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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).
1286 Results
965
Recovery from depression, work productivity, and health care costs among primary care patients
Type: Journal Article
Year: 2000
Publication Place: UNITED STATES
Abstract: We describe a secondary analysis of data from a randomized trial conducted at seven primary care clinics of a Seattle area HMO. Adults with major depression (n=290) beginning antidepressant treatment completed structured interviews at baseline, 1, 3, 6, 9, 12, 18, and 24 months. Interviews examined clinical outcomes (Hamilton Depression Rating Scale and depression module of the Structured Clinical Interview for DSM-IIIR), employment status, and work days missed due to illness. Medical comorbidity was assessed using computerized pharmacy data, and medical costs were assessed using the HMO's computerized accounting data. Using data from the 12-month assessment, patients were classified as remitted (41%), improved but not remitted (47%), and persistently depressed (12%). After adjustment for depression severity and medical comorbidity at baseline, patients with greater clinical improvement were more likely to maintain paid employment (P=.007) and reported fewer days missed from work due to illness (P<.001). Patients with better 12-month clinical outcomes had marginally lower health care costs during the second year of follow-up (P=.06). We conclude that recovery from depression is associated with significant reductions in work disability and possible reductions in health care costs. Although observational data cannot definitively prove any causal relationships, these longitudinal results strengthen previous findings regarding the economic burden of depression on employers and health insurers.
Topic(s):
Financing & Sustainability
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Reference Links: View the PubMed citation for Recovery from depression, work productivity, and health care costs among primary care patients
968
Referral without access: For psychiatric services, wait for the beep
Type: Journal Article
Year: 2009
Publication Place: United States
Abstract: STUDY OBJECTIVE: We examine access to care for acute depression by insurance status compared to access for acute medical conditions in 9 metropolitan areas in the United States. METHODS: Using an audit study design, trained research assistants posing as patients referred from a local emergency department (ED) for treatment of depression called each clinic twice, with differing insurance status. The main outcome measure was the ability to schedule a mental health appointment within 2 weeks of the ED visit. RESULTS: In 45% of 322 calls to mental health clinics, the research assistant reached an answering machine compared with 8% of calls to medical clinics. As a result, only 31% of callers with depression vignettes were able to determine whether they could get an appointment versus 78% of callers with medical complaints. When they reached appointment personnel by telephone, 57% of depression callers successfully arranged an appointment (39% within 14 days). Among depression callers who reached appointment personnel, 67% of privately insured and 33% of Medicaid callers were able to make an appointment, for overall appointment rates of 22% and 12%, respectively. Appointment success for the uninsured was comparable to that of Medicaid patients. The high percentage of callers who encountered answering machines prevented us from completing the designed analysis of paired calls to individual clinics. CONCLUSION: Our findings indicate that the process for obtaining urgent follow-up appointments is systematically different for patients seeking behavioral health care than for those with physical complaints. The use of voicemail, in lieu of having a person answer the telephone, is much more prevalent in behavioral than physical health settings. More work is needed to determine the effect of this practice on depressed individuals and vulnerable populations.
