare holds promise for closing the treatment gap for mental disorders in LMICs at district level. However, a minimum number of mental health specialists are still required to provide supervision of non-specialists as well as specialized referral treatment services.
Topic(s):
Key & Foundational
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Reference Links:
View the DOI record for Lessons from case studies of integrating mental health into primary health care in South Africa and Uganda
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View the PubMed citation for Lessons from case studies of integrating mental health into primary health care in South Africa and Uganda