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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).
695 Results
142
COOP/WONCA charts as a screen for mental disorders in primary care
Type: Journal Article
Year: 2011
Publication Place: United States
Abstract: PURPOSE: Most people with mental disorders receive treatment in primary care. The charts developed by the Dartmouth Primary Care Cooperative Research Network (COOP) and the World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians (WONCA) have not yet been evaluated as a screen for these disorders, using a structured psychiatric interview by an expert or considering diagnoses other than depression. We evaluated the validity and feasibility of the COOP/WONCA Charts as a mental disorders screen by comparing them both with other questionnaires previously validated and with the assessment of a mental health specialist using a structured diagnostic interview. METHODS: We trained community health workers and nurse assistants working in a collaborative mental health care model to administer the COOP/WONCA Charts, the 20-item Self-Reporting Questionnaire (SRQ-20), and the World Health Organization-Five Well-Being Index (WHO-5) to 120 primary care patients. A psychiatrist blinded to the patients' results on these questionnaires administered the SCID, or Structured Clinical Interview for the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). RESULTS: The area under the receiver operating characteristic curve was at least 0.80 for single items, a 3-item combination, and the total score of the COOP/ WONCA Charts, as well as for the SRQ-20 and the WHO-5, for screening both for all mental disorders and for depressive disorders. The accuracy, sensitivity, specificity, and positive and negative predictive values of these measures ranged between 0.77 and 0.92. Community health workers and nurse assistants rated the understandability, ease of use, and clinical relevance of all 3 questionnaires as satisfactory. CONCLUSIONS: One-time assessment of patients with the COOP/WONCA Charts is a valid and feasible option for screening for mental disorders by primary care teams.
Topic(s):
Education & Workforce
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, Healthcare Policy
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Reference Links: 
View the DOI record for COOP/WONCA charts as a screen for mental disorders in primary care
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View the PubMed citation for COOP/WONCA charts as a screen for mental disorders in primary care144
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
146
Cost and quality impact of Intermountain's mental health integration program
Type: Journal Article
Year: 2010
Publication Place: United States
Abstract: Most patients with mental health (MH) conditions, such as depression, receive care for their conditions from a primary care physician (PCP) in their health/medical home. Providing MH care, however, presents many challenges for the PCP, including (1) the difficulty of getting needed consultation from an MH specialist; (2) the time constraints of a busy PCP practice; (3) the complicated nature of recognizing depression, which may be described with only somatic complaints; (4) the barriers to reimbursement and compensation; and (5) associated medical and social comorbidities. Practice managers, emergency departments, and health plans are stretched to provide care for complex patients with unmet MH needs. At the same time, payment reform linked to accountable care organizations and/or episodic bundle payments, MH parity rules, and increasing MH costs to large employers and payers all highlight the critical need to identify high-quality, efficient, integrated MH care delivery practices. Over the past ten years, Intermountain Healthcare has developed a team-based approach-known as mental health integration (MHI)-for caring for these patients and their families. The team includes the PCPs and their staff, and they, in turn, are integrated with MH professionals, community resources, care management, and the patient and his or her family. The integration model goes far beyond co-location in its team-based approach; it is operationalized at the clinic, thereby improving both physician and staff satisfaction. Patients treated in MHI clinics also show improved satisfaction, lower costs, and better quality outcomes. The MHI program is financially sustainable in routinized clinics without subsidies. MHI is a successful approach to improving care for patients with MH conditions in primary care health homes.
Topic(s):
Education & Workforce
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, Financing & Sustainability
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, Medically Unexplained Symptoms
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, Healthcare Policy
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Reference Links: View the PubMed citation for Cost and quality impact of Intermountain's mental health integration program
147
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 depression148
Cost-Effectiveness of Publicly Funded Treatment of Opioid Use Disorder in California
Type: Journal Article
Year: 2018
Publication Place: United States
Topic(s):
Opioids & Substance Use
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, Financing & Sustainability
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, Healthcare Policy
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Reference Links:
View the DOI record for Cost-Effectiveness of Publicly Funded Treatment of Opioid Use Disorder in California
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View the PubMed citation for Cost-Effectiveness of Publicly Funded Treatment of Opioid Use Disorder in California150
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 Clinics153
Current strategies and barriers in integrated health care: A survey of publicly funded providers in Texas
Type: Journal Article
Year: 2010
Publication Place: United States
Abstract: OBJECTIVE: This study aimed to assess the extent to which publicly funded behavioral health and primary care providers in Texas have integrated physical and mental health care, the strategies used in implementation efforts and barriers encountered in integration. METHOD: A survey of behavioral health and primary care providers in Texas was conducted to examine providers' perceptions of efforts to integrate physical and mental health care in their organizations. Integration strategies utilized, health conditions targeted and barriers to implementation were evaluated. Descriptive analyses were conducted to determine organizations' current integration strategies and perceived clinical, organizational and financial barriers to integration. RESULTS: Out of 382 surveys initially distributed, a final subsample of 84 organizations with complete data was examined, a response rate of 22%. Among this sample of behavioral health and primary care providers, many shared integration practice strategies and endorsed similar barriers to integration. CONCLUSION: The findings from this study suggest that publicly funded organizations in Texas attempting to integrate physical and mental health care were aware of and employing practice strategies considered essential to the successful treatment of mental health issues in primary care settings. Attention to barriers that still exist, especially regarding workforce and funding issues, will be critical for organizations considering and attempting integration.
Topic(s):
Education & Workforce
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, Financing & Sustainability
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, Healthcare Policy
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Reference Links:
View the DOI record for Current strategies and barriers in integrated health care: A survey of publicly funded providers in Texas
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View the PubMed citation for Current strategies and barriers in integrated health care: A survey of publicly funded providers in Texas158
Depression in primary health care: From evidence to policy
Type: Journal Article
Year: 2008
Publication Place: Australia
Abstract: OBJECTIVE: To consider the implications for mental health policy of a recent synthesis of the literature on the effectiveness of different service delivery models for depression in primary care. METHODS: A discussion based on the results of several systematic reviews of primary care models for depression management. Primary care was defined broadly within a prevention, early-intervention, treatment and recovery/support framework, and incorporated both community and general practice settings. RESULTS: There were promising effective models for depression interventions both in the broader community and in general practice settings. CONCLUSIONS: There is a need to support evidence-based models for depression care, including innovative new technologies for facilitating consumer self-management of depression. The ability of practitioner training and guideline implementation to improve consumer outcomes for depression is limited. Policies and incentives are required to facilitate the reorganisation of general practice and, in particular, the implementation of care management as well as enhanced care and guided self-help in these settings.
Topic(s):
Education & Workforce
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, Healthcare Policy
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Reference Links: View the PubMed citation for Depression in primary health care: From evidence to policy