Topic(s):
Financing & Sustainability
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View the DOI record for Referral without access: For psychiatric services, wait for the beep
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View the PubMed citation for Referral without access: For psychiatric services, wait for the beep970
Reimbursement for primary care mental health
Type: Journal Article
Year: 2013
Publication Place: United States
Topic(s):
Financing & Sustainability
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974
Report estimates substantial economic impact of integrated care
Type: Journal Article
Year: 2014
Publication Place: United States
Topic(s):
Financing & Sustainability
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Reference Links:
View the DOI record for Report estimates substantial economic impact of integrated care
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View the PubMed citation for Report estimates substantial economic impact of integrated care975
Report urges addressing barriers to reimbursement for mental health care
Type: Journal Article
Year: 2008
Publication Place: United States
Topic(s):
Financing & Sustainability
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, Key & Foundational
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View the DOI record for Report urges addressing barriers to reimbursement for mental health care
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View the PubMed citation for Report urges addressing barriers to reimbursement for mental health care976
Research and evaluation in the transformation of primary care
Type: Journal Article
Year: 2014
Publication Place: United States
Topic(s):
Education & Workforce
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, Financing & Sustainability
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Reference Links:
View the DOI record for Research and evaluation in the transformation of primary care
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View the PubMed citation for Research and evaluation in the transformation of primary care979
Resource document on risk management and liability issues in integrated care models
Type: Journal Article
Year: 2014
Publication Place: United States
Abstract: In the wake of the implementation of the Affordable Care Act, more than 30 million previously uninsured Americans will gain access to health care. Some of these individuals may never have interfaced with the behavioral health system. In response to an increasing need for behavioral health services, improved outcomes, and cost containment, there is a growing shift from independent behavioral health and primary care practices to collaborative care practice models. These new models have psychiatrists working with primary care providers (PCPs) and behavioral health providers (BHPs, typically social workers or psychologists) using a systematic approach to concurrently treat behavioral health and physical health conditions. By following this approach it allows the extension of psychiatric expertise to more patients.From early studies in the 1990's to improve the detection and treatment of depression in elderly patients in primary care settings, to more recent work on outcomes in the management of depression in patients with multiple chronic conditions, a vast body of research has demonstrated the benefit of collaborative care models. However, as with any new treatment modality, psychiatrists may approach collaborative care models with a degree of uncertainty about liability risks. While there are several documents as well as case law addressing the potential malpractice risk of consultation in other medical specialties, a review of the literature revealed few publications offering guidelines for psychiatric consultations. Previous publications have been limited in scope by focusing on interactions between psychiatrists with non-physician treatment providers and have not addressed the potential liability exposure in the overlapping roles of the psychiatrist within an integrated care setting. However, these authors likely could not have anticipated the change in scope of practice of psychiatry in recent years. This resource document provides background information on medical malpractice cases, defines the doctor-patient relationship, and distinguishes the different forms of "split treatment" and how this applies to psychiatric consultation offered to PCPs and BHPs in primary care settings. In addition, it describes the duty of the psychiatrist across the spectrum of roles on an integrated care team and makes recommendations to reduce the risk of medical malpractice issues.Close proximity can foster a culture of cooperation and mutual education between PCPs and psychiatrists. This approach, often referred to as "co-location," has several benefits for patients. The PCP may or may not choose to communicate with the psychiatrist about the behavioral health of patients or make referrals, but the contiguity may increase the chances of successful referral. Limitations in this model have given rise to new treatment paradigms for improving care. In integrated care settings, behavioral health specialists are incorporated into the primary care practice with the psychiatrist providing consultation to the PCP and BHP for management of a patient's behavioral health conditions. These recommendations may be based upon an informal or "curbside" consultation request by the PCP or BHP, a review of the medical record or registry, and, less frequently, by formal evaluation of the patient in person or by televideo.There are a number of integrated care models including the Improving Mood Promoting Access to Collaborative Treatment (IMPACT) model and Massachusetts Child Psychiatry Access Project (MCPAP). In these models of care, the psychiatry consultant's role may include key aspects of both formal and informal consultation and varying aspects of "split treatment" (including what have traditionally been referred to as supervisory, consultative or collaborative roles for non-physicians).This resource document provides a framework for some of the issues to consider when working in practices offering integrated care, and provides practical points to consider in managing liability concerns. Keep in mind that issues regarding liability may not always be clear, particularly in specialty areas that are rapidly evolving. Where indicated, the psychiatrist should clarify the extent of their involvement clinically and the level of interaction with the patient and care team. Whether there is liability for malpractice depends upon specific circumstances surrounding each case and each state has different laws, regulations and caselaw. Finally, consulting an attorney or risk manager for guidance on specific issues is strongly encouraged.
Topic(s):
Education & Workforce
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, Financing & Sustainability
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View the DOI record for Resource document on risk management and liability issues in integrated care models
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View the PubMed citation for Resource document on risk management and liability issues in integrated care models980
Responding to the opioid and overdose crisis with innovative services: The recovery community center office-based opioid treatment (RCC-OBOT) model
Type: Journal Article
Year: 2019
Topic(s):
Education & Workforce
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, Financing & Sustainability
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, Healthcare Policy
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, Opioids & Substance Use
